OBJECTIVES: To design a tool for nonvalvular atrial fibrillation (NVAF) to inform individuals of their individual stroke and bleeding risks, assist in clarifying priorities, and promote communication. DESIGN: Clustered randomized controlled trial. SETTING: Primary care clinics. PARTICIPANTS: Individuals with NVAF (N = 135). INTERVENTION: Completion of tool before regularly scheduled visit. MEASUREMENTS: Primary outcomes included the 100-point informed and values clarity subscales of the decisional conflict scale (lower scores indicate individual is more informed and has greater clarity). Secondary outcomes included knowledge, patient-clinician communication, and change in treatment. RESULTS:Sixty-nine individuals were enrolled in the intervention group and 66 in the control group. After their visit, intervention participants had lower scores on the informed (mean difference = -11.9, 95% confidence interval (CI) = -21.1 to -2.7) and values clarity subscales (mean difference = -14.6, 95% CI = -22.6 to -6.6). Greater proportions of intervention participants knew medications for reducing stroke risk (61% vs 31%, P < .001) and side effects (49% vs 37%, P = .07). Stroke (71% vs 12%) and bleeding risk (69% vs 20%) were discussed more frequently in the intervention than control group (P < .001). Five intervention participants expressed a preference for medication that was not concordant with their current treatment plan. There was no change in treatment plan in either group. CONCLUSION: The tool was effective in improving perceived and actual knowledge and values clarity and in increasing physician-patient communication but did not change treatment.
RCT Entities:
OBJECTIVES: To design a tool for nonvalvular atrial fibrillation (NVAF) to inform individuals of their individual stroke and bleeding risks, assist in clarifying priorities, and promote communication. DESIGN: Clustered randomized controlled trial. SETTING: Primary care clinics. PARTICIPANTS: Individuals with NVAF (N = 135). INTERVENTION: Completion of tool before regularly scheduled visit. MEASUREMENTS: Primary outcomes included the 100-point informed and values clarity subscales of the decisional conflict scale (lower scores indicate individual is more informed and has greater clarity). Secondary outcomes included knowledge, patient-clinician communication, and change in treatment. RESULTS: Sixty-nine individuals were enrolled in the intervention group and 66 in the control group. After their visit, intervention participants had lower scores on the informed (mean difference = -11.9, 95% confidence interval (CI) = -21.1 to -2.7) and values clarity subscales (mean difference = -14.6, 95% CI = -22.6 to -6.6). Greater proportions of intervention participants knew medications for reducing stroke risk (61% vs 31%, P < .001) and side effects (49% vs 37%, P = .07). Stroke (71% vs 12%) and bleeding risk (69% vs 20%) were discussed more frequently in the intervention than control group (P < .001). Five intervention participants expressed a preference for medication that was not concordant with their current treatment plan. There was no change in treatment plan in either group. CONCLUSION: The tool was effective in improving perceived and actual knowledge and values clarity and in increasing physician-patient communication but did not change treatment.
Authors: Brian F Gage; Yan Yan; Paul E Milligan; Amy D Waterman; Robert Culverhouse; Michael W Rich; Martha J Radford Journal: Am Heart J Date: 2006-03 Impact factor: 4.749
Authors: Glyn Elwyn; Annette O'Connor; Dawn Stacey; Robert Volk; Adrian Edwards; Angela Coulter; Richard Thomson; Alexandra Barratt; Michael Barry; Steven Bernstein; Phyllis Butow; Aileen Clarke; Vikki Entwistle; Deb Feldman-Stewart; Margaret Holmes-Rovner; Hilary Llewellyn-Thomas; Nora Moumjid; Al Mulley; Cornelia Ruland; Karen Sepucha; Alan Sykes; Tim Whelan Journal: BMJ Date: 2006-08-14
Authors: Finlay A McAlister; Malcolm Man-Son-Hing; Sharon E Straus; William A Ghali; David Anderson; Sumit R Majumdar; Paul Gibson; Jafna L Cox; Miriam Fradette Journal: CMAJ Date: 2005-08-30 Impact factor: 8.262
Authors: Stuart J Connolly; Michael D Ezekowitz; Salim Yusuf; John Eikelboom; Jonas Oldgren; Amit Parekh; Janice Pogue; Paul A Reilly; Ellison Themeles; Jeanne Varrone; Susan Wang; Marco Alings; Denis Xavier; Jun Zhu; Rafael Diaz; Basil S Lewis; Harald Darius; Hans-Christoph Diener; Campbell D Joyner; Lars Wallentin Journal: N Engl J Med Date: 2009-08-30 Impact factor: 91.245
Authors: Annette M O'Connor; Carol L Bennett; Dawn Stacey; Michael Barry; Nananda F Col; Karen B Eden; Vikki A Entwistle; Valerie Fiset; Margaret Holmes-Rovner; Sara Khangura; Hilary Llewellyn-Thomas; David Rovner Journal: Cochrane Database Syst Rev Date: 2009-07-08
Authors: Ahsan M Arozullah; Paul R Yarnold; Charles L Bennett; Robert C Soltysik; Michael S Wolf; Rosario M Ferreira; Shoou-Yih D Lee; Stacey Costello; Adil Shakir; Caroline Denwood; Fred B Bryant; Terry Davis Journal: Med Care Date: 2007-11 Impact factor: 2.983
Authors: Richard G Thomson; Martin P Eccles; I Nick Steen; Jane Greenaway; Lynne Stobbart; Madeleine J Murtagh; Carl R May Journal: Qual Saf Health Care Date: 2007-06
Authors: René Rodríguez-Gutiérrez; Juan Manuel Millan-Alanis; Francisco J Barrera; Rozalina G McCoy Journal: Curr Diab Rep Date: 2021-12-13 Impact factor: 4.810
Authors: Mina K Chung; Angela Fagerlin; Paul J Wang; Tinuola B Ajayi; Larry A Allen; Tina Baykaner; Emelia J Benjamin; Megan Branda; Kerri L Cavanaugh; Lin Y Chen; George H Crossley; Rebecca K Delaney; Lee L Eckhardt; Kathleen L Grady; Ian G Hargraves; Mellanie True Hills; Matthew M Kalscheur; Daniel B Kramer; Marleen Kunneman; Rachel Lampert; Aisha T Langford; Krystina B Lewis; Ying Lu; John M Mandrola; Kathryn Martinez; Daniel D Matlock; Sarah R McCarthy; Victor M Montori; Peter A Noseworthy; Kate M Orland; Elissa Ozanne; Rod Passman; Krishna Pundi; Dan M Roden; Elizabeth V Saarel; Monika M Schmidt; Samuel F Sears; Dawn Stacey; Randall S Stafford; Benjamin A Steinberg; Sojin Youn Wass; Jennifer M Wright Journal: Circ Arrhythm Electrophysiol Date: 2021-12-06
Authors: Thomas H Wieringa; Rene Rodriguez-Gutierrez; Gabriela Spencer-Bonilla; Maartje de Wit; Oscar J Ponce; Manuel F Sanchez-Herrera; Nataly R Espinoza; Yaara Zisman-Ilani; Marleen Kunneman; Linda J Schoonmade; Victor M Montori; Frank J Snoek Journal: Syst Rev Date: 2019-05-20
Authors: Julia C M van Weert; Barbara C van Munster; Remco Sanders; René Spijker; Lotty Hooft; Jesse Jansen Journal: BMC Med Inform Decis Mak Date: 2016-04-21 Impact factor: 2.796
Authors: Margaret Holmes-Rovner; Akshay Srikanth; Stephen G Henry; Aisha Langford; David R Rovner; Angela Fagerlin Journal: Health Expect Date: 2017-09-07 Impact factor: 3.377