A Patient Decision Aid for Anticoagulation Therapy in Patients With Nonvalvular Atrial Fibrillation: Development and Pilot Study
BackgroundAtrial 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 mak...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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JMIR Publications
2021-08-01
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| Series: | JMIR Cardio |
| Online Access: | https://cardio.jmir.org/2021/2/e23464 |
| _version_ | 1797735806797873152 |
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| author | Kim Paul de Castro Harold Henrison Chiu Ronna Cheska De Leon-Yao Lorraine Almelor-Sembrana Antonio Miguel Dans |
| author_facet | Kim Paul de Castro Harold Henrison Chiu Ronna Cheska De Leon-Yao Lorraine Almelor-Sembrana Antonio Miguel Dans |
| author_sort | Kim Paul de Castro |
| collection | DOAJ |
| description |
BackgroundAtrial 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 are from Western countries.
ObjectiveWe 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.
MethodsWe 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.
ResultsAnticoagulant 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.
ConclusionsOur 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. |
| first_indexed | 2024-03-12T13:04:25Z |
| format | Article |
| id | doaj.art-70c5a2f6dd35474ba89aecff07e8cc87 |
| institution | Directory Open Access Journal |
| issn | 2561-1011 |
| language | English |
| last_indexed | 2024-03-12T13:04:25Z |
| publishDate | 2021-08-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | JMIR Cardio |
| spelling | doaj.art-70c5a2f6dd35474ba89aecff07e8cc872023-08-28T18:30:17ZengJMIR PublicationsJMIR Cardio2561-10112021-08-0152e2346410.2196/23464A Patient Decision Aid for Anticoagulation Therapy in Patients With Nonvalvular Atrial Fibrillation: Development and Pilot StudyKim Paul de Castrohttps://orcid.org/0000-0002-1303-4408Harold Henrison Chiuhttps://orcid.org/0000-0002-2021-7843Ronna Cheska De Leon-Yaohttps://orcid.org/0000-0001-6669-3928Lorraine Almelor-Sembranahttps://orcid.org/0000-0002-1578-7489Antonio Miguel Danshttps://orcid.org/0000-0002-9694-8757 BackgroundAtrial 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 are from Western countries. ObjectiveWe 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. MethodsWe 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. ResultsAnticoagulant 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. ConclusionsOur 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.https://cardio.jmir.org/2021/2/e23464 |
| spellingShingle | Kim Paul de Castro Harold Henrison Chiu Ronna Cheska De Leon-Yao Lorraine Almelor-Sembrana Antonio Miguel Dans A Patient Decision Aid for Anticoagulation Therapy in Patients With Nonvalvular Atrial Fibrillation: Development and Pilot Study JMIR Cardio |
| title | A Patient Decision Aid for Anticoagulation Therapy in Patients With Nonvalvular Atrial Fibrillation: Development and Pilot Study |
| title_full | A Patient Decision Aid for Anticoagulation Therapy in Patients With Nonvalvular Atrial Fibrillation: Development and Pilot Study |
| title_fullStr | A Patient Decision Aid for Anticoagulation Therapy in Patients With Nonvalvular Atrial Fibrillation: Development and Pilot Study |
| title_full_unstemmed | A Patient Decision Aid for Anticoagulation Therapy in Patients With Nonvalvular Atrial Fibrillation: Development and Pilot Study |
| title_short | A Patient Decision Aid for Anticoagulation Therapy in Patients With Nonvalvular Atrial Fibrillation: Development and Pilot Study |
| title_sort | patient decision aid for anticoagulation therapy in patients with nonvalvular atrial fibrillation development and pilot study |
| url | https://cardio.jmir.org/2021/2/e23464 |
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