Evaluating the Effect of a Patient Decision Aid for Atrial Fibrillation Stroke Prevention Therapy

Abstract

Background: Stroke prevention therapy decisions for patients with atrial fibrillation (AF) are complex and require trade-offs, but few validated patient decision aids (PDAs) are available to facilitate shared decision making. Objective: To evaluate the effects of a novel PDA on decision-making parameters for AF patients choosing stroke prevention therapy. Methods: We developed an evidence-based individualized online AF PDA for stroke prevention therapy and evaluated it in a prospective observational pilot study. The primary outcome was decisional conflict. Secondary outcomes were knowledge, usability/acceptability, patient preferences, effects on therapy choices, and participant feedback. Results: 37 participants completed the PDA. The PDA could be completed independently and was well accepted. It significantly decreased the mean decisional conflict score ( P < 0.001) and all its subscales and increased participant AF knowledge ( P = 0.02). 76% of participants indicated that their individualized therapy attribute ranking was congruent with their values. The PDA-generated best-match therapy was chosen by 70% of participants in decision 1 (no therapy, aspirin, or oral anticoagulant), and 17% for decision 2 (choice of anticoagulant). Among AF patients, 60% chose a different drug than that currently prescribed to them. Conclusion and Relevance: Our PDA was effective for reducing decisional conflict, increasing patient knowledge, eliciting patients’ values, and presenting therapy options that aligned with patients’ values and preferences. Using the PDA revealed that many patients have therapy preferences different from their currently prescribed treatment. The PDA is a practical and potentially valuable tool to facilitate decision making about stroke prevention therapy for AF.

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

“…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.…”

“…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 ).…”

“…Twelve decision aids met more than 50% of the IPDAS items (Figure 2). The top-rated tools were PtDA, [51][52][53] Anticoagulation Choice, [45][46][47][48] Don't Wait to Anticoagulate, 38 and PDA, 55 which met .70% of all IPDAS items. PtDA was the only tool that assessed for readability.…”

Canadian Stroke Best Practice Recommendations, seventh edition: acetylsalicylic acid for prevention of vascular events

“…There is currently no evidence that directly addresses the role of shared decision-making in the context of ASA for primary prevention, although interventions to support shared decisionmaking have been evaluated for the treatment of hypertension, 25,26 atrial fibrillation 27 and diabetes. 28…”

Recommandations canadiennes pour les pratiques optimales de soins de l’AVC, septième édition : l’acide acétylsalicylique pour la prévention d’événements vasculaires

“…On ne dispose actuellement d'aucune donnée probante quant au rôle de la prise de décision partagée dans le contexte d'un traitement avec l'AAS en prévention primaire, quoique des interventions visant à appuyer la prise de décision partagée ont été évaluées pour le traitement de l'hypertension artérielle 25,26 , de la fibrillation auriculaire 27 et du diabète 28 .…”