Shared decision-making tool for thromboprophylaxis in atrial fibrillation – A feasibility study

Eckman, Mark H.; Costea, Alexandru; Attari, Mehran; Munjal, J.; Wise, R.; Knochelmann, Carol; Flaherty, Matthew L.; Baker, Pete; Ireton, Robert C.; Harnett, Brett; Leonard, Anthony; Steen, Dylan; Rose, Adam C.; Kues, John R.

doi:10.1016/j.ahj.2018.01.003

Cited by 20 publications

(21 citation statements)

References 34 publications

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“…Table 1 and Supplementary Material 5 describe the 14 included SDM tools. 31 – 55 All but 2 were in English; the mAF app 42 was in Chinese and MATCh AFib 43 , 44 in Portuguese. When examining their intended use, 3 were patient decision aids, 5 were encounter tools, 4 had features of both, and 2 were not classifiable because of either lack of information or access to the tool itself.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Resultsmentioning

confidence: 99%

“…Six studies, including 2 randomized trials 42 , 48 and 4 nonrandomized studies, 34 , 43 , 53 , 55 at high risk of bias reported the effect of SDM tools on SDM outcomes ( Table 2 and Supplementary Material 6 ).…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2021

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“… 8 To implement this recommendation, several tools to facilitate SDM among patients with AF have been developed. 9 , 10 , 11 , 12 , 13 However, most of these tools have not been rigorously evaluated, omit DOAC medications, present outdated data, do not directly support the patient-clinician conversation, or do not address practical considerations that are important to the success of ongoing safe anticoagulant treatment, such as leisure activities, diet, travel, and out-of-pocket costs. 9 , 11 , 14 , 15 , 16 …”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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; for the Shared Decision Making for Atrial Fibrillation (SDM4AFib) Trial Investigators IMPORTANCE Shared decision-making (SDM) about anticoagulant treatment in patients with atrial fibrillation (AF) is widely recommended but its effectiveness is unclear. OBJECTIVE To assess the extent to which the use of an SDM tool affects the quality of SDM and anticoagulant treatment decisions in at-risk patients with AF. DESIGN, SETTING, AND PARTICIPANTS This encounter-randomized trial recruited patients with nonvalvular AF who were considering starting or reviewing anticoagulant treatment and their clinicians at academic, community, and safety-net medical centers between January 30, 2017 and June 27, 2019. Encounters were randomized to either the standard care arm or care that included the use of an SDM tool (intervention arm). Data were analyzed from August 1 to November 30, 2019. INTERVENTIONS Standard care or care using the Anticoagulation Choice Shared Decision Making tool (which presents individualized risk estimates and compares anticoagulant treatment options across issues of importance to patients) during the clinical encounter. MAIN OUTCOMES AND MEASURES Quality of SDM (which included quality of communication, patient knowledge about AF and anticoagulant treatment, accuracy of patient estimates of their own stroke risk [within 30% of their estimate], decisional conflict, and satisfaction), decisions made during the encounter, duration of the encounter, and clinician involvement of patients in the SDM process. RESULTS The clinical trial enrolled 922 patients (559 men [60.6%]; mean [SD] age, 71 [11] years) and 244 clinicians. A total of 463 patients were randomized to the intervention arm and 459 patients to the standard care arm. Participants in both arms reported high communication quality, high knowledge, and low decisional conflict, demonstrated low accuracy in their risk perception, and would similarly recommend the approach used in their encounter. Clinicians were significantly more satisfied after intervention encounters (400 of 453 encounters [88.3%] vs 277 of 448 encounters [61.8%]; adjusted relative risk, 1.49; 95% CI, 1.42-1.53). A total of 747 of 873 patients (85.6%) chose to start or continue receiving an anticoagulant medication. Patient involvement in decision-making (as assessed through video recordings of the encounters using the Observing Patient Involvement in Decision Making 12-item scale) scores were significantly higher in the intervention arm (mean [SD] score, 33.0 [10.8] points vs 29.1 [13.1] points, respectively; adjusted mean difference, 4.2 points; 95% CI, 2.8-5.6 points). No significant between-arm difference was found in encounter duration (mean [SD] duration, 32 [16] minutes in the intervention arm vs 31 [17] minutes in the standard care arm; adjusted mean between-arm difference, 1.1; 95% CI, −0.3 to 2.5 minutes). CONCLUSION AND RELEVANCE The use of an SDM encounter tool improved several measures of SDM quality and clinician satisfaction, with no significant effect on treatment decisions...

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“…Individual patient utilities can be used to inform shared decision making through the use of personalized decision analyses for a variety of clinical disorders. 3,4,[58][59][60] Most recently, we examined the feasibility of performing real-time utility assessments and personalized decision analyses to facilitate patient visits with their cardiologists to discuss anticoagulation options to prevent atrial fibrillation-related stroke. 59 One could envision a future in which many preference sensitive decisions are facilitated by such an approach.…”

Section: Discussionmentioning

confidence: 99%

Automated Tool for Health Utility Assessments: The Gambler II

Adejare

Eckman

2020

MDM Policy & Practice

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Background. The Gambler II is a web-based utility assessment tool supporting visual analogue scale (VAS), standard gamble (SG), and time trade-off (TTO) utility assessments. It contains novel features, including an easy to use project development authoring tool and use of multimedia clips for health state descriptions. Objectives. Evaluate the usability and understandability of the patient-facing side of The Gambler. Investigate the feasibility of using The Gambler and evaluate its impact on patient knowledge regarding the relevant health states. Materials and Methods. We used The Gambler to assess utilities on a convenience sample of 55 users for common long-term complications of type 2 diabetes mellitus: diabetic neuropathy, diabetic retinopathy, and diabetic foot infection requiring transmetatarsal amputation. Using VAS, SG, and TTO, we collected metadata, such as time spent on each assessment and the entire assessment process. We evaluated usability with an adaptation of the System Usability Scale survey and understandability. We evaluated impact on knowledge gained through knowledge assessments about these complications before and after use of The Gambler. Results. Overall satisfaction with The Gambler was high, 4.02 on a 5-point scale. Usability rated highly at 84.93 on a normalized scale between 0 and 100. Knowledge scores increased significantly following use of The Gambler from pretest mean of 68% to posttest mean of 76% ( P < 0.01). Average time using the software: ∼7½ minutes. Conclusions. The Gambler is an easy to use and understand computer-based tool for utility assessment. It is feasible to use within clinical encounters to support shared decision making, and it has unique features that make it a powerful tool for investigators interested in research on health utilities.

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Shared decision-making tool for thromboprophylaxis in atrial fibrillation – A feasibility study

Cited by 20 publications

References 34 publications

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

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

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

Automated Tool for Health Utility Assessments: The Gambler II

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