Marleen Kunneman1, Ian G Hargraves2, Angela L Sivly3, Megan E Branda4, Christina M LaVecchia5, Nanon H M Labrie6, Sarah Brand-McCarthy7, Victor Montori8. 1. Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: Kunneman@lumc.nl. 2. Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA. Electronic address: Hargraves.Ian@mayo.edu. 3. Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA. Electronic address: Sivly.Angela@mayo.edu. 4. Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO, USA; Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA. Electronic address: MEGAN.BRANDA@CUANSCHUTZ.EDU. 5. Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; School of Arts and Sciences, Neumann University, Auston, PA, USA. Electronic address: lavecchc@neumann.edu. 6. Athena Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. Electronic address: n.h.m.labrie@vu.nl. 7. Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA. Electronic address: mccarthy.sarah@mayo.edu. 8. Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA. Electronic address: Montori.Victor@mayo.edu.
Abstract
OBJECTIVE: To evaluate how the use of a within-encounter SDM tool (compared to usual care in a randomized trial) contributes to care plans that make sense to patients with atrial fibrillation considering anticoagulation. METHODS: In a planned subgroup of the trial, 123 patients rated post-encounter how much sense their decided-upon care plan made to them and explained why. We explored how sense ratings related to observed patient involvement (OPTION12), patient's decisional conflict, and adherence to their plan based on pharmacy records. We analyzed patient motives using Burke's pentad. RESULTS: Plan sensibility was similarly high in both arms (Usual care n = 62: mean 9.4/10 (SD 1.0) vs SDM tool n = 61: 9.2/10 (SD 1.5); p = .8), significantly and weakly correlated to decisional conflict (rho=-0.28, p = .002), but not to OPTION12 or adherence. Plans made sense to most patients given their known efficacy, safety and what is involved in implementing them. CONCLUSION: Adding an effective intervention to promote SDM did not affect how much, or why, care plans made sense to patients receiving usual care, nor patient adherence to them. PRACTICE IMPLICATIONS: Evaluating the extent to which care plans make sense can improve SDM assessments, particularly when SDM extends beyond selecting from a menu of options.
OBJECTIVE: To evaluate how the use of a within-encounter SDM tool (compared to usual care in a randomized trial) contributes to care plans that make sense to patients with atrial fibrillation considering anticoagulation. METHODS: In a planned subgroup of the trial, 123 patients rated post-encounter how much sense their decided-upon care plan made to them and explained why. We explored how sense ratings related to observed patient involvement (OPTION12), patient's decisional conflict, and adherence to their plan based on pharmacy records. We analyzed patient motives using Burke's pentad. RESULTS: Plan sensibility was similarly high in both arms (Usual care n = 62: mean 9.4/10 (SD 1.0) vs SDM tool n = 61: 9.2/10 (SD 1.5); p = .8), significantly and weakly correlated to decisional conflict (rho=-0.28, p = .002), but not to OPTION12 or adherence. Plans made sense to most patients given their known efficacy, safety and what is involved in implementing them. CONCLUSION: Adding an effective intervention to promote SDM did not affect how much, or why, care plans made sense to patients receiving usual care, nor patient adherence to them. PRACTICE IMPLICATIONS: Evaluating the extent to which care plans make sense can improve SDM assessments, particularly when SDM extends beyond selecting from a menu of options.
Authors: Mary C Politi; Catherine H Saunders; Victoria F Grabinski; Renata W Yen; Amy E Cyr; Marie-Anne Durand; Glyn Elwyn Journal: PLoS One Date: 2021-12-16 Impact factor: 3.240