Chronic nonvalvular atrial fibrillation (AF) is a very common and costly public health problem. AF may reduce the quality and duration of life, particularly by increasing the risk of devastating thromboembolic strokes. Anticoagulants, including vitamin K antagonists (VKAs,e.g., warfarin) and non VKA anticoagulants (NOACs, e.g., dabigatran, -xabans), are very effective, but impose treatment demands on patients in terms of medication use, out-of-pocket costs, dietary, activity, and travel restrictions, and increased bleeding risk. Recognizing these challenges, leading cardiovascular societies in 2014 formulated a class I recommendation of shared decision making (SDM) for the individualization of anticoagulation therapy in at-risk patients with AF. However, clinicians have little guidance as to available materials promoting SDM, and whether patient decision aids(designed for patient use prior to visit) are better than conversation aids (designed for use during clinical encounter) to support high-quality SDM. For over a decade, the Mayo Shared Decision Making National Resource Center has partnered with patients, clinicians and multidisciplinary teams to make SDM possible through the use of tools for patients with chronic conditions making preventive and treatment decisions in emergency care, primary care, and specialty care settings. We produce these tools for the clinical encounter, based on rigorous evidence summaries (in collaboration with the AHRQ-designated Mayo Evidence-based Practice Center) and systematic observations of clinical encounters. Building on this experience, we propose to conduct an environmental scan to identify tools that have demonstrated efficacy in supporting the SDM process, and/or have followed a rigorous design process and a transparent incorporation of the best available research evidence as demanded by the International Patient Decision Aids Standards Collaboration criteria. Based on the insights from the environmental scan, we will identify the two best exemplars of patient decision aids and conversation aids. The content will be reconciled and designed to have two SDM tools that differ only in the delivery method, and ready for a multicenter randomized clinical trial to compare their effectiveness to promote high-quality SDM in AF patients. If successful, this work will improve the quality of anticoagulation therapy and the care and outcomes of millions of patients with AF.
|Program type||Strategically Focused Research Network|
|Effective start/end date||07/01/2018 → 06/30/2022|