Decision aids improved afib patients' knowledge
A trial of decision aids for patients and clinicians found that patients with atrial fibrillation engaged in better shared decision making about stroke prevention treatment with these interventions than if they were randomized to usual care.
Pre-visit or in-visit decision aids for nonvalvular atrial fibrillation individually or in combination had better outcomes compared with usual care, a study found.
Researchers conducted a cluster randomized controlled trial at six U.S. academic medical centers among adults with a diagnosis of nonvalvular atrial fibrillation who were at risk for stroke (CHA2DS2-VASc score ≥1 for men, ≥2 for women) and were scheduled for a clinical appointment to discuss stroke prevention. Patients were randomized to use a patient decision aid or usual care, and clinicians were randomized to use an encounter decision aid or usual care with all their patients. The primary outcome was quality of shared decision making measured by knowledge of atrial fibrillation and its management and decisional conflict. Results were published Jan. 9 by BMJ.
The study initially included 1,214 patients, 604 randomized to the patient decision aid and 610 to usual care; 97 were later deemed ineligible. Compared with usual care, the combined use of both the patient decision aid and the clinician encounter decision aid improved the quality of shared decision making (adjusted mean difference in OPTION12 scores, 12.1 [95% CI, 8.0 to 16.2]; P<0.001), improved patients' knowledge (odds ratio comparing the proportion of correct responses on the knowledge score, 1.68 [95% CI, 1.35 to 2.09]; P<0.001), and reduced patients' decisional conflict (adjusted mean difference in decisional conflict scores, −6.3 [95% CI −9.6 to −3.1]; P<0.001).
Statistically significant improvements were also observed with the encounter decision aid alone versus usual care for all three outcomes. The patient decision aid alone was better than usual care for quality of shared decision making and knowledge but not decisional conflict. There were no important differences among groups in treatment choices for stroke prevention or in participants' satisfaction and no statistically significant difference in the length of visit across study groups.
The magnitude of improvement in quality of shared decision making was greatest for the encounter decision aid alone versus usual care, the study authors reported. They noted that the encounter decision aid alone and combined encounter decision aid and patient decision aid groups markedly outperformed the patient decision aid alone group.
“The findings from this trial are timely, given the increasing importance of shared decision making for prescribing of oral anticoagulants in atrial fibrillation clinical guidelines,” the authors wrote. “Existing guidelines suggest that shared decision making should be part of decision making on atrial fibrillation related stroke prevention; however, little guidance is provided on how shared decision making can or should be achieved. This study implies that using either a patient decision aid or an encounter decision aid is effective in achieving shared decision making when making decisions about atrial fibrillation.”