1. Shared Decision Making Tools for People Facing Stroke Prevention Strategies in Atrial Fibrillation: A Systematic Review and Environmental Scan
- Author
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Nataly R. Espinoza Suarez, Oscar J. Ponce, Victor M. Montori, Carolina Liu-Sanchez, Paige Organick, Anjali Thota, Tereza Belluzzo, Juan P. Brito, Elissa M. Ozanne, Sarah R. Brand-McCarthy, Meritxell Urtecho, Angela Fagerlin, Freddy J.K. Toloza, Larry J. Prokop, Soumya Jaladi, Victor D. Torres Roldan, Ian Hargraves, Peter A. Noseworthy, and Francisco J Barrera
- Subjects
medicine.medical_specialty ,shared decision making ,Decision Making ,030204 cardiovascular system & hematology ,Decision Support Techniques ,03 medical and health sciences ,0302 clinical medicine ,Cardiovascular prevention ,Original Research Articles ,Atrial Fibrillation ,Decision aids ,Medicine ,Humans ,030212 general & internal medicine ,Intensive care medicine ,anticoagulation ,business.industry ,Health Policy ,cardiovascular prevention ,Atrial fibrillation ,Guideline ,medicine.disease ,Stroke ,decision aids ,Stroke prevention ,Patient Participation ,business ,Decision Making, Shared - Abstract
Objective Shared decision making (SDM) tools can help implement guideline recommendations for patients with atrial fibrillation (AF) considering stroke prevention strategies. We sought to characterize all available SDM tools for this purpose and examine their quality and clinical impact. Methods We searched through multiple bibliographic databases, social media, and an SDM tool repository from inception to May 2020 and contacted authors of identified SDM tools. Eligible tools had to offer information about warfarin and ≥1 direct oral anticoagulant. We extracted tool characteristics, assessed their adherence to the International Patient Decision Aids Standards, and obtained information about their efficacy in promoting SDM. Results We found 14 SDM tools. Most tools provided up-to-date information about the options, but very few included practical considerations (e.g., out-of-pocket cost). Five of these SDM tools, all used by patients prior to the encounter, were tested in trials at high risk of bias and were found to produce small improvements in patient knowledge and reductions in decisional conflict. Conclusion Several SDM tools for stroke prevention in AF are available, but whether they promote high-quality SDM is yet to be known. The implementation of guidelines for SDM in this context requires user-centered development and evaluation of SDM tools that can effectively promote high-quality SDM and improve stroke prevention in patients with AF.
- Published
- 2021