Accepted for/Published in: JMIR Cardio
Date Submitted: Oct 24, 2024
Open Peer Review Period: Oct 24, 2024 - Dec 19, 2024
Date Accepted: Feb 18, 2025
(closed for review but you can still tweet)
A web-based tool to perform a values clarification for stroke prevention in patients with atrial fibrillation: Design and preliminary testing
ABSTRACT
Background:
Atrial fibrillation (AF) is associated with an increased risk of stroke. Anticoagulation reduces the risk of stroke, but the risk versus benefit of anticoagulation is a critical decision between patients and providers.
Objective:
This study aimed to evaluate if a visual with a value clarification alters the understanding of the tradeoffs of anticoagulation in AF.
Methods:
A decision support tool was developed to evaluate the impact on oral anticoagulation (OAC) decision-making and confidence in naive participants who had not been diagnosed with AF and had not taken anticoagulants. Participants were randomized into three groups: the standard (control) group, the visual group, and the visual with value clarification group. Participants were randomly assigned to a gauge or icon array visualization of stroke risk within the two visualization groups. The primary outcome of decision quality was the SURE test. Secondary outcomes included participants' likelihood of choosing OAC and their perceptions of the benefits and risks associated with OAC therapy.
Results:
Participants' confidence in making an OAC choice was not statistically different between the three groups. Participants were less likely to choose OAC in the visual groups (mean ratings: Standard 58.3, Visual 51.4, Visual+VC 51.9, p=0.03). They felt the reduction in stroke risk from an OAC was less in the visual groups (Standard 63.8, Visual 54.2, Visual+VC 58.6, p<0.001). Visualization methods (gauge vs. icon array) showed no significant differences in overall SURE test results. Participants were less likely to choose OAC and perceived a smaller stroke risk reduction with gauge than icon array (OAC choice: gauge 48.8, icon array 55.4, p=0.03; stroke risk reduction: gauge 52.1, icon array 60.4, p=0.001).
Conclusions:
Visual aids can modestly affect decision confidence and perceptions regarding the benefits of anticoagulation therapy but do not significantly change overall decision certainty in a scenario where the guidelines do not recommend for or against the treatment. Future work should determine the role of a gauge versus icon array in visual aids for decision-making in stroke prevention in AF.
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