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BACKGROUND/RATIONALE:
Atrial fibrillation (AF) is the most potent risk factor for stroke and six randomized trials of anticoagulants have demonstrated a risk reduction of stroke by two-thirds. Unfortunately, anticoagulants are often under-used for stroke prevention in AF. Reasons for this underuse are not entirely known, but include discordance between providers’ and patients’ preferences and beliefs about the use of anticoagulants for stroke prevention in AF. Efforts to better understand this decision-making could potentially improve patient outcomes. VA Health Services Research & Development funded this project (QUERI RRP 06-153).
OBJECTIVE(S):
This project has the following goals: (1) testing the feasibility of a previously validated clinical decision aid “Making Choices: An Atrial Fibrillation Treatment Decision-Making Aid” in the VA population; and (2) developing an implementation process for using this decision aid in the VA population.
METHODS:
We sent the decision aid to eligible veterans who contacted us after being informed of the study by their VAMC provider. The aid includes an audiotape/CD, workbook and personal worksheet. Patients review the booklet and worksheet while listening to the audiotape/CD at home to prepare them for a discussion with their providers. UF IRB and the VA R&D Committee approved this study.
FINDINGS/RESULTS:
Of the 10 veterans who have contacted us, 7 have enrolled and 3 were excluded. On average the 7 enrolled veterans rated the AF, risk of stroke, benefits of medication, and risk of medication information in the Decision Aid as ‘very good’, and the type of stroke information as ‘good’. One veteran expressed a preference for making the final decision about his therapy after seriously considering his provider’s opinion; two veterans expressed they prefer sharing the responsibility for making the final decision with their provider; and one veteran, recently diagnosed with AF, used the decision aid worksheet during a discussion with his physician.
IMPACT:
This implementation process can potentially lead to patients actively participating in decision-making about their healthcare to improve their health-related outcomes.
PUBLICATIONS:
None at this time.
DRA:
Aging and Age-Related Changes
DRE:
Prevention, Communication and Decision Making
Keywords:
Stroke
MeSH Terms:
none
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