Alternatively, some patients will prefer that their physician make their deci- sions for them, and physicians who do so in such instances should be regarded as giving patient-centered care. In addition, all patients should be educated about their options. This education can be very brief in urgent settings, such as when a patient is having an ST-elevation myocardial infarction with cardiogenic shock. However, if any uncer- tainty exists about the superiority of PCI versus optimal medi- cal therapy or surgical revascularization (as is usually the case with elective PCI), then the patient should be provided an opportunity to learn about the relative risks and benefits of therapies under consideration. The writing committee struggled with whether to include process measures that focused on decision making and educa- tion through patient surveys. Surveys might be able to address general quality of decisions and ask patients about whether they were involved as much or as little as they desired. Survey results could then be shared at the physician and hospital levels, so both individual clinicians and institutions could understand and improve their decision-making processes. However, there are as yet no validated instruments addressing these domains, nor have other critical details been worked out. These limitations left the writing committee less enthusiastic about supporting a measure at the present time, but this should be a priority area for future investigation. 4.2. Outcome Measures If the focus of process measures reflects the journey, outcome measures shed light on the destination the end, rather than the means. Outcome measures offer the potential advantage of pro- viding readouts on entire populations, rather than smaller popu- lation subsets, and they focus on the end results of care that are most important to clinicians and patients. 