While there is little directly comparable research with which to relate these findings, a number of ideas that emerged from this study have also been identified elsewhere including variability among physicians in the informed consent process, patient preference for physicians to choose devices and the use of devices approved in purchasing group contracts. Interviews with 11 American cardiologists revealed substantial variation in the extent to which they discussed ICD risks with patients . In a survey of 364 American orthopaedic surgeons, cost reduction programmes based on volume discounting at their institution was a frequently listed factor that influenced their decision-making . In the same study, among 102 patients undergoing hip or knee arthroplasty, 93.1% said that their orthopaedic surgeon should choose the device; 5.9% said that physicians should consult patients when making the decision. With respect to PE in general, a systematic review found that time constraints, lack of applicability due to patient characteristics and specifics of the clinical situation were the most frequent barriers of shared decision-making .