Mark H Eckman1, Alexandru Costea2, Mehran Attari2, Jitender Munjal2, Ruth E Wise3, Carol Knochelmann2, Matthew L Flaherty4, Pete Baker5, Robert Ireton5, Brett M Harnett5, Anthony C Leonard6, Dylan Steen2, Adam Rose3, John Kues6. 1. Division of General Internal Medicine and Center for Clinical Effectiveness, University of Cincinnati, Cincinnati, OH; Center for Health Informatics, University of Cincinnati, Cincinnati, OH. Electronic address: mark.eckman@uc.edu. 2. Division of Cardiovascular Health and Disease, University of Cincinnati, Cincinnati, OH. 3. Division of General Internal Medicine and Center for Clinical Effectiveness, University of Cincinnati, Cincinnati, OH. 4. Department of Neurology, University of Cincinnati, Cincinnati, OH. 5. Center for Health Informatics, University of Cincinnati, Cincinnati, OH. 6. Department of Family and Community Medicine, University of Cincinnati, Cincinnati, OH.
Abstract
BACKGROUND: Appropriate thromboprophylaxis for patients with atrial fibrillation or atrial flutter (AF) remains a national challenge. METHODS: We hypothesized that a shared decision-making interaction facilitated by an Atrial Fibrillation Shared Decision Making Tool (AFSDM) would improve patient knowledge about atrial fibrillation, and the risks and benefits of various treatment options for stroke prevention; increase satisfaction with the decision-making process; improve the therapeutic alliance between patient and the clinical care team; and increase medication adherence. Using a pre- and post-visit study design, we enrolled 76 patients and completed 2 office visits and 1-month telephone follow-up for 65 patients being seen in our Arrhythmia Clinic over the 1-year period (July 2016 through June 2017). Our primary outcome measure was change in decisional conflict between the first and second clinical visit. RESULTS: Decisional conflict decreased from an average of 31 to 9. Mean change was 22.3 (95% CI, 25.7 - 37.1), corresponding to an effect size of 0.94 standard deviations. Satisfaction with decision increased from 4.0 to 4.5, measures of therapeutic alliance with the care team (Kim Alliance scale) increased from 100.1 to 103.1, and satisfaction with provider increased from 4.2 to 4.5 (P < .0001 for all measures). AF knowledge assessment scores increased from 8.4 to 9.1, and knowledge about personal stroke and bleeding risk increased from 1 to 1.5 (P < .0001). Finally, medication adherence improved as reflected by an increase in the Morisky Medication Adherence scale from 5.9 to 6.4 (P < .0001). CONCLUSIONS: A shared decision-making interaction, facilitated by an AFSDM can significantly improve multiple measures of decision-making quality, leading to improved medication adherence and patient satisfaction.
BACKGROUND: Appropriate thromboprophylaxis for patients with atrial fibrillation or atrial flutter (AF) remains a national challenge. METHODS: We hypothesized that a shared decision-making interaction facilitated by an Atrial Fibrillation Shared Decision Making Tool (AFSDM) would improve patient knowledge about atrial fibrillation, and the risks and benefits of various treatment options for stroke prevention; increase satisfaction with the decision-making process; improve the therapeutic alliance between patient and the clinical care team; and increase medication adherence. Using a pre- and post-visit study design, we enrolled 76 patients and completed 2 office visits and 1-month telephone follow-up for 65 patients being seen in our Arrhythmia Clinic over the 1-year period (July 2016 through June 2017). Our primary outcome measure was change in decisional conflict between the first and second clinical visit. RESULTS: Decisional conflict decreased from an average of 31 to 9. Mean change was 22.3 (95% CI, 25.7 - 37.1), corresponding to an effect size of 0.94 standard deviations. Satisfaction with decision increased from 4.0 to 4.5, measures of therapeutic alliance with the care team (Kim Alliance scale) increased from 100.1 to 103.1, and satisfaction with provider increased from 4.2 to 4.5 (P < .0001 for all measures). AF knowledge assessment scores increased from 8.4 to 9.1, and knowledge about personal stroke and bleeding risk increased from 1 to 1.5 (P < .0001). Finally, medication adherence improved as reflected by an increase in the Morisky Medication Adherence scale from 5.9 to 6.4 (P < .0001). CONCLUSIONS: A shared decision-making interaction, facilitated by an AFSDM can significantly improve multiple measures of decision-making quality, leading to improved medication adherence and patient satisfaction.
Authors: Robert J Stanton; Mark H Eckman; Daniel Woo; Charles J Moomaw; Mary Haverbusch; Matthew L Flaherty; Dawn O Kleindorfer Journal: Stroke Date: 2020-01-31 Impact factor: 7.914
Authors: Marleen Kunneman; Megan E Branda; Ian G Hargraves; Angela L Sivly; Alexander T Lee; Haeshik Gorr; Bruce Burnett; Takeki Suzuki; Elizabeth A Jackson; Erik Hess; Mark Linzer; Sarah R Brand-McCarthy; Juan P Brito; Peter A Noseworthy; Victor M Montori Journal: JAMA Intern Med Date: 2020-07-20 Impact factor: 21.873
Authors: Peter A Noseworthy; Megan E Branda; Marleen Kunneman; Ian G Hargraves; Angela L Sivly; Juan P Brito; Bruce Burnett; Claudia Zeballos-Palacios; Mark Linzer; Takeki Suzuki; Alexander T Lee; Haeshik Gorr; Elizabeth A Jackson; Erik Hess; Sarah R Brand-McCarthy; Nilay D Shah; Victor M Montori Journal: J Am Heart Assoc Date: 2022-01-13 Impact factor: 6.106
Authors: Victor D Torres Roldan; Sarah R Brand-McCarthy; Oscar J Ponce; Tereza Belluzzo; Meritxell Urtecho; Nataly R Espinoza Suarez; Freddy J K Toloza; Anjali D Thota; Paige W Organick; Francisco Barrera; Carolina Liu-Sanchez; Soumya Jaladi; Larry Prokop; Elissa M Ozanne; Angela Fagerlin; Ian G Hargraves; Peter A Noseworthy; Victor M Montori; Juan P Brito Journal: Med Decis Making Date: 2021-04-24 Impact factor: 2.583
Authors: Marleen Kunneman; Megan E Branda; Ian G Hargraves; Angela L Sivly; Alexander T Lee; Haeshik Gorr; Bruce Burnett; Takeki Suzuki; Elizabeth A Jackson; Erik Hess; Mark Linzer; Sarah R Brand-McCarthy; Juan P Brito; Peter A Noseworthy; Victor M Montori Journal: JAMA Intern Med Date: 2020-09-01 Impact factor: 21.873
Authors: Jordy Mehawej; Jane Saczynski; Jerry H Gurwitz; Hawa O Abu; Benita A Bamgbade; Wei-Jia Wang; Tenes Paul; Katherine Trymbulak; Connor Saleeba; Zi-Yue Wang; Catarina I Kiefe; Robert J Goldberg; David D McManus Journal: J Geriatr Cardiol Date: 2020-08 Impact factor: 3.189