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Accepted for/Published in: JMIR Cardio

Date Submitted: Aug 13, 2020
Date Accepted: Jun 2, 2021
Date Submitted to PubMed: Aug 12, 2021

The final, peer-reviewed published version of this preprint can be found here:

A Patient Decision Aid for Anticoagulation Therapy in Patients With Nonvalvular Atrial Fibrillation: Development and Pilot Study

de Castro KP, Chiu HH, De Leon - Yao RC, Almelor - Sembrana L, Dans AM

A Patient Decision Aid for Anticoagulation Therapy in Patients With Nonvalvular Atrial Fibrillation: Development and Pilot Study

JMIR Cardio 2021;5(2):e23464

DOI: 10.2196/23464

PMID: 34385138

PMCID: 8391739

A Patient Decision Aid for Anticoagulation Therapy in Patients with Non-Valvular Atrial Fibrillation: Development and Pilot Study

  • Kim Paul de Castro; 
  • Harold Henrison Chiu; 
  • Ronna Cheska De Leon - Yao; 
  • Lorraine Almelor - Sembrana; 
  • Antonio Miguel Dans

ABSTRACT

Background:

Clinical guidelines often recommended increasing patient involvement in healthcare decisions. However, majority of available patient decision aids (PtDA) are from Western countries.

Objective:

We thus aimed to develop and pilot test a PtDA to help patients with non-valvular atrial fibrillation (AF) choose an oral anticoagulant for stroke prevention in the local setting, a first of its kind in Asia and in a lower middle income country. 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 PtDA for anticoagulation therapy in patients with non-valvular AF. Focus group discussions identified decisional needs, which were subsequently incorporated into the PtDA to compare choices for anticoagulation. Based on recommendations, the prototype PtDA was rendered by at least 30 patients and 30 physicians. Decisional conflict and patient knowledge were tested before and after the PtDA was rendered. Patient and physician acceptability were measured after each encounter.

Results:

Anticoagulant options were compared by the PtDA using 3 factors that were identified – impact on stroke and bleeding risk, and price. The comparisons were presented as tables and graphs. The prototype PtDA was rendered by 30 doctors and 37 patients for pilot testing. The mean duration of the encounters was 15 minutes. Decisional conflict score was reduced by 35 points in a 100-point scale (P<0.001). AF knowledge scores improved from 10 to 15 (P<0.001). The PtDA was acceptable both for patients and doctors.

Conclusions:

Our study showed that an app-based PtDA for anticoagulation therapy in patients with non-valvular AF 1) reduced patient decisional conflict, 2) improved patient knowledge, and 3) was acceptable to patients and physicians. PtDAs are potentially acceptable and useful in the local setting and probably in Asia. A randomized controlled trial is warranted to test effectiveness compared to usual care. PtDAs for other conditions should also be developed.


 Citation

Please cite as:

de Castro KP, Chiu HH, De Leon - Yao RC, Almelor - Sembrana L, Dans AM

A Patient Decision Aid for Anticoagulation Therapy in Patients With Nonvalvular Atrial Fibrillation: Development and Pilot Study

JMIR Cardio 2021;5(2):e23464

DOI: 10.2196/23464

PMID: 34385138

PMCID: 8391739

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