Intended for healthcare professionals

Letters Shared decision making in low risk chest pain

Shared decision making in low risk chest pain: looking ahead

BMJ 2017; 356 doi: (Published 23 January 2017) Cite this as: BMJ 2017;356:j324
  1. David R Vinson, senior physician,
  2. Dustin W Ballard, senior physician,
  3. Dustin G Mark, senior physician,
  4. Uli K Chettipally, senior physician
  5. On behalf of the CREST Network
  1. The Permanente Medical Group, Oakland, CA 94612, USA
  1. drvinson{at}

We commend Hess and colleagues for studying shared decision making,1 which is best suited for forks in the road, where neither course is clearly superior.23 This currently seems to be the case for patients with low risk chest pain in the emergency department. But the field is rapidly changing,456 and what is equivocal today may not be in the coming years.

With outpatient care for low risk chest pain projected to increase in the future, we will still need to educate patients better about their risks and explain the rationale for our recommendations. A clear, accessible pictographic decision aid can help us to communicate our thoughts clearly and give patients a better understanding of their situation.1

The next generation of electronic tools for shared decision making might incorporate principles from learning healthcare systems. We envision tools that will update risk calculators based on the most recent evidence and tailor risk profiling to the appropriate population and healthcare setting. Patient preferences—their tolerance of risk, cultural affiliations, and previous shared decision making choices—might also be integrated. Hess and colleagues’ study shows that, with a good decision aid in hand, that extra patient centred discussion takes only a minute. And we can’t imagine a minute better spent.



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