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August 25, 1999JAMA

A Patient Decision Aid Regarding Antithrombotic Therapy for Stroke Prevention in Atrial FibrillationA Randomized Controlled Trial

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Why the study?

Does an audiobooklet decision aid improve the ability to make choices regarding antithrombotic therapy in patients with atrial fibrillation?

Population

287 patients from the SPAF III aspirin cohort study with atrial fibrillation and a relatively low risk of…

Comparison

Usual care plus use of an audiobooklet decision… vs Usual care alone.

Design

RCT, randomized

Follow-up

6 months

Key result

An audiobooklet decision aid increased the proportion of atrial fibrillation patients making a definitive choice about antithrombotic therapy compared to usual care alone (99% vs 94%; P=0.02).

Authors

MMMalcolm Man‐Son‐Hing

Discussion

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Overview

Supports routine use of decision aids for AF antithrombotic decisions; extends evidence on shared decision-making tools.

Key Points

  • This trial aims to evaluate if an audiobooklet decision aid influences decision-making regarding antithrombotic therapy for atrial fibrillation patients.
  • Randomized controlled trial conducted from May 1997 to April 1998 at 14 centers involved in the SPAF III trial.
  • 287 patients with atrial fibrillation were assigned to receive usual care plus an audiobooklet or usual care alone.
  • Measured outcomes included knowledge, decisional conflict, satisfaction, and adherence to chosen therapy after 6 months.
  • 99% of patients in the audiobooklet group made a decision regarding therapy compared to 94% in the control group (P = .02).
  • 53%-80% of the audiobooklet group correctly estimated risks of stroke and hemorrhage compared to 16%-28% in the control group.
  • Adherence to initial therapy choice was similar in both groups after 6 months (95% vs 93%; P = .44).

Study Design

Type

RCT (n=287)

Randomization

randomized

Multicenter

Yes

Structured PICO

Does an audiobooklet decision aid improve the ability to make choices regarding antithrombotic therapy in patients with atrial fibrillation?

P
Population
287 patients from the SPAF III aspirin cohort study with atrial fibrillation and a relatively low risk of stroke who received 325 mg/d of aspirin and were followed up for a mean of 2 years.
I
Intervention
Usual care plus use of an audiobooklet (AB) decision aid explaining the results of a clinical trial to help patients decide whether to continue taking aspirin or switch to warfarin.
C
Comparator
Usual care alone.
O
Outcome
Patients' ability to make choices regarding antithrombotic therapy, and 6-month adherence to these decisions.patient reported

Main Result

Absolute Event Rate: 99% vs 94%

p-value: p=.02

A patient decision aid improved understanding of benefits and risks and helped patients with atrial fibrillation make definitive choices about antithrombotic therapy.

Cite This Study

Malcolm Man‐Son‐Hing (1999) conducted an RCT in atrial fibrillation (n=287). audiobooklet (AB) decision aid plus usual care vs. usual care alone was evaluated on Patients' ability to make choices regarding antithrombotic therapy (p=.02). An audiobooklet decision aid increased the proportion of atrial fibrillation patients making a definitive choice about antithrombotic therapy compared to usual care alone (99% vs 94%; P=0.02).

synapsesocial.com/papers/6a0f14af2eca052da648122fhttps://doi.org/10.1001/jama.282.8.737
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