Both pre-visit patient decision aids and in-visit encounter decision aids improved shared decision-making outcomes compared to usual care for stroke prevention in patients with atrial fibrillation, according to a large multicenter randomized controlled trial.
Researchers reported that using both decision aid tools together yielded the most significant improvements in shared decision-making quality, patient knowledge, and reduction in decisional conflict. The study included 1,117 patients across six U.S. academic medical centers.
"Patients who received both the encounter decision aid and patient decision aid had improved observer-assessed quality of shared decision-making, objectively assessed patient knowledge, and patient-reported decisional conflict compared with usual care," reported lead author Elissa M. Ozanne, PhD, of the University of Utah, and colleagues.
Combined use of both decision aids vs usual care showed a 12.1-point improvement in shared decision-making quality (95% confidence interval [CI] = 8.0–16.2, P < .001), 68% higher odds of improved knowledge (odds ratio [OR] = 1.68, 95% CI = 1.35–2.09, P < .001), and a 6.3-point reduction in decisional conflict (95% CI = –9.6 to –3.1, P < .001).
Notably, the study found no statistically significant differences between groups in treatment choices for stroke prevention, patient satisfaction, or length of clinical visits (mean = 20.3–21.6 minutes across groups).
The cluster randomized trial included patients aged ≥18 years with nonvalvular atrial fibrillation at risk for stroke (CHA₂DS₂-VASc ≥1 for men, ≥2 for women). Participants were randomized to receive either a pre-visit patient decision aid, an in-visit encounter decision aid used by clinicians, both aids, or usual care.
Direct oral anticoagulants remained the most commonly prescribed treatment across all groups (63.7%–70.0%), with high concordance (76.2%–77.9%) between clinician and patient-reported treatment choices.
"This trial provides evidence about the relative value of supporting shared decision-making with an encounter decision aid, a patient decision aid, or a combination of these tools," noted the researchers in The BMJ. They emphasized that either decision aid approach appeared feasible within clinical workflow, with minimal impact on visit duration.
Full disclosures can be found in the study.