Communication & Medicine, Vol 14, No 1 (2017)

Cardiologists’ experiences and perceptions of patient involvement and communication related to shared decision-making regarding atrial fibrillation treatment

Eleni Siouta, Ulla Hellström Muhli, Bjöörn Fossum, Klas Karlgren
Issued Date: 12 Aug 2017


Objective: To feel involved in decisions about atrial fibrillation (AF) treatment, patients need supportive communication from cardiologists. Shedding light on cardiologists’ perceptions of patient involvement in AF care settings is thus of importance. We examine (1) how cardiologists describe patient involvement and communication related to shared decisionmaking regarding AF treatment, and (2) their perceptions of efforts to involve patients in the treatment decisions. Methods: Ten cardiologists were interviewed in four Swedish hospitals. A qualitative content analysis was performed on the interview data. Results: Cardiologists’ perceptions of patient involvement in treatment decisions are framed in terms of (1) ideology, (2) experience, and (3) responsibility. Conclusion: By taking into account patients’ feelings in the consultations, and by actively encouraging patients to be involved, the cardiologists contributed to patient involvement. Practice Implications: One key to improving compliance with legislation aimed at increasing patient involvement in treatment decisions could lie in paying attention to physician–patient communication and the conditions for patient involvement in decision-making about treatment.

Download Media

PDF (Price: £17.50 )

DOI: 10.1558/cam.30587


Agoritsas, T., Heen, A. F., Brandt, L. and Alonso-Coello, P. (2015) Decision aids that really promote shared decision making: The pace quickens. British Medical Journal 350: g7624.

Alonso-Coello, P., Montori, V. M., Solà, I., Schünemann, H. J., Devereaux, P. J., Charles, C., Roura, M., Díaz, M.G., Souto, J. C. and Alonso, R. (2008) Values and preferences in oral anticoagulation in patients with atrial fibrillation: Physicians’ and patients’ perspectives. Protocol for a two-phase study. BMC Health Services 8: 221.

Arnetz, J. E., Winblad, U., Arnetz, B. and Höglund, A. (2008) Physicians’ and nurses’ perceptions of patient involvement in myocardial infarction care. European Journal of Cardiovascular Nursing 7 (2): 113–120.

Barello, S., Graffigna, G. and Vegni, E. (2012) Patient engagement as an emerging challenge for healthcare services: Mapping the literature. Nursing Research and Practice Article 905934.

Blakeman, T., Macdonald, W., Bower, P., Gately, C. and Chew-Graham, C. (2016) A qualitative study of GPs’ attitudes to self-management of chronic disease. British Journal of General Practice 56 (527): 407–414.

Burton, D., Blundell, N., Jones, M., Fraser, A. and Elwyn, G. (2010) Shared decision-making in cardiology: Do patients want it and do doctors provide it? Patient Education and Counseling 80 (2): 173–179.

Camm, A. J., Lip, G. Y., De Caterina, R., Savelieva, I., Atar, D., Hohnloser, S. H., Hindricks, G. and Kirchhof, P. (2012) 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: An update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. European Heart Journal 33 (21): 2719–2747.

Chewning, B., Bylund, C. L., Shah, B. and Arora, N. K. (2012) Patient preferences for shared decisions: A systematic review. Patient Education and Counseling 86 (1): 9–18.

Couët, N., Desroches, S., Robitaille, H., Vaillancourt, H., Leblanc, A. and Turcotte, S. (2013) Assessments of the extent to which health-care providers involve patients in decision making: A systematic review of studies using the OPTION instrument. Health Expectations 18 (4): 542–561.

Coulter, A. (2011) Engaging Patients in Healthcare. Maidenhead, UK: McGraw-Hill Education and Open University Press.

Dobesh, P. P. and Fanikos, J. (2015) Direct oral anticoagulants for the prevention of stroke in patients with nonvalvular atrial fibrillation: Understanding differences and similarities. Drugs 75 (14): 1627–1644.

Durand, A. M., Carpenter, L., Dolan, H., Bravo, P., Mann, M., Bunn, F. and Elwyn, G. (2014) Do interventions designed to support shared decision-making reduce health inequalities? PLOS ONE 9 (4): e94670.

Eckman, M. H., Wong, L. K. S., Soo, Y. O. Y., Lam, W. and Yang, S. R. (2008) Patient-specific decision-making for warfarin therapy in nonvalvular atrial fibrillation: How will screening with genetics and imaging help? Stroke 39 (12): 3308–3315.

Edwards, A. and Elwyn, G. (2009) Shared Decision-Making in Health Care: Achieving Evidence-Based Patient Choice. Oxford: Oxford University Press.

Elwyn, G. and Charles, C. (2009) Shared decision-making: From conceptual models to implementation in clinical practice. In A. Edwards and G. Elwyn (eds) Shared Decision-Making in Health Care: Achieving Evidence-Based Patient Choice, 117–121. Oxford: Oxford University Press.

Elwyn, G., Hutchings, H., Edwards, A., Rapport, F., Wensing, M., Cheung, W. Y. and Grol, R. (2005) The OPTION scale: Measuring the extent that clinicians involve patients in decision-making tasks. Health Expectations 8 (1): 34–42.

Elwyn, G., Lloyd, A., May, C. and van der Weijden, T. (2014) Collaborative deliberation: A model for patient care. Patient Education and Counseling 97 (2): 158–164.

Elwyn, G. and Miron-Shatz, T. (2010) Deliberation before determination: The definition and evaluation of good decision making. Health Expectations 13 (2): 139–147.

Entwistle, V. A. and Watt, I. S. (2006) Patient involvement in treatment decision-making: The case for a broader conceptual framework. Patient Education and Counseling 63 (3): 268–278.

Goffman, E. (1981) Forms of Talk. Philadelphia: University of Pennsylvania Press.

Hakim, F. A. and Shen, W. K. (2014) Atrial fibrillation in the elderly: A review. Future Cardiology 10 (6): 745–758.

Hargraves, I. and Montori, V. M. (2014) Decision aids, empowerment, and shared decision making. British Medical Journal 349: g5811. d

Hellström Muhli, U. (2003) Att Överbrygga Perspektiv: En Studie av Behovsbedömningssamtal Inom Äldreinriktat Socialt Arbete. Bridging Perspective: A Study of the Needs Assessment Calls within the Elderly-Oriented Social Work. Unpublished doctoral dissertation, University of Göteborg, Göteborg.

Hellström Muhli, U. (2010) Accounts of professional and institutional tension in the context of Swedish elderly care. Journal of Aging Studies 24 (1): 47–56.

Ijäs-Kallio, T., Ruusuvuori, J. and Peräkylä, A. (2010) Patient involvement in problem presentation and diagnosis delivery in primary care. Communication & Medicine 7 (2): 131–141.

January C. T., Wann L. S., Alpert J. S., Calkins H., Cigarroa J. E., Cleveland J. C. J., Conti, J. B., Ellinor P. T., Ezekowitz, M. D., Field, M. E., Murray, K. T., Sacco, R. L., Stevenson, W. G., Tchou, P. J., Tracy, C. M. and Yancy, C. W. (2014) AHA/ACC/HRS Guideline for the management of patients with atrial fibrillation. Journal of the American College of Cardiology 64 (21): 2305–2307.

Joseph-Williams, N., Elwyn, G. and Edwards, A. (2014) Knowledge is not power for patients: A systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making. Patient Education and Counseling 94 (3): 291–309.

Kazemian, P., Oudit, G. and Jugdutt, B. I. (2012) Atrial fibrillation and heart failure in the elderly. Heart Failure Reviews 17 (4–5): 597–613.

Krippendorff, K. (2014) Content Analysis: An Introduction to its Methodology. Thousand Oaks, CA: Sage.

Laidsaar-Powell, R., Butow, P. N., Bu, S. and Charles, C. (2013) Physician–patient–companion communication and decision-making: A systematic review of triadic medical consultations. Patient Education and Counseling 91 (1): 3–13.

Légaré, F., Rattéa, S., Gravela, K. and Grahamc, I. D. (2008) Barriers and facilitators to implementing shared decision-making in clinical practice: Update of a systematic review of health professionals’ perceptions. Patient Education and Counseling 73 (3): 526–535.

Lip, G. Y., Skjøth, F. and Rasmussen, L. H. (2015) Oral anticoagulation, aspirin, or no therapy in patients with nonvalvular AF With 0 or 1 Stroke Risk Factor Based on the CHA2DS2-VASc Score. Journal of the American College of Cardiology 65 (14): 1385–1394.

Montori, V. M., Brito, J. P. and Murad, M. H. (2013) The optimal practice of evidence-based medicine: Incorporating patient preferences in practice guidelines. Journal of the American Medical Association 310 (23): 2503–2504.

National Board of Health and Welfare (2012) Din skyldighet att informera och göra patienten delaktig : handbok för vårdgivare, chefer och personal. aktuell från 1 januari 2012 [Your Obligation to Inform and Make the Patient Involved: Handbook for Health Care Providers, Managers and Staff. Current from 1 January 2012]. Stockholm: National Board of Health and Welfare.

National Guidelines for Cardiac Care (2008) Decision Support for Priorities. Stockholm: Socialstyrelsen.

Polit, D. F. and Beck, C. T. (2017) [2010] Essentials of Nursing Research: Appraising Evidence for Nursing Practice. Philadelphia, PA: Wolters Kluwer Health and Lippincott Williams & Wilkins.

Sarangi, S. (2010) Healthcare interaction as an expert communicative system: An activity analysis perspective. In J. Streeck (ed.) New Adventures in Language and Interaction, 167–197. Amsterdam: John Benjamins.

Siouta, E. (2016) Communication and Patient Involvement in Decision Making. Unpublished doctoral dissetation, Karolinska Institutet, Stockholm.

Siouta, E., Hellström Muhli, U., Hedberg, B., Broström, A., Fossum, B. and Karlgren, K. (2015) Patients’ experiences of communication and involvement in decision-making about atrial fibrillation treatment in consultations with nurses and physicians. Scandinavian Journal of Caring Sciences 30 (3): 535–546.

Stacey, D., Légaré, F., Col, N. F., Bennett, C. L., Barry, M. J., Eden, K. B., Holmes-Rovner, M., Llewellyn-Thomas, H., Lyddiatt, A., Thomson, R. and Trevena, L. (2017) Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews 12 (4): CD001431.

Street, R. L., Gordon, H. S., Ward, M. M., Krupat, E. and Kravitz, R. L. (2005) Patient participation in medical consultations: Why some patients are more involved than others. Medical Care 43 (10): 960–969.


  • There are currently no refbacks.

Equinox Publishing Ltd - 415 The Workstation 15 Paternoster Row, Sheffield, S1 2BX United Kingdom
Telephone: +44 (0)114 221-0285 - Email:

Privacy Policy