scholarly journals A Patient Decision Aid for Anticoagulation Therapy in Patients With Nonvalvular Atrial Fibrillation: Development and Pilot Study

JMIR Cardio ◽  
10.2196/23464 ◽  
2021 ◽  
Vol 5 (2) ◽  
pp. e23464
Author(s):  
Kim Paul de Castro ◽  
Harold Henrison Chiu ◽  
Ronna Cheska De Leon-Yao ◽  
Lorraine Almelor-Sembrana ◽  
Antonio Miguel Dans
Keyword(s):  
Atrial Fibrillation ◽  
Decision Aid ◽  
Controlled Trial ◽  
Anticoagulation Therapy ◽  
Decisional Conflict ◽  
Mobile App ◽  
Patient Knowledge ◽  
Patient Decision Aid ◽  
Patient Acceptability ◽  
Patient Decision

Background Atrial fibrillation (AF) is one of the most common predisposing factors for ischemic stroke worldwide. Because of this, patients with AF are prescribed anticoagulant medications to decrease the risk. The availability of different options for oral anticoagulation makes it difficult for some patients to decide a preferred choice of medication. Clinical guidelines often recommend enhancing the decision-making process of patients by increasing their involvement in health decisions. In particular, the use of patient decision aids (PDAs) in patients with AF was associated with increased knowledge and increased likelihood of making a choice. However, the majority of available PDAs is from Western countries. Objective We aimed to develop and pilot test a PDA to help patients with nonvalvular AF choose an oral anticoagulant for stroke prevention in the local setting. Outcomes were (1) reduction in patient decisional conflict, (2) improvement in patient knowledge, and (3) patient and physician acceptability. Methods We followed the International Patient Decision Aid Standards (IPDAS) to develop a mobile app–based PDA for anticoagulation therapy in patients with nonvalvular AF. Focus group discussions identified decisional needs, which were subsequently incorporated into the PDA to compare choices for anticoagulation. Based on recommendations, the prototype PDA was rendered by at least 30 patients and 30 physicians. Decisional conflict and patient knowledge were tested before and after the PDA was implemented. Patient acceptability and physician acceptability were measured after each encounter. Results Anticoagulant options were compared by the PDA using three factors that were identified (impact on stroke and bleeding risk, and price). The comparisons were presented as tables and graphs. The prototype PDA was rendered by 30 doctors and 37 patients for pilot testing. The mean duration of the encounters was 15 minutes. The decisional conflict score reduced by 35 points (100-point scale; P<.001). The AF knowledge score improved from 10 to 15 (P<.001). The PDA was acceptable for both patients and doctors. Conclusions Our study showed that an app-based PDA for anticoagulation therapy in patients with nonvalvular AF (1) reduced patient decisional conflict, (2) improved patient knowledge, and (3) was acceptable to patients and physicians. A PDA is potentially acceptable and useful in our setting. A randomized controlled trial is warranted to test its effectiveness compared to usual care. PDAs for other conditions should also be developed.

scholarly journals A Patient Decision Aid for Anticoagulation Therapy in Patients With Nonvalvular Atrial Fibrillation: Development and Pilot Study (Preprint)

2020 ◽  
Author(s):  
Kim Paul de Castro ◽  
Harold Henrison Chiu ◽  
Ronna Cheska De Leon-Yao ◽  
Lorraine Almelor-Sembrana ◽  
Antonio Miguel Dans
Keyword(s):  
Atrial Fibrillation ◽  
Decision Aid ◽  
Controlled Trial ◽  
Anticoagulation Therapy ◽  
Decisional Conflict ◽  
Mobile App ◽  
Patient Knowledge ◽  
Patient Decision Aid ◽  
Patient Acceptability ◽  
Patient Decision

BACKGROUND Atrial fibrillation (AF) is one of the most common predisposing factors for ischemic stroke worldwide. Because of this, patients with AF are prescribed anticoagulant medications to decrease the risk. The availability of different options for oral anticoagulation makes it difficult for some patients to decide a preferred choice of medication. Clinical guidelines often recommend enhancing the decision-making process of patients by increasing their involvement in health decisions. In particular, the use of patient decision aids (PDAs) in patients with AF was associated with increased knowledge and increased likelihood of making a choice. However, the majority of available PDAs is from Western countries. OBJECTIVE We aimed to develop and pilot test a PDA to help patients with nonvalvular AF choose an oral anticoagulant for stroke prevention in the local setting. Outcomes were (1) reduction in patient decisional conflict, (2) improvement in patient knowledge, and (3) patient and physician acceptability. METHODS We followed the International Patient Decision Aid Standards (IPDAS) to develop a mobile app–based PDA for anticoagulation therapy in patients with nonvalvular AF. Focus group discussions identified decisional needs, which were subsequently incorporated into the PDA to compare choices for anticoagulation. Based on recommendations, the prototype PDA was rendered by at least 30 patients and 30 physicians. Decisional conflict and patient knowledge were tested before and after the PDA was implemented. Patient acceptability and physician acceptability were measured after each encounter. RESULTS Anticoagulant options were compared by the PDA using three factors that were identified (impact on stroke and bleeding risk, and price). The comparisons were presented as tables and graphs. The prototype PDA was rendered by 30 doctors and 37 patients for pilot testing. The mean duration of the encounters was 15 minutes. The decisional conflict score reduced by 35 points (100-point scale; <i>P</i>&lt;.001). The AF knowledge score improved from 10 to 15 (<i>P</i>&lt;.001). The PDA was acceptable for both patients and doctors. CONCLUSIONS Our study showed that an app-based PDA for anticoagulation therapy in patients with nonvalvular AF (1) reduced patient decisional conflict, (2) improved patient knowledge, and (3) was acceptable to patients and physicians. A PDA is potentially acceptable and useful in our setting. A randomized controlled trial is warranted to test its effectiveness compared to usual care. PDAs for other conditions should also be developed.

Improved Decisional Conflict and Preparedness for Decision Making Using a Patient Decision Aid for Treatment Selection in Psoriasis: A Pilot Study

2014 ◽  
Vol 18 (2) ◽  
pp. 114-118 ◽  
Author(s):  
Jerry Tan ◽  
Barat Wolfe
Keyword(s):  
Decision Making ◽  
Pilot Study ◽  
Decision Aid ◽  
Decisional Conflict ◽  
Patient Knowledge ◽  
Patient Decision Aid ◽  
Validated Questionnaires ◽  
Patient Decision ◽  
Patient Preparation ◽  
Psoriasis Severity

Background: We developed a patient decision aid (pDA) to assist psoriasis patients in treatment decisions. Objective: This pilot study evaluated the pDA in patient knowledge, decisional conflict, and preparation for decision making. Methods: Newly referred psoriasis patients in a private dermatology office completed self-administered surveys at three time points: before (visit 1) and on two occasions after provision of the pDA (visit 2 up to 2 weeks after visit 1; visit 3 up to 6 weeks after visit 1). The survey included questions regarding knowledge of psoriasis and its treatment and validated questionnaires on decisional conflict and preparation for decision making. Results: Ten psoriasis patients participated (seven men, three women; mean age 45.7 years), with a mean age of 11.4 years since diagnosis. Improvement by visit 3 was observed for knowledge ( p = .06), reduced decisional conflict ( p ≤ .001), and preparation for decision making ( p ≤ .05). Patients tended to self-select treatment appropriate to the level of psoriasis severity. Conclusion: This pilot study of the pDA showed improved patient knowledge of psoriasis and its treatments, reduced decisional conflict, and increased patient preparation for decision making. Limitations: This small study was not randomized and did not have a comparator arm.

scholarly journals Assessing Preference Shift and Effects on Patient Knowledge and Decisional Conflict: Cross-Sectional Study of an Interactive Prostate-Specific Antigen Test Patient Decision Aid (Preprint)

2018 ◽  
Author(s):  
Peter Scalia ◽  
Glyn Elwyn ◽  
Jan Kremer ◽  
Marjan Faber ◽  
Marie-Anne Durand
Keyword(s):  
Prostate Specific Antigen ◽  
Decision Aid ◽  
Specific Antigen ◽  
Decisional Conflict ◽  
Patient Decision Aid ◽  
Web Based ◽  
Psa Test ◽  
Psa Testing ◽  
Patient Decision ◽  
The Web

BACKGROUND Randomized trials of Web-based decision aids for prostate-specific antigen (PSA) testing indicate that these interventions improve knowledge and reduce decisional conflict. However, we do not know about these tools’ impact on people who spontaneously use a PSA testing patient decision aid on the internet. OBJECTIVE The objectives of this study were to (1) determine the impact of the Web-based PSA Option Grid patient decision aid on preference shift, knowledge, and decisional conflict; (2) identify which frequently asked questions (FAQs) are associated with preference shift; and (3) explore the possible relationships between these outcomes. METHODS Data were collected between January 1, 2016, and December 30, 2017. Users who accessed the Web-based, interactive PSA Option Grid were provided with 3 options: have a PSA test, no PSA test, or unsure. Users first declared their initial preference and then completed 5 knowledge questions and a 4-item (yes or no) validated decisional conflict scale (Sure of myself, Understand information, Risk-benefit ratio, Encouragement; SURE). Next, users were presented with 10 FAQs and asked to identify their preference for each question based on the information provided. At the end, users declared their final preference and completed the same knowledge and decisional conflict questions. Paired sample t tests were employed to compare before and after knowledge and decisional conflict scores. A multinomial regression analysis was performed to determine which FAQs were associated with a shift in screening preference. RESULTS Of all the people who accessed the PSA Option Grid, 39.8% (186/467) completed the interactive journey and associated surveys. After excluding 22 female users, we analyzed 164 responses. At completion, users shifted their preference to “not having the PSA test” (43/164, 26.2%, vs 117/164, 71.3%; P<.001), had higher levels of knowledge (112/164, 68.3%, vs 146/164, 89.0%; P<.001), and lower decisional conflict (94/164, 57.3%, vs 18/164, 11.0%; P<.001). There were 3 FAQs associated with preference shift: “What does the test involve?” “If my PSA level is high, what are the chances that I have prostate cancer?” and “What are the risks?” We did not find any relationship between knowledge, decisional conflict, and preference shift. CONCLUSIONS Unprompted use of the interactive PSA Option Grid leads to preference shift, increased knowledge, and reduced decisional conflict, which confirms the ability of these tools to influence decision making, even when used outside clinical encounters.

scholarly journals Effect of a patient decision aid (PDA) for type 2 diabetes on knowledge, decisional self-efficacy, and decisional conflict

2015 ◽  
Vol 16 (1) ◽  
Author(s):  
Robert. A. Bailey ◽  
Michael Pfeifer ◽  
Alicia C. Shillington ◽  
Qing Harshaw ◽  
Martha M. Funnell ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Self Efficacy ◽  
Decision Aid ◽  
Decisional Conflict ◽  
Patient Decision Aid ◽  
Patient Decision

scholarly journals A patient decision aid for antidepressant use in pregnancy: study protocol for a randomized controlled trial

Trials ◽  
2016 ◽  
Vol 17 (1) ◽  
Author(s):  
Simone Vigod ◽  
Neesha Hussain-Shamsy ◽  
Sophie Grigoriadis ◽  
Louise M. Howard ◽  
Kelly Metcalfe ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Study Protocol ◽  
Decision Aid ◽  
Controlled Trial ◽  
Patient Decision Aid ◽  
Randomized Controlled ◽  
Patient Decision ◽  
Antidepressant Use ◽  
In Pregnancy
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