Shared Decision-Making Aid for Stroke-Prevention Strategies in Patients With Atrial Fibrillation Receiving...

Area of Science:

• Nephrology
• Cardiology
• Health Decision Science

Background:

• Current atrial fibrillation guidelines emphasize shared decision-making for stroke prevention.
• No decision aid currently exists for stroke prevention strategies in atrial fibrillation patients undergoing hemodialysis.
• Existing decision aids improve patient knowledge and reduce decisional conflict.

Purpose of the Study:

• To develop and field-test the first decision aid for Atrial Fibrillation in HemoDialysis (AFHD-DA).
• To support shared decision-making for stroke prevention in patients with atrial fibrillation receiving hemodialysis.

Main Methods:

• A sequential 3-phase mixed-methods study adhering to International Patient Decision Aid Standards.
• Development involved systematic reviews, focus groups, and interviews.
• Field-testing included simulated clinical consultations assessing decisional conflict and patient knowledge.

Main Results:

• The AFHD-DA demonstrated high acceptability and usability.
• Significant reduction in decisional conflict scores (41.0 to 13.6, P < .001).
• Significant improvement in patient knowledge scores (62.7 to 76.6, P = .001).

Conclusions:

• The AFHD-DA facilitates time-efficient shared decision-making.
• It enhances patient knowledge and decreases decisional conflict for stroke prevention in atrial fibrillation patients on hemodialysis.
• This decision aid is a valuable tool for this specific patient population.