A pilot randomized controlled trial of a decision support tool to improve the quality of communication and decision-making in individuals with atrial fibrillation. Academic Article uri icon

abstract

  • OBJECTIVES: To design a tool for nonvalvular atrial fibrillation (NVAF) to inform individuals of their individual stroke and bleeding risks, assist in clarifying priorities, and promote communication. DESIGN: Clustered randomized controlled trial. SETTING: Primary care clinics. PARTICIPANTS: Individuals with NVAF (N = 135). INTERVENTION: Completion of tool before regularly scheduled visit. MEASUREMENTS: Primary outcomes included the 100-point informed and values clarity subscales of the decisional conflict scale (lower scores indicate individual is more informed and has greater clarity). Secondary outcomes included knowledge, patient-clinician communication, and change in treatment. RESULTS: Sixty-nine individuals were enrolled in the intervention group and 66 in the control group. After their visit, intervention participants had lower scores on the informed (mean difference = -11.9, 95% confidence interval (CI) = -21.1 to -2.7) and values clarity subscales (mean difference = -14.6, 95% CI = -22.6 to -6.6). Greater proportions of intervention participants knew medications for reducing stroke risk (61% vs 31%, P < .001) and side effects (49% vs 37%, P = .07). Stroke (71% vs 12%) and bleeding risk (69% vs 20%) were discussed more frequently in the intervention than control group (P < .001). Five intervention participants expressed a preference for medication that was not concordant with their current treatment plan. There was no change in treatment plan in either group. CONCLUSION: The tool was effective in improving perceived and actual knowledge and values clarity and in increasing physician-patient communication but did not change treatment.

published proceedings

  • J Am Geriatr Soc

altmetric score

  • 3

author list (cited authors)

  • Fraenkel, L., Street, R. L., Towle, V., O'Leary, J. R., Iannone, L., Van Ness, P. H., & Fried, T. R.

citation count

  • 27

complete list of authors

  • Fraenkel, Liana||Street, Richard L||Towle, Virginia||O'Leary, John R||Iannone, Lynne||Van Ness, Peter H||Fried, Terri R

publication date

  • August 2012

publisher