Long-term stroke and bleeding risk in patients with atrial fibrillation treated with oral anticoagulants in contemporary practice: Providing evidence for shared decision-making

2017 ◽  
Vol 245 ◽  
pp. 174-177 ◽  
Author(s):  
Peter A. Noseworthy ◽  
Xiaoxi Yao ◽  
Bernard J. Gersh ◽  
Ian Hargraves ◽  
Nilay D. Shah ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Shared Decision Making ◽  
Oral Anticoagulants ◽  
Bleeding Risk ◽  
Shared Decision ◽  
Contemporary Practice

scholarly journals Shared decision-making in atrial fibrillation: patient-reported involvement in treatment decisions

2020 ◽  
Vol 6 (4) ◽  
pp. 263-272 ◽  
Author(s):  
Fatima Ali-Ahmed ◽  
Karen Pieper ◽  
Rebecca North ◽  
Larry A Allen ◽  
Paul S Chan ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Shared Decision Making ◽  
Atrial Fibrillation Patient ◽  
Bleeding Risk ◽  
Treatment Decisions ◽  
Rhythm Control ◽  
Shared Decision ◽  
Patient Reported ◽  
Informed Treatment

Abstract Aims  To determine the extent of shared decision-making (SDM), during selection of oral anticoagulant (OAC) and rhythm control treatments, in patients with newly diagnosed atrial fibrillation (AF). Methods and results  We evaluated survey data from 1006 patients with new-onset AF enrolled at 56 US sites participating in the SATELLITE substudy of the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT II). Patients completed surveys at enrolment and at 6-month follow-up. Patients were asked about who made their AF treatment decisions. Shared decision-making was classified as one that the patient felt was an autonomous decision or a shared decision with their healthcare provider (HCP). Approximately half of patients reported that their OAC treatment decisions were made entirely by their HCP. Compared with those reporting no SDM, patients reporting SDM for OAC were more often female (47.2% vs. 38.4%), while patients reporting SDM for rhythm control were more often male (62.2% vs. 57.6%). The most important factors cited by patients during decision-making for OAC were reducing stroke and bleeding risk, and their HCP’s recommendations. After adjustment, patients with self-reported understanding of OAC, and rhythm control options, had higher odds of having participated in SDM [odds ratio (OR) 2.54, confidence interval (CI): 1.75–3.68 and OR 2.36, CI: 1.50–3.71, both P ≤ 0.001, respectively]. Conclusion  Shared decision-making is not widely implemented in contemporary AF practice. Patient understanding about available therapeutic options is associated with a more than a two-fold higher likelihood of SDM, and may be a potential target for future interventions.

scholarly journals Exploring provider perspectives on patients with atrial fibrillation who are not prescribed anticoagulation therapy

2021 ◽  
Author(s):  
Catherine Yao ◽  
Aubrey E. Jones ◽  
Stacey Slager ◽  
Angela Fagerlin ◽  
Daniel M. Witt
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Shared Decision Making ◽  
Oral Anticoagulants ◽  
Anticoagulation Therapy ◽  
Shared Decision ◽  
Provider Education ◽  
Prescribing Practices ◽  
Structured Interviews ◽  
Provider Perspectives

AbstractBackgroundEvidence-based guidelines strongly recommend oral anticoagulants to prevent stroke in patients with non-valvular atrial fibrillation (AF). However, many patients are not prescribed guideline recommended anticoagulant therapy.ObjectivesTo explore themes underlying anticoagulant prescribing or discontinuation in patients with AF and compare and contrast prescribing preferences between cardiologists and general practitioners.MethodsProviders at the University of Utah Health system were recruited to participate in semi-structured interviews. An interview guide directed the 15-minute interviews with focus on anticoagulant prescribing practices for patients with AF. Interviews were transcribed verbatim. Two reviewers independently read transcripts and labeled passages of text corresponding with key concepts and themes.ResultsOf the eleven practitioners interviewed, seven practiced in cardiology, two in internal medicine and two in family medicine. The most prominent reasons cited for not prescribing anticoagulation for stroke prevention in AF patients were concerns about intracranial bleeding, followed by gastrointestinal bleeding. Other common reasons were increased age, thrombocytopenia, chemotherapy, previous or concerns of noncompliance, and comorbidities. Providers believed patient refusal of anticoagulants was related to fear of bleeding, medication burden, or warfarin’s negative reputation. All prescribers reported similar prescribing strategies, including using risk stratification, shared decision making, and utilizing specialized anticoagulation clinics and pharmacists as resources.ConclusionFear of bleeding was a common theme underlying anticoagulant underutilization in patients with AF. Identifying major reasons directly from providers can be utilized to develop patient education addressing common fears and misconceptions, promote shared decision making, and provide provider education and resources to achieve appropriate anticoagulant prescribing.

Use of an Atrial Fibrillation Medication Decision Aid Improves Knowledge and Process for Decision Making (Preprint)

2018 ◽  
Author(s):  
Molly Beinfeld ◽  
Suzanne Brodney ◽  
Michael Barry ◽  
Erika Poole ◽  
Adam Kunin
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Shared Decision Making ◽  
Anticoagulant Therapy ◽  
Decision Aid ◽  
Response Rate ◽  
Intervention Group ◽  
Shared Decision ◽  
Community Based ◽  
Baseline Group

BACKGROUND A rural community-based Cardiology practice implemented shared decision making supported by an evidence-based decision aid booklet to improve the quality of anticoagulant therapy decisions in patients with atrial fibrillation. OBJECTIVE To develop a practical workflow for implementation of an anticoagulant therapy decision aid and to assess the impact on patients’ knowledge and process for anticoagulant medication decision making. METHODS The organization surveyed all patients with atrial fibrillation being seen at Copley Hospital to establish a baseline level of knowledge, certainty about the decision and process for decision making. The intervention surveys included the same knowledge, certainty, process and demographic questions as the baseline surveys, but also included questions asking for feedback on the decision aid booklet. Stroke risk scores (CHA2DS2-VASc score) were calculated by Copley staff for both groups using EMR data. RESULTS We received 46 completed surveys in the baseline group (64% response rate) and 50 surveys in the intervention group (72% response rate). The intervention group had higher knowledge score than the baseline group (3.6 out of 4 correct answers vs 3.1, p=0.036) and Decision Process Score (2.89 out of 4 vs 2.09, p=0.0023) but similar scores on the SURE scale (3.12 out of 4 vs 3.17, p=0.79). Knowledge and Process score differences were sustained even after adjusting for co-variates in stepwise linear regression analyses. Patients with high school or lower education appeared to benefit the most from shared decision making, as demonstrated by their knowledge scores. CONCLUSIONS It is feasible and practical to implement shared decision making supported by decision aids in a community-based Cardiology practice. Shared decision making can improve knowledge and process for decision making for patients with atrial fibrillation. CLINICALTRIAL None

Shared Decision Making and Long-Term Outcome in Schizophrenia Treatment

2007 ◽  
Vol 68 (07) ◽  
pp. 992-997 ◽  
Author(s):  
Johannes Hamann ◽  
Rudolf Cohen ◽  
Stefan Leucht ◽  
Raymonde Busch ◽  
Werner Kissling
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Shared Decision ◽  
Term Outcome ◽  
Long Term Outcome

scholarly journals Assessment of Shared Decision-making for Stroke Prevention in Patients With Atrial Fibrillation

2020 ◽  
Vol 180 (9) ◽  
pp. 1215 ◽  
Author(s):  
Marleen Kunneman ◽  
Megan E. Branda ◽  
Ian G. Hargraves ◽  
Angela L. Sivly ◽  
Alexander T. Lee ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Shared Decision Making ◽  
Stroke Prevention ◽  
Shared Decision

Patient involvement in consultation for atrial fibrillation – the cardiologists’ perspective

2019 ◽  
Vol 32 (4) ◽  
pp. 765-776 ◽  
Author(s):  
Ulla Hellström Muhli ◽  
Jan Trost ◽  
Eleni Siouta
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Content Analysis ◽  
Shared Decision Making ◽  
Patient Involvement ◽  
Qualitative Content Analysis ◽  
Medical Consultation ◽  
Shared Decision ◽  
Consultation Process ◽  
Content Type

Purpose The purpose of this paper is to analyse the accounts of Swedish cardiologists concerning patient involvement in consultations for atrial fibrillation (AF). The questions were: how cardiologists handle and provide scope for patient involvement in medical consultations regarding AF treatment and how cardiologists describe their familiarity with shared decision-making. Design/methodology/approach A descriptive study was designed. Ten interviews with cardiologists at four Swedish hospitals were held, and a qualitative content analysis was performed on the collected data. Findings The analysis shows cardiologists’ accounts of persuasive practice, protective practice, professional role and medical craftsmanship when it comes to patient involvement and shared decision-making. The term “shared decision-making” implies a concept of not only making one decision but also ensuring that it is finalised with a satisfactory agreement between both parties involved, the patient as well as the cardiologist. In order for the idea of patient involvement to be fulfilled, the two parties involved must have equal power, which can never actually be guaranteed. Research limitations/implications Methodologically, this paper reflects the special contribution that can be made by the research design of descriptive qualitative content analysis (Krippendorff, 2004) to reveal and understand cardiologists’ perspectives on patient involvement and participation in medical consultation and shared decision-making. The utility of this kind of analysis is to find what cardiologists said and how they arrived at their understanding about patient involvement. Accordingly, there is no quantification in this type of research. Practical implications Cardiologists should prioritise patient involvement and participation in decision-making regarding AF treatment decisions in consultations when trying to meet the request of patient involvement. Originality/value Theoretically, the authors have learned that the patient involvement and shared decision-making requires the ability to see patients as active participants in the medical consultation process.

The Impact of a Shared Decision-Making Training Program on Dementia Care Planning in Long-Term Care

2018 ◽  
Vol 64 (4) ◽  
pp. 1123-1135 ◽  
Author(s):  
Elena Mariani ◽  
Rabih Chattat ◽  
Giovanni Ottoboni ◽  
Raymond Koopmans ◽  
Myrra Vernooij-Dassen ◽  
...  
Keyword(s):  
Decision Making ◽  
Training Program ◽  
Shared Decision Making ◽  
Long Term Care ◽  
Dementia Care ◽  
Care Planning ◽  
Shared Decision ◽  
Term Care ◽  
The Impact
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