In summary, this study revealed several factors that, apart from potentially variable patient preference, challenge PE. Further research is needed to identify conditions, for example, type of device and patient characteristics, in which different forms of PE (consult, involve and partner) are relevant and feasible. For now, most participants agreed that informing and involving patients were feasible. Yet some noted that discussions about device risks and benefits varied across physicians, and this was also found to be true elsewhere [18–21]. This study generated a preliminary framework (Table 2) by which physicians can more consistently and thoroughly engage patients in discussions about medical devices, even when decisions may not be preference sensitive due to constraints on choice imposed by patient, physician, device or health system characteristics. Further research is needed to evaluate use and impact of this framework on patient and physician satisfaction with consultations about implantable devices.