Shared decision making difficult to implement in AAV


By Selina Wellbelove

11 Mar 2024

The benefits of shared decision making between clinicians and patients in disease management are clear, but the approach is “proving difficult” to implement in practice for people with ANCA-associated vasculitis, international experts report.

Writing in Annals of the Rheumatic Diseases (link here), a European group of clinicians emphasised that shared decision making is “particularly important” for patients who have complex diseases such as anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV), “where numerous conflicting factors need to be balanced to reach optimal individualised treatment and patient outcomes”.

Indeed, the European Alliance of Associations for Rheumatology (EULAR) 2022 recommendations for AAV call for implementation of shared decision making to guide best care, with consideration given to the efficacy, safety and cost of treatment.

However, in correspondence published the group stressed that despite “substantial interest” in shared decision making, its implementation is clinical practice “is proving difficult to achieve” for several reasons.

“Barriers to implementation include lack of sufficient knowledge and communication about the disease, uncertain prioritisation of management goals, absence of proven initiatives in healthcare settings, lack of dedicated healthcare spaces and poor patient health status,” they said.

These barriers must be overcome across the care pathway to facilitate personalised care and improve outcomes, particularly for patients with AAV.

As a first step in shared decision making, clinicians should seek to identify the patient’s key concerns, priorities and preferences before setting patient-centred treatment goals. Individualised treatment can then be guided with help of decision aids “such as the three-talk model based on choice, option and decision talk stages to provide balanced information,” the authors noted.

They also stressed that the importance of considering whether any proposed treatment strategies pose additional burden on health related quality of life (HRQoL), “given the substantial side effects associated with traditional AAV treatments”.

“Ultimately, measures to enable individualised patient care in AAV can help to optimise patient HRQoL and long-term outcomes. However, increased efforts of the entire AAV community are needed to develop and implement adequate tools and processes that will support implementation of [shared decision making],” they said.

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