Disclosures: Benjamin and Valentine report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
May 11, 2021
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AHA/ACC report on ethics, professionalism in CV care focuses on inclusion, wellness

Disclosures: Benjamin and Valentine report no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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The American Heart Association and American College of Cardiology published a consensus conference report that addresses medical ethics, professionalism and other timely topics in CV medicine.

The report, which was published in Circulation and the Journal of the American College of Cardiology, is based on the proceedings of the joint 2020 consensus conference report on professionalism and ethics and focuses on topics such as diversity, equity, inclusion and belonging; racial, ethnic and gender inequities; conflicts of interest; clinician well-being; data privacy; social justice; and modern health care delivery systems.

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Adapting to changes

“The delivery of cardiovascular care is evolving rapidly. Through this evolution, our professional obligations to patient-centered care must remain steadfast,” Ivor Benjamin, MD, FACC, FAHA, former AHA president, co-director of the NIH T32 postdoctoral fellowship in cardiovascular sciences, professor of medicine at the Medical College of Wisconsin, and co-chair of the consensus conference report, said in a press release. “How we engage and employ staff, receive payment, and provide and document patient care requires maintaining standards that are beyond reproach. We must maintain and promote integrity in all we do to protect public trust in science and medicine. Individuals and professional communities must take responsibility for evaluating and maintaining standards of care while promoting an environment of diversity, equity, inclusion and excellence for all.”

Recommendations from the report will be presented and discussed Saturday during the ACC Scientific Session forum “Diversity and Equity: The Means to Expand Inclusion and Belonging.”

One section of the report is on “Navigating Conflicts: RWIs and COIs in Teaching and Publications, Peer Review, Research Data, Technology, and Expert Testimony.”

It addressed interests a researcher or other health care professional might have that could give rise to a potential conflict of interest and biased decision-making.

The committee recommends that disclosure of relationships with industry should be mandatory for educational activities and scientific publications. According to the report, the ACC and AHA should educate members and promote compliance with these disclosure policies and utilize oversight bodies to manage and oversee the integrity of any activity or publication, in accordance with applicable laws, industry standards and best practices.

Another section, “Diversity, Equity, Inclusion, and Belonging: Optimizing Cardiovascular Health Care, Research, and Education Through Equity and Respect and Eliminating Bias, Discrimination, Harassment and Racism,” addressed aspects of diversity, equity, inclusion in addition to systematic inequalities in treatment, power and resources of individuals and groups.

The committee recommends that leadership at the clinical, academic, organizational and society level be held accountable for institutional culture and for visibly championing, working toward diversity, equity, inclusion and belonging, with the goal of eliminating unprofessional behaviors, sexism and racism.

The report added that educators especially have responsibility to ensure diversity among those entering the CV community and eliminate bias, sexual harassment and racism in schools and training programs.

Clinician well-being

In the “Enhancing the Well-Being of Clinicians” section, researchers discussed how factors such as consolidation of medical practices, higher productivity expectations, reduced reimbursements, legislative and regulatory requirements, explosion of electronic health records and the growth of clerical burden may negatively affect clinician well-being.

“Health care organizations must actively support and be accountable for the psychosocial health of their workforces,” the committee wrote. “The majority of investment in clinician well-being research and interventions must be directed to improving organizational factors to create and sustain work environments within which clinicians thrive.”

Additionally, organizations must prioritize the regular assessment of clinician well-being as a marker of organizational health, according to the statement.

The committee recommended the establishment of professional well-being infrastructure that includes the creation of a senior leadership position dedicated to prioritizing clinician well-being.

The “Patient Autonomy, Privacy, and Social Justice in Health Care” section of the consensus report highlights three areas of importance to modern medicine.

Although patient preferences and values, including the outcomes most important to them, are significant, the committee recommended that formal shared decision-making should be reserved for decisions with significant trade-offs among reasonable options.

Regarding patient privacy, the committee recommended that hospitals and health systems engaging in medical information sharing should consider using a patient-elected data governance board to adjudicate access requests and sharing of medical data. Additionally, exclusive licensing of data sets for research should be avoided because it may limit the data’s use for advancing public health goals, according to the report.

To address social justice, the writing committee stated that the Liaison Committee on Medical Education and the Accreditation Council for Graduate Medical Education should require a course on social justice, race and racism as part of the curriculum of every medical school that they accredit.

The “Modern Healthcare Delivery: Challenges Related to New Care Delivery Systems” section of the consensus report discussed how, although the delivery of care to people and communities continues to evolve, “professional obligations to patient-centricity must remain consistent.”

According to the report, changes in employment, payment models, delivery sites of care and documentation of care require maintenance of standards to meet the primary goal of the “triple aim” strategy to improve the health of the population, enhance patient satisfaction and reduce cost of care. However, these factors may increase burnout among physicians. Therefore, the “quadruple aim” strategy included clinician satisfaction.

The committee recommended that although clinician well-being is essential for achieving the quadruple aim, clinician satisfaction must not detract from achieving the triple aim for patients.

C. Michael Valentine

“We have seen the COVID-19 pandemic challenge the physical and economic health of the entire country, coupled with a series of national tragedies that have awakened the call for social justice,” C. Michael Valentine, MD, MACC, FAHA, past president of the ACC, professor of medicine at the Heart and Vascular Center at the University of Virginia and conference co-chair, said in the release. “There is no better time than now to review, evaluate and take a fresh perspective on medical ethics and professionalism. We hope this report will provide cardiovascular professionals and health systems with the recommendations and tools they need to address conflicts of interest, racial, ethnic and gender inequities, and improve diversity, inclusion and wellness among our workforce. The majority of our members are now employed and must be engaged as the leaders for change in cardiovascular care.”