Development of a decision aid for patients with atrial fibrillation who are considering antithrombotic therapy

Man-Son-Hing, Malcolm; O’Connor, Annette M.; Hart, Robert G.; Feldman, George B.; Blackshear, Joseph L.; Anderson, David C.

doi:10.1046/j.1525-1497.2000.90909.x

Cited by 30 publications

(25 citation statements)

References 38 publications

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“…However, there did not appear to be a significant difference in decisional regret (patient's feelings of regret or remorse after a healthcare decision) or the rate of changing from aspirin to warfarin between groups. [49][50][51] It is important to note, however, that the group of patients examined were at low risk of stroke according to the SPAF III trial inclusion criteria and had already been using aspirin for at least 2 years. The decision aid in this case was presented as an audio booklet (which did not individualize the bleeding risk) and an interactive worksheet completed before (but used during) the clinical encounter.…”

Section: Sdm In Thromboembolism Preventionmentioning

confidence: 99%

“…The decision aid in this case was presented as an audio booklet (which did not individualize the bleeding risk) and an interactive worksheet completed before (but used during) the clinical encounter. 49,51 More recent SDM studies in AF have reported decreased decisional conflict (the state of uncertainty surrounding a decision, a more accurate measure of the quality of the decision-making process because regret is strongly affected by the outcome the patient experiences, not the communication of the visit), increased patient satisfaction, and a trend toward increased knowledge compared with "traditional counseling" or guideline-based therapies groups, yet the findings have not been consistent. [52][53][54][55][56] Table 3 summarizes the evidence from these studies.…”

Section: Sdm In Thromboembolism Preventionmentioning

confidence: 99%

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Shared Decision Making in Atrial Fibrillation

et al. 2014

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You are seeing Mr Roberts, a 69-year-old retired office manager referred from the emergency department for treatment of atrial fibrillation (AF). He presented the previous night to the emergency department with shortness of breath and palpitations and was found to be in AF with a rapid ventricular response and a heart rate of 140 bpm. He was treated with intravenous diltiazem and spontaneously converted to sinus rhythm. He was then discharged from the emergency department with an outpatient cardiology appointment. He has a background history of hypertension but no other cardiac disease. His only medication is a thiazide diuretic. On questioning, he reports experiencing several episodes of palpitations over the last 2 to 3 years; typically, these are brief and self-limited. His transthoracic echocardiogram, thyroid studies, and electrolytes are all within normal limits. His ECG shows sinus rhythm with no other significant abnormality. His CHADS 2 score is 1 and CHA 2 DS 2 -Vasc score is 2. He has a family history of gastrointestinal hemorrhage-associated death and is uncomfortable about long-term anticoagulation. Additionally, he is reluctant about taking a daily medication plus his blood pressure pill. How might you present current best practice while ensuring that his treatment program is consistent with his goals, values, and preferences? Introduction AF is the most common arrhythmia requiring treatment, affecting ≈5 million Americans, with the prevalence expected to double by 2050.1-3 AF accounts for more than a third of all hospitalizations for cardiac rhythm disturbances. Hospitalization for AF has risen dramatically over the past 20 years and is projected to continue to rise as the population ages. 4 Importantly, AF is associated with a doubling in patient-matched and adjusted mortality.5 Atrial fibrillation can range from completely asymptomatic to highly symptomatic and can negatively affect patients' quality of life if left untreated. 6 Studies have demonstrated significant gaps in AF patient's knowledge about their condition, as well as knowledge of the risks and benefits of the treatment they are currently taking for their AF despite their disease being treated for several years. 7A landmark study in 2007 observed multidisciplinary groups of clinicians and patients discussing AF management and noted that all groups recognized the difficulties in managing the disease, but no group agreed with the other on the optimal way to improve patient care.8 A meta-synthesis of qualitative studies from 2012 examined the perspectives of both clinicians and patients and found that patients often experienced a paternalistic model of decision making, whereas clinicians involved in these same conversations reported that a shared decision making (SDM) model was used. 9 This discordance has been reported by other studies and indicates that patients wish for more information about their treatment options and that clinician bias and practice style, not patient preferences, influenced the outcome of starting oral anticoagul...

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Section: Sdm In Thromboembolism Preventionmentioning

confidence: 99%

Section: Sdm In Thromboembolism Preventionmentioning

confidence: 99%

Shared Decision Making in Atrial Fibrillation

et al. 2014

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“…They were also asked to provide written reasons for their choices (aided by a checklist), to complete the Atrial Fibrillation Information Questionnaire again, to indicate their satisfaction with the decision instrument on a 6-point scale and to complete the Decisional Conflict Questionnaire. 31 The Decisional Conflict Questionnaire measures perceptions of personal uncertainty in making a treatment choice, with a lower score indicating more comfort with the decision made; scores higher than 2.5 are associated with decisional conflict.…”

Section: -43mentioning

confidence: 99%

“…[27][28][29][30] It has been reported that they can improve knowledge, reduce decisional conflict and stimulate patients to be more active in decision-making. [31][32][33] However, the jury is still out as to their appropriateness for all patients, their cost-effectiveness and their usability in busy clinical practices or when providers disagree with their advice. [31][32][33] In addition, it is unknown whether the features of decision instruments in terms of their format and content may influence patient decisions.…”

mentioning

confidence: 99%

Influence of decision aids on patient preferences for anticoagulant therapy: a randomized trial

Holbrook¹,

Labiris²,

Goldsmith³

et al. 2007

Canadian Medical Association Journal

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Research W arfarin therapy is strongly recommended for the prevention of stroke in moderate-and high-risk patients with atrial fibrillation.1-10 However, it is associated with a risk of major bleeding. The actual rate of serious bleeding in clinical practice varies widely and depends on the patient's risk category and the quality of monitoring of the international normalized ratio.11-14 Studies in clinical settings have shown that warfarin's effectiveness is similar to that measured in randomized trials, but its utilization in clinical practice is lower than expected. 15-25Acetylsalicylic acid is safer than warfarin, but less effective.

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“…Professional interventions included locally disseminated guidelines, 11-14 stroke orders or protocols, 15-20 a tool to aid clinical decision making 21 ; and training or academic detailing. [22][23][24][25][26][27][28][29][30][31] Primary prevention interventions included information and feedback, 32,33 media campaigns, 34,35 peer support and education, 36 patient decision-aids, [37][38][39] and multifactorial educational, screening and monitoring programs. 40 -47 Secondary prevention interventions included a shared medical record, 48 an intervention incorporating a shared record plus monitoring, 49 and multifaceted interventions incorporating educational and psychosocial components.…”

Section: Redfern Et Al Review Of Complex Interventions In Stroke Carementioning

confidence: 99%