Dr. Greg Hirsch, cardiac surgeon and co-chair of the Maritime Heart Centre Development Council, is also research lead on “Implementation of shared decision-making in cardiac interventions,” a grant-funded project that aims to empower patients to have an active role in their cardiac care through careful discussions with their healthcare providers.
A donor-funded grant will help Atlantic Canadian patients receiving advanced cardiac care at the QEII Health Sciences Centre voice their individual concerns, values and preferences through a collaborative process called shared decision-making.
Thanks to QEII Foundation donors, more than $217,000 was awarded to five research initiatives this summer through the Maritime Heart Centre Innovation Fund; a donor-funded program which provides otherwise inaccessible research dollars for QEII physicians and researchers.
“The Innovation Fund allows us to fund investigations and improvements in clinical care, quality improvements and educational improvements for the care of Atlantic Canadians who come to the QEII,” says Dr. Greg Hirsch, co-chair of the Maritime Heart Centre Development Council. “The grants for projects always have to be rooted in something practical that will ultimately have an impact.”
This year, Dr. Hirsch is also research lead for one of the five initiatives that received grant funding, “Implementation of shared decision-making in cardiac interventions.”
The $45,102 donor-dollars that the project received will help train healthcare teams to better inform patients of the risks and benefits of cardiac procedures. With careful communication, patients can be empowered to make the best decisions suited to their lifestyle and values alongside their healthcare providers.
Why does shared decision-making matter?
According to Dr. Hirsch, shared decision-making, a process that’s been embraced by healthcare professionals around the globe for over 20 years, has not yet been effectively implemented anywhere in North America in surgical or advanced cardiac care.
“In shared decision-making, we acknowledge that there’s not just one expert in a consultation with a patient. There are two, the clinician and the patient,” Dr. Hirsch explains. “For so many years, we’ve had a lot of what we call ‘assumed authoritative inferiority’ where patients feel they don’t know enough to express a treatment preference.”
In shared decision-making, healthcare providers acknowledge that a patient has more insight into their own lives and preferences than a doctor has at first glance. Providers aim to inform patients of the risks and benefits of cardiac procedures so that patients can consider how it may impact their current values and lifestyle.
Traditionally in cardiac procedures, extending longevity has been the ultimate outcome for healthcare teams. “In some cases, however, maybe longevity isn’t the answer,” explains Dr. Hirsch. “When you have an 83-year-old grandmother with comorbidities who has a bad aortic valve and some blocked arteries but is still living independently with her grandchildren coming to visit for cookies and homework help, maintaining her independent lifestyle means the world to her.”
“She is the expert on if she wants to wager a surgery that has the risk of completely taking away her independence versus some longevity,” says Dr. Hirsch. “That love and affection from her family may mean more to her than the risk. Shared decision-making trains clinicians, like me, to have these discussions, when before, we would never consider this and just offer the surgery.”
Shared decision-making can also help patients and healthcare teams navigate other situations like choosing between more or less-invasive surgeries based on work schedules, and can help prepare patients and families for possible yet unexpected risks such as having to temporarily be on a respirator during recovery.
Dr. Hirsch hopes that the process will reduce the number of patients who regret their cardiac surgeries. “We find that now, 20 per cent of patients who are frail and over age 65 have decisional regret regarding their cardiac procedures. That’s something we don’t want to experience as caregivers – and something you really don’t want to experience as a patient,” Dr. Hirsch says.
Bringing shared decision-making in cardiac care to Nova Scotia
Thanks to the generosity of QEII Foundation donors, Dr. Hirsch’s team is working diligently to integrate the process of shared decision-making into cardiac care – right here in Nova Scotia.
Previously, Dr. Hirsch led a project training cardiac teams in shared decision-making, but the practice quickly fell off once the study ended.
“Since then, we’ve done research on what the barriers are,” Dr. Hirsch explains. “Lack of time is our biggest enemy. In cardiac care, things are moving fast. The surgeon or interventional cardiologist comes in and there’s not a lot of time for a conversation.”
With this most recent project and grant, Dr. Hirsch’s team will re-train doctors and include nurses in on the process of shared decision-making so that patients have the opportunity to voice their preferences at every stage of their cardiac care.
The project will also work to develop printed and electronic decisional aids. With the guidance of a nurse, patients will use these decisional aids to learn about the risks and benefits of their cardiac procedures, helping save time before important discussions with their surgeons.
“The decisional aid documents will help patients understand what’s really at stake – and help them understand that they do have a preference to express,” Dr. Hirsch says.
The impact
Dr. Hirsch is excited about the positive changes that the funding his team has received could make for Atlantic Canadians receiving advanced cardiac care.
“We’re focusing our biggest effort on patients receiving coronary bypass surgery, valve replacement surgery or the combination of the two,” he explains. Major surgeries come with higher risks, so shared decision-making will give patients a chance be engaged in navigating these complex procedures.
“The funding we’ve received is going to enable us to train teams in shared decision-making so that when patients come to that crucial point of decision, they understand their voice matters,” Dr. Hirsch explains. “As a result, I think people are going to be far more satisfied whether they choose surgery or not.”
Without kind QEII Foundation donors, it wouldn’t be possible to advance patient care in our community through research projects like these.
“It’s no secret that we have an underfunded healthcare system as a country and province, and we don’t have a lot of research funds,” Dr. Hirsch says.
“When folks do reach into their pockets and make a donation, small or large, they are really making a difference here in Nova Scotia.”
To learn more about how our donors are advancing heart health care at the QEII or to donate today, visit: https://qe2foundation.ca/current-priorities/heart-health