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BACKGROUND/RATIONALE:
AF is the most potent common risk factor for stroke. Despite strong evidence that use of anticoagulation in AF reduces the risk of strokes, only about one-third of AF out-patients receive anticoagulants. Reasons for the low rates of guideline adherence include patient, provider, and system barriers. System barriers are that providers have insufficient time and skill in exploring patient's and family's treatment preferences due to heavy workloads and limited patient education materials. Despite barriers, research shows that veterans have a strong desire for information and want to share in decisions with providers. Team members' (Beyth, Uphold, Wing) direct-to-consumer implementation project found that veterans embrace stroke prevention information and that when education materials are made available, providers readily engage in empowering patients to take an active role in changing their risk behaviors (STR 04-347). Drs. Beyth's and Wilson's work suggests that a stroke prevention patient decision aid appeals to veterans and VA providers (RRP # 06-153).
OBJECTIVE(S):
The aims of this project are to 1) describe veterans' perceptions of atrial fibrillation (AF), stroke, stroke prevention, behaviors regarding using medications and treatments, and shared-decision-making beliefs, and 2) develop and evaluate a script and video design to improve shared decision making related to stroke prevention.
METHODS:
We will conduct 8 face-to-face qualitative interviews with patients who have AF to discuss their perceptions of atrial fibrillation, stroke, stroke prevention, behaviors regarding using medications/treatments, and shared-decision-making beliefs. We will analyze the data with the constant-comparative method using the NVivo (N7) computer program. Findings from these interviews will be the foundation for developing a script and video design to improve shared decision making regarding stroke prevention options. Our technical team (creative director, health communication specialist, telecommunications specialist) will put the script in broadcast terms and carefully plan that the video has appropriate shots, wording, length, lighting, set design, editing, sound, tone, and spokespersons. The interdisciplinary healthcare team (2 nurses, 2 physicians, 1 pharmacy administration researcher) will lead in the development of the clinical content. After completion of the script/video design, we will convene a focus group of NF/SG VHS nurses and other providers to evaluate and make recommendations for improving the video. We will also conduct face-to-face interviews and obtain feedback about our script/design from 3 of the veterans who have atrial fibrillation and who participated in our first qualitative interviews regarding their perceptions of shared decision making. These focus group and individual interviews will be audio-taped, transcribed, coded, and analyzed using traditional qualitative methods. Based on feedback from our partners and findings from the focus group and interviews, we will modify and refine our video script and design.
FINDINGS/RESULTS:
In the interviews, patients were concerned about the risks of bleeding, taking a medication that was labelled “rat poison”, and about the need for frequent blood tests. Although most patients wanted to be involved in decision making related to treatment choices, they also said they would defer to the advice of their providers. Our marketing research found that for our target audience (i.e., veterans with atrial fibrillation), day-time TV was the venue most used to obtain information. We developed a video design and script that incorporated the marketing research resuts and findings from the qualitative interviews. To evaluate our draft video and script, we conducted a focus group with healthcare providers (MD, Nurses, Pharmacists). The focus group participants provided primarily positive feedback. They stated that when the video is finalized they recommended that it be made available to newly diagnosed AF patients in primary care clinics and during hospitalizations. They suggested that the video be available in patient waiting rooms and on DVDs in patients' hospital rooms. Participants recommended that we include a family member in the video and that we emphasize further that warfarin is the best choice. Participants also stated that golfing may not appeal to the veteran population.
IMPACT:
By making this future video a part of the "treatment" program for veterans with atrial fibrillation (AF), we will not only improve the quality of care veterans receive (through improved communication with nurses and other providers), but we will also improve the patients' quality of life (empowering them to participate in their own care, and hopefully preventing a stroke).
PUBLICATIONS:
None at this time.
DRA:
Chronic Diseases
DRE:
Quality of Care
Keywords:
Stroke, Patient-centered Care
MeSH Terms:
none
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