scholarly journals The potential use of decision analysis to support shared decision making in the face of uncertainty: the example of atrial fibrillation and warfarin anticoagulation

2000 ◽  
Vol 9 (4) ◽  
pp. 238-244 ◽  
Author(s):  
A Robinson
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Decision Analysis ◽  
Shared Decision Making ◽  
Shared Decision ◽  
The Face ◽  
Potential Use

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

MORE WORK NEEDED ON DECISION ANALYSIS FOR SHARED DECISION-MAKING: A SCOPING REVIEW

2021 ◽  
Author(s):  
Brittany Humphries ◽  
Montserrat León-García ◽  
Ena Niño de Guzman Quispe ◽  
Carlos Canelo-Aybar ◽  
Claudia Valli ◽  
...  
Keyword(s):  
Decision Making ◽  
Decision Analysis ◽  
Shared Decision Making ◽  
Scoping Review ◽  
Shared Decision

The Promise of Electronic Health Records to Promote Shared Decision Making: A Narrative Review and a Look Ahead

2018 ◽  
Vol 38 (8) ◽  
pp. 1040-1045 ◽  
Author(s):  
Alyce Mei-Shiuan Kuo ◽  
Berry Thavalathil ◽  
Glyn Elwyn ◽  
Zsuzsanna Nemeth ◽  
Stuti Dang
Keyword(s):  
Decision Making ◽  
Electronic Health Records ◽  
Shared Decision Making ◽  
Decisional Conflict ◽  
Shared Decision ◽  
Health Records ◽  
Look Ahead ◽  
The Face ◽  
Electronic Health ◽  
The Impact

Background. Shared decision making (SDM) involves the sharing of best available evidence between patients and providers in the face of difficult decisions. We examine outcomes that occur when electronic health records (EHRs) are purposefully used with the goal of improving SDM and detail which EHR functions can benefit SDM. Methods. A systematic search of PubMed yielded 1369 articles. Studies were included only if they used EHR interventions to support SDM and included results that showed impact on SDM. Articles were excluded if they did not measure the impact of the intervention on SDM or did not discuss how SDM had been supported by the EHR. Results. Five studies demonstrated improved clinical outcomes, positive lifestyle behavior changes, more deliberation from patients regarding use of imaging, and less decisional conflict about medication use among patients with use of EHRs aiding SDM. Discussion. Few EHRs have integrated SDM, and even fewer evaluations of these exist. EHRs have potential in supporting providers during all steps of SDM. The promise of EHRs to support SDM has yet to be fully exploited.

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

Additive Multicriteria Decision Analysis Models: Misleading Aids for Life-Critical Shared Decision Making

2019 ◽  
Vol 39 (4) ◽  
pp. 437-449 ◽  
Author(s):  
Edouard Kujawski ◽  
Evangelos Triantaphyllou ◽  
Juri Yanase
Keyword(s):  
Decision Making ◽  
Decision Analysis ◽  
Shared Decision Making ◽  
Premature Death ◽  
Quality Adjusted Life Year ◽  
Multicriteria Decision Analysis ◽  
Additive Models ◽  
Shared Decision ◽  
Multicriteria Decision ◽  
Related Quality

Background. There is growing interest in multicriteria decision analysis (MCDA) for shared decision making (SDM). A distinguishing feature is that a preferred treatment should extend years of life and/or improve health-related quality of life (HRQL). Additive MCDA models are inadequate for the task. A plethora of MCDA models exist, each claiming that it can correctly solve real-world problems. However, most were developed in nonhealth fields and rely on additive models. This makes the problem of choosing an MCDA model as an aid for SDM a challenging and urgent one. Methods. A published 2017 MCDA of a hypothetical prostate cancer patient is used as a case in point of how not to do and how to do MCDA for SDM. We critically review it and analyze it using several additive linear MCDA models with years of life and HRQL as attributes and the linear quality-adjusted life-year (QALY) model. The following simple reasonableness test is presented for applicability of a method as an aid for SDM: Can a treatment that causes premature death trump a treatment that causes acceptable adverse effects? Results. Additive MCDA models and the linear QALY recommend significantly different alternatives. Additive MCDA models fail the proposed reasonableness test; the linear QALY model passes. Conclusions. MCDA possesses a strong craft element in addition to its technical aspects. MCDA practitioners and clinicians need to understand model limitations to choose models appropriate to the context. Additive MCDA models are inadequate for life-critical SDM. We advocate QALY models with additional research for increased realism as a tool for SDM.

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.

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