Shared decision-making tool for thromboprophylaxis in atrial fibrillation – A feasibility study
| Autor: | Anthony C. Leonard, Mark H. Eckman, Matthew L. Flaherty, Ruth E. Wise, Peter Baker, Mehran Attari, Robert Ireton, Dylan L. Steen, Brett M. Harnett, Alexandru Costea, Adam C. Rose, Carol Knochelmann, Jitender Munjal, John Kues |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Decision Making MEDLINE Medication adherence Decisional conflict 030204 cardiovascular system & hematology Medication Adherence 03 medical and health sciences 0302 clinical medicine Patient satisfaction Risk Factors Atrial Fibrillation Humans Medicine 030212 general & internal medicine Patient participation Aged business.industry Anticoagulants Thrombosis Atrial fibrillation medicine.disease Patient Satisfaction Scale (social sciences) Emergency medicine Feasibility Studies Female Patient Participation Cardiology and Cardiovascular Medicine business Atrial flutter Follow-Up Studies |
| Zdroj: | American Heart Journal. 199:13-21 |
| ISSN: | 0002-8703 |
| DOI: | 10.1016/j.ahj.2018.01.003 |
| Popis: | Appropriate thromboprophylaxis for patients with atrial fibrillation or atrial flutter (AF) remains a national challenge.We hypothesized that a shared decision-making interaction facilitated by an Atrial Fibrillation Shared Decision Making Tool (AFSDM) would improve patient knowledge about atrial fibrillation, and the risks and benefits of various treatment options for stroke prevention; increase satisfaction with the decision-making process; improve the therapeutic alliance between patient and the clinical care team; and increase medication adherence. Using a pre- and post-visit study design, we enrolled 76 patients and completed 2 office visits and 1-month telephone follow-up for 65 patients being seen in our Arrhythmia Clinic over the 1-year period (July 2016 through June 2017). Our primary outcome measure was change in decisional conflict between the first and second clinical visit.Decisional conflict decreased from an average of 31 to 9. Mean change was 22.3 (95% CI, 25.7 - 37.1), corresponding to an effect size of 0.94 standard deviations. Satisfaction with decision increased from 4.0 to 4.5, measures of therapeutic alliance with the care team (Kim Alliance scale) increased from 100.1 to 103.1, and satisfaction with provider increased from 4.2 to 4.5 (P.0001 for all measures). AF knowledge assessment scores increased from 8.4 to 9.1, and knowledge about personal stroke and bleeding risk increased from 1 to 1.5 (P.0001). Finally, medication adherence improved as reflected by an increase in the Morisky Medication Adherence scale from 5.9 to 6.4 (P.0001).A shared decision-making interaction, facilitated by an AFSDM can significantly improve multiple measures of decision-making quality, leading to improved medication adherence and patient satisfaction. |
| Databáze: | OpenAIRE |
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