Exploring Patients' Values and Preferences for Initial Atrial Fibrillation Education

Abstract

Background People with a new diagnosis of atrial fibrillation (AF) require knowledge to build skills and confidence to engage in decision making for AF treatment and prevention of AF-related complications. Data to guide development of content and approaches that enable acquisition of knowledge to support effective self-management are lacking. Objective The aim of this study was to explore patients' values concerning the content of initial AF education, describe how providers delivered education, and identify patients' preferences for approaches to education. Methods We used a qualitative inductive approach. Twenty-five participants given a diagnosis of AF within 18 months of enrollment were recruited from midwest US healthcare system clinics. Data were collected using a semistructured interview guide and were analyzed using qualitative content analysis. Results Themes emerging were as follows: (1) important to know, (2) recollections of the how and what of education, and (3) preferences for educational resources. Participants highly valued providers' explanations that AF was not immediately life-threatening and did not require limitations to usual activities. This reassurance from providers decreased fear and then enabled participants to learn about AF management. Verbal explanations were the primary approach to delivering education, but participants consistently expressed preferences for receiving written information and videos to supplement verbal explanations. Conclusions Addressing emotional and quality of life concerns at the time of AF diagnosis reduced fear and was critical for enabling participants to attend to discussions about treatment and self-management. The value participants placed on written and video resources as an adjunct to verbal explanation suggests that providers should consider educational approaches beyond verbal explanations.

Patients' experiences across the trajectory of atrial fibrillation: A qualitative systematic review

“…More importantly, AF episodes may be asymptomatic in some cases. Patients with silent AF usually neglect the importance of timely medical treatment 9–13 Hoping this was all just stress related.…”

Patient‐reported outcomes and subsequent management in atrial fibrillation clinical practice: Results from the Utah mEVAL AF program

“…The data sources are derived from the health system's enterprise data warehouse, and include all billing encounters with diagnosis codes (inpatient, outpatient, procedural), as well as medication orders, laboratory results, electrocardiography results, and echocardiography results. Clinical comorbidities were measured using previously validated algorithms for use in administrative data analyses of cardiovascular disease and includes all health system encounters up to and including the baseline visit 9,10 . Comorbidity rates were calculated based on ICD codes as part of clinical billing encounters, as previously described 14 .…”

“…to and including the baseline visit. 9,10 Comorbidity rates were calculated based on ICD codes as part of clinical billing encounters, as previously described. 14 Medication rates and laboratory values were based on orders and results between 90 days before and 30 days after the index visit.…”

“…2 To date, reports on PROs from outside of clinical trials, are primarily limited to small, selected cohorts sampled once to answer specific questions or assess procedural outcomes for AF. [3][4][5][6][7][8][9][10][11] Rarely are PROs collected longitudinally, across broad AF cohorts.…”

“…Though AF‐related HRQoL is rigorously measured with patient‐reported outcomes (PROs) in many major clinical trials, PROs are rarely collected in routine clinical practice, despite a major objective of AF treatment being to improve HRQoL 2 . To date, reports on PROs from outside of clinical trials, are primarily limited to small, selected cohorts sampled once to answer specific questions or assess procedural outcomes for AF 3–11 . Rarely are PROs collected longitudinally, across broad AF cohorts.…”