Marleen Kunneman|Megan E. Branda|Ian Hargraves|Angela Sivly|Alexander T. Lee|Haeshik Gorr|Bruce Burnett|Takeki Suzuki|Elizabeth A. Jackson|Erik P. Hess|Mark Linzer|Sarah McCarthy|Juan P. Brito|Peter A. Noseworthy|Víctor M. Montori
Assessment of Shared Decision-making for Stroke Prevention in Patients With Atrial Fibrillation
Leiden University|Mayo Clinic in Arizona|Colorado School of Public Health|University of Colorado Denver|Mayo Clinic in Florida|Mayo Clinic in Arizona|Mayo Clinic in Arizona|Mayo Clinic in Arizona|General Department of Preventive Medicine|Park Nicollet Health Services|University of Mississippi Medical Center|University of Alabama at Birmingham|University of Alabama at Birmingham|General Department of Preventive Medicine|Mayo Clinic in Arizona|Mayo Clinic in Florida|Mayo Clinic in Arizona|Mayo Clinic in Florida
h3importanceh3 shared decisionmaking sdm anticoagulant treatment patients atrial fibrillation af widely recommended effectiveness unclear h3objectiveh3 assess extent use sdm tool affects quality sdm anticoagulant treatment decisions atrisk patients af h3design setting participantsh3 encounterrandomized trial recruited patients nonvalvular af considering starting reviewing anticoagulant treatment clinicians academic community safetynet medical centers january 30 2017 june 27 2019 encounters randomized either standard care arm care included use sdm tool intervention arm data analyzed august 1 november 30 2019 h3interventionsh3 standard care care using anticoagulation choice shared decision making tool presents individualized risk estimates compares anticoagulant treatment options across issues importance patients clinical encounter h3main outcomes measuresh3 quality sdm included quality communication patient knowledge af anticoagulant treatment accuracy patient estimates stroke risk within 30 estimate decisional conflict satisfaction decisions made encounter duration encounter clinician involvement patients sdm process h3resultsh3 clinical trial enrolled 922 patients 559 men 606 mean sd age 71 11 years 244 clinicians total 463 patients randomized intervention arm 459 patients standard care arm participants arms reported high communication quality high knowledge low decisional conflict demonstrated low accuracy risk perception would similarly recommend approach used encounter clinicians significantly satisfied intervention encounters 400 453 encounters 883 vs 277 448 encounters 618 adjusted relative risk 149 95 ci 142153 total 747 873 patients 856 chose start continue receiving anticoagulant medication patient involvement decisionmaking assessed video recordings encounters using observing patient involvement decision making 12item scale scores significantly higher intervention arm mean sd score 330 108 points vs 291 131 points respectively adjusted mean difference 42 points 95 ci 2856 points significant betweenarm difference found encounter duration mean sd duration 32 16 minutes intervention arm vs 31 17 minutes standard care arm adjusted mean betweenarm difference 11 95 ci 03 25 minutes h3conclusion relevanceh3 use sdm encounter tool improved several measures sdm quality clinician satisfaction significant effect treatment decisions encounter duration results help calibrate expectations value implementing sdm tools care patients af h3trial registrationh3 clinicaltrialsgov identifiernct02905032