Optimising shared decision-making in the chronic angina care pathway

This report presents the findings of a project delivered by the Patients Association and The Open University, supported by Societal Challenges funding, to develop a toolkit to improve shared decision-making in the care pathway for chronic angina treated with planned coronary angioplasty (heart stents). The project explored patient and staff experiences of decision-making, informed consent and care pathways, and identified opportunities to strengthen support for shared decision-making in cardiology services. 

The research involved an online survey and workshops with 45 patients and carers and 10 health professionals, followed by a stakeholder engagement event with seven representatives and clinical leaders from national cardiology and patient organisation representatives.

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Key findings of the report

The project identified four key themes shaping patient and staff experiences: 

There is significant variation in the provision of decision support.
Patients experienced inconsistent care pathways and access to information which affected the quality of shared decision-making and informed consent. 

Patient preferences are not always reflected in practice.
Many patients reported receiving information too late in the pathway and expressed a preference for earlier involvement and greater continuity of care with the same clinicians. 

Shared decision-making is often misunderstood.
It was frequently described as information-sharing rather than a collaborative process, highlighting the need for clearer understanding and practical support for implementation. 

System pressures influence the facilitation of shared decision-making.
Staff highlighted constraints including workforce capacity, IT systems, lack of private space for conversations, and variation in service design.

Recommendations 

The findings informed the development of a toolkit that will: 

• Improve understanding of shared decision-making and its principles
• Provide practical tools to support reflection and improvement in care pathways
• Signpost to accessible patient information and consent resources
• Support better informed consent processes and documentation
• Promote patient partnership in service design and evaluation 

Conclusion 

The findings highlight the need for clearer, more consistent support for shared decision-making in cardiology services. The upcoming toolkit will support teams to embed better decision-making practices across the chronic angina care pathway.

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Next steps 

The toolkit will be developed by The Open University and the Patients Association in collaboration with patients, clinicians and national organisations, with publication expected in late 2026.