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Published on: February 26, 2013
A Patient Decision Aid for Anticoagulation Therapy in Patients With Nonvalvular Atrial Fibrillation: Development and
Kim Paul de Castro1, Harold Henrison Chiu1, Ronna Cheska De Leon-Yao1
1Department of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines.
Insights
A new mobile app-based patient decision aid (PDA) for atrial fibrillation (AF) effectively reduced decisional conflict and improved knowledge regarding oral anticoagulants for stroke prevention. The PDA was well-received by both patients and physicians in the pilot study.
Area of Science:
- Cardiology
- Health Informatics
- Patient Decision Making
Background:
- Atrial fibrillation (AF) is a major risk factor for ischemic stroke, necessitating anticoagulant therapy.
- Choosing among oral anticoagulants presents a challenge for patients due to multiple options.
- Patient decision aids (PDAs) can enhance informed decision-making, but culturally relevant tools are scarce.
Purpose of the Study:
- To develop and pilot test a mobile app-based PDA for patients with nonvalvular AF.
- To assess the PDA's impact on patient decisional conflict and knowledge.
- To evaluate patient and physician acceptability of the PDA.
Main Methods:
- Developed a mobile app-based PDA following IPDAS guidelines.
- Incorporated patient-identified decisional needs into the PDA's comparison features.
- Pilot tested the PDA with 30 physicians and 37 patients, measuring decisional conflict and knowledge before and after use.
Main Results:
- The PDA compared anticoagulant options based on stroke risk, bleeding risk, and price.
- Patient decisional conflict scores decreased significantly (35 points, P<.001).
- Patient knowledge scores improved significantly (from 10 to 15, P<.001), with high acceptability among patients and physicians.
Conclusions:
- An app-based PDA effectively reduced decisional conflict and improved knowledge for nonvalvular AF patients choosing anticoagulants.
- The PDA demonstrated acceptability and utility in the local setting.
- Further randomized controlled trials are recommended to confirm effectiveness against usual care.
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 are 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.
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