scholarly journals Shared Decision Making Tools for People Facing Stroke Prevention Strategies in Atrial Fibrillation: A Systematic Review and Environmental Scan

2021 ◽  
pp. 0272989X2110056
Author(s):  
Victor D. Torres Roldan ◽  
Sarah R. Brand-McCarthy ◽  
Oscar J. Ponce ◽  
Tereza Belluzzo ◽  
Meritxell Urtecho ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Shared Decision Making ◽  
Stroke Prevention ◽  
Decision Aids ◽  
Decisional Conflict ◽  
Bibliographic Databases ◽  
Shared Decision ◽  
Prevention Strategies ◽  
High Quality

Objective Shared decision making (SDM) tools can help implement guideline recommendations for patients with atrial fibrillation (AF) considering stroke prevention strategies. We sought to characterize all available SDM tools for this purpose and examine their quality and clinical impact. Methods We searched through multiple bibliographic databases, social media, and an SDM tool repository from inception to May 2020 and contacted authors of identified SDM tools. Eligible tools had to offer information about warfarin and ≥1 direct oral anticoagulant. We extracted tool characteristics, assessed their adherence to the International Patient Decision Aids Standards, and obtained information about their efficacy in promoting SDM. Results We found 14 SDM tools. Most tools provided up-to-date information about the options, but very few included practical considerations (e.g., out-of-pocket cost). Five of these SDM tools, all used by patients prior to the encounter, were tested in trials at high risk of bias and were found to produce small improvements in patient knowledge and reductions in decisional conflict. Conclusion Several SDM tools for stroke prevention in AF are available, but whether they promote high-quality SDM is yet to be known. The implementation of guidelines for SDM in this context requires user-centered development and evaluation of SDM tools that can effectively promote high-quality SDM and improve stroke prevention in patients with AF.

scholarly journals Personalized, Electronic Health Record–Integrated Decision Aid for Stroke Prevention in Atrial Fibrillation: A Small Cluster Randomized Trial and Qualitative Analysis of Efficacy and Acceptability

2021 ◽  
Author(s):  
Stacey L. Schott ◽  
Julia Berkowitz ◽  
Shayne E. Dodge ◽  
Curtis L. Petersen ◽  
Catherine H. Saunders ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Shared Decision Making ◽  
Stroke Prevention ◽  
Decision Aid ◽  
Stroke Risk ◽  
Cluster Randomized Trial ◽  
Decisional Conflict ◽  
Patient Knowledge ◽  
Shared Decision

Background: Shared decision-making in cardiology is increasingly recommended to improve patient-centeredness of care. Decision aids can improve patient knowledge and decisional quality but are infrequently used in real-world practice. This mixed-methods study tests the efficacy and acceptability of a decision aid integrated into the electronic health record (Integrated Decision Aid [IDeA]) and delivered by clinicians for patients with atrial fibrillation considering options to reduce stroke risk. We aimed to determine whether the IDeA improves patient knowledge, reduces decisional conflict, and is seen as acceptable by clinicians and patients. Methods: A small cluster randomized trial included 6 cardiovascular clinicians and 66 patients randomized either to the IDeA (HealthDecision) or usual care (clinician discretion) during a clinical encounter when stroke prevention treatment options were discussed. The primary outcome was patient knowledge of personalized stroke risk. Exploratory outcomes included decisional conflict, values concordance, trust, the presence of a shared decision-making process, and patient knowledge related to time spent using the IDeA. Additionally, we conducted semistructured interviews with clinicians and patients who used the IDeA were conducted to assess acceptability and predictions of future use. Results: The IDeA significantly increased patients’ knowledge of their stroke risk (odds ratio, 3.88 [95% CI, 1.39–10.78]; P <0.01]). Patients had less uncertainty about their final decision ( P =0.04). There were no significant differences in values concordance, trust in clinician or shared decision-making. Despite training, each clinician used the IDeA differently. Qualitative analysis revealed patients prefer using the IDeA earlier in their diagnosis. Clinicians were satisfied with the IDeA, yet varied in the contexts in which they planned to use it in the future. Conclusions: Using an Integrated Decision Aid, or IDeA, increases patient knowledge and lessens uncertainty for decision-making around stroke prevention in atrial fibrillation. Qualitative data provide insight into potential implementation strategies in real-world practice.

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

Abstract 13111: Factors Associated With Patient Engagement in Shared Decision-Making for Stroke Prevention Among Older Adults With Atrial Fibrillation: Implications for Patient-Provider Communication

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jordy Mehawej ◽  
Jane Saczynski ◽  
Hawa O Abu ◽  
Benita Bamgbade ◽  
Marc Gagnier ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Older Adults ◽  
Decision Making ◽  
Shared Decision Making ◽  
Patient Engagement ◽  
Stroke Prevention ◽  
Cognitively Impaired ◽  
Shared Decision ◽  
Factors Associated ◽  
Long Term Treatment

Introduction: Though engaging patients with atrial fibrillation (AF) in the decision-making process for stroke prevention is encouraged by guidelines, little is known about the extent of, and the factors associated with, patient engagement in this process. Hypothesis: Patient engagement in shared decision-making (SDM) would be modest and that older participants will less likely engage in SDM for stroke prevention. Methods: Data are from the ongoing SAGE (Systematic Assessment of Geriatric Elements)-AF study which enrolled older adults aged 65 years and older with AF from clinics in Massachusetts and Georgia. Participants on an oral anticoagulant (OAC) reported whether they were engaged in the decision to be on an OAC by answering “Yes” to the question: “Did you participate actively in choosing to take an OAC?”. We used multiple logistic regression analysis to examine the sociodemographic, geriatric, psychosocial, and clinical factors associated with patient engagement in SDM for stroke prevention. Results: Participants (N= 807) were on average 75 years old and 48% were female. Approximately, 61% engaged in the decision to be on an OAC. Participants aged 80 years and older (aOR= 0.53; 95 % CI:0.31-0.89) and those cognitively impaired (aOR= 0.69; 95 % CI: 0.48, 0.99) were less likely to engage in SDM than respective comparison groups. Participants who reported being very knowledgeable of their AF associated risk of stroke had higher odds of engaging in SDM than those with less knowledge (aOR= 3.06; 95 % CI:1.59, 5.90). Conclusions: Clinicians should identify older patients and those who are cognitively impaired who are less likely to engage in SDM for stroke prevention, promote patient engagement, and provide support to ensure sustained engagement that would enhance long-term treatment outcomes for patients with AF.

scholarly journals Exploring patient–provider decision-making for use of anticoagulation for stroke prevention in atrial fibrillation: Results of the INFORM-AF study

2018 ◽  
Vol 18 (4) ◽  
pp. 280-288 ◽  
Author(s):  
Sean D Pokorney ◽  
Diane Bloom ◽  
Christopher B Granger ◽  
Kevin L Thomas ◽  
Sana M Al-Khatib ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Stroke Prevention ◽  
Decision Aids ◽  
Oral Anticoagulants ◽  
Bleeding Risk ◽  
Decisional Conflict ◽  
Increased Risk ◽  
Outpatient Settings ◽  
Depth Interviews

Background: Atrial fibrillation is associated with stroke, yet approximately 50% of patients are not treated with guideline-directed oral anticoagulants (OACs). Aims: Given that the etiology of this gap in care is not well understood, we explored decision-making by patients and physicians regarding OAC use for stroke prevention in atrial fibrillation. Methods and results: We conducted a descriptive qualitative study among providers ( N=28) and their patients with atrial fibrillation for whom OACs were indicated ( N=25). We used purposive sampling across three outpatient settings in which atrial fibrillation patients are commonly managed: primary care ( n=14), geriatrics ( n=10), and cardiology ( n=4). Eligible patients were stratified by those prescribed OAC ( n=13) and not prescribed OAC ( n=12). Semi-structured, in-depth interviews assessed decision-making regarding risk and OAC use. Classical content analysis was used to code narratives and identify themes. Results among patients consisted of the overarching theme of trust in provider recommendations. Sub-themes included: awareness of increased risk of stroke with atrial fibrillation; willingness to accept medications recommended by their physician; and low demand for explanatory decision aids. Among physicians, the overarching theme was decisional conflict regarding the balance between stroke and bleeding risk, and the optimal medication to prescribe. Subthemes included: absence of decision aids for communication; and misperceptions around the assessment and management of stroke risk with atrial fibrillation. Conclusions: Patient involvement in decision-making around OAC use did not occur in this study of patients with atrial fibrillation. Improved access to decision aids may increase patient engagement in the decision-making process of OAC use for stroke prevention.

scholarly journals Factors Associated With Patient Engagement in Shared Decision-Making for Stroke Prevention Among Older Adults with Atrial Fibrillation

2021 ◽  
Vol 24 (3) ◽  
pp. 174-183
Author(s):  
Jordy Mehawej ◽  
Jane Saczysnki ◽  
Hawa O. Abu ◽  
Marc Gagnier ◽  
Benita Bamgbade ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Older Adults ◽  
Decision Making ◽  
Shared Decision Making ◽  
Patient Engagement ◽  
Stroke Prevention ◽  
Cognitively Impaired ◽  
Shared Decision ◽  
Factors Associated ◽  
Do So

Objective To examine the extent of, and factors associated with, patient engagement in shared decision-making (SDM) for stroke prevention among patients with atrial fibrillation (AF). Methods We used data from the Systematic Assessment of Geriatric Elements-Atrial Fibrillation study which includes older ( ≥65 years) patients with AF and a CHA2DS2-VASc≥2. Partici­pants reported engagement in SDM by answering whether they actively participated in choosing to take an oral antico­agulant (OAC) for their condition. Multiple logistic regression was used to assess associations between sociodemographic, clinical, geriatric, and psychosocial factors and patient en­gagement in SDM. Results A total of 807 participants (mean age 75 years; 48% female) on an OAC were studied. Of these, 61% engaged in SDM. Older participants (≥80 years) and those cognitively impaired were less likely to engage in SDM, while those very know­ledgeable of their AF associated stroke risk were more likely to do so than respective comparison groups. Conclusions A considerable proportion of older adults with AF did not engage in SDM for stroke prevention with older patients and those cognitively impaired less likely to do so. Clinicians should identify patients who are less likely to engage in SDM, promote patient engagement, and foster better patient-provider communication which may enhance long- term patient outcomes.

Abstract WP403: Factors Associated With Patient-Reported Shared Decision-Making for Stroke Prevention in Atrial Fibrillation

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Emily C O'Brien ◽  
Karen Pieper ◽  
Rebecca Thiem ◽  
Gregg C Fonarow ◽  
Peter R Kowey ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Decision Making ◽  
Shared Decision Making ◽  
Stroke Prevention ◽  
Shared Decision ◽  
Factors Associated ◽  
Patient Reported

Abstract 182: Shared Decision-Making Results in Knowledge Transfer Across Diverse Patient Subgroups: An Encounter-Level Meta-Analysis of Decision Aid Trials

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Megan Coylewright ◽  
Megan E Branda ◽  
Nilay D Shah ◽  
Erik P Hess ◽  
Annie LeBlanc ◽  
...  
Keyword(s):  
Decision Making ◽  
Knowledge Transfer ◽  
Shared Decision Making ◽  
Formal Education ◽  
Meta Analysis ◽  
Decision Aids ◽  
Decisional Conflict ◽  
Shared Decision ◽  
The Impact ◽  
Patient Subgroups

Background: Shared decision-making with decision aids (DA) improves patient knowledge and reduces decisional conflict. The extent to which they do so across sociodemographic subgroups remains unknown. Methods: An encounter-level meta-analysis of five DA randomized trials examined the impact of sociodemographic variables on knowledge transfer and decisional conflict using a generalized linear model stratified by study and adjusted by treatment arm. Results: We analyzed 595 patient-clinician encounters. Significantly higher knowledge transfer with DA occurred in nearly all patient subgroups when compared to usual care (UC). Patients with more formal education tended to have greater knowledge transfer with UC; this was diminished with DA. There was a trend towards improved decisional conflict in all subgroups with the use of DA; overall decisional conflict was low. (see Table) Conclusion: The use of DA compared to UC significantly increases knowledge transfer across diverse subgroups and there is a tendency towards reduced decisional conflict. Differences at baseline, such as knowledge transfer across educational strata, may be mitigated with use of DA. In conclusion, DA are found to be effective across patient subgroups and may represent a novel strategy to lessen disparities.

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