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. 2021 Jul;41(5):540-549.
doi: 10.1177/0272989X211005655. Epub 2021 Apr 24.

Shared Decision Making Tools for People Facing Stroke Prevention Strategies in Atrial Fibrillation: A Systematic Review and Environmental Scan

Victor D Torres Roldan  1 , Sarah R Brand-McCarthy  1   2 , Oscar J Ponce  1 , Tereza Belluzzo  3 , Meritxell Urtecho  1 , Nataly R Espinoza Suarez  1 , Freddy J K Toloza  1 , Anjali D Thota  1 , Paige W Organick  1 , Francisco Barrera  1   4 , Carolina Liu-Sanchez  5 , Soumya Jaladi  1 , Larry Prokop  6 , Elissa M Ozanne  7 , Angela Fagerlin  7   8 , Ian G Hargraves  1 , Peter A Noseworthy  1   9 , Victor M Montori  1 , Juan P Brito  1
Affiliations

Shared Decision Making Tools for People Facing Stroke Prevention Strategies in Atrial Fibrillation: A Systematic Review and Environmental Scan

Victor D Torres Roldan et al. Med Decis Making. 2021 Jul.

Abstract

Objective: Shared decision making (SDM) tools can help implement guideline recommendations for patients with atrial fibrillation (AF) considering stroke prevention strategies. We sought to characterize all available SDM tools for this purpose and examine their quality and clinical impact.

Methods: We searched through multiple bibliographic databases, social media, and an SDM tool repository from inception to May 2020 and contacted authors of identified SDM tools. Eligible tools had to offer information about warfarin and ≥1 direct oral anticoagulant. We extracted tool characteristics, assessed their adherence to the International Patient Decision Aids Standards, and obtained information about their efficacy in promoting SDM.

Results: We found 14 SDM tools. Most tools provided up-to-date information about the options, but very few included practical considerations (e.g., out-of-pocket cost). Five of these SDM tools, all used by patients prior to the encounter, were tested in trials at high risk of bias and were found to produce small improvements in patient knowledge and reductions in decisional conflict.

Conclusion: Several SDM tools for stroke prevention in AF are available, but whether they promote high-quality SDM is yet to be known. The implementation of guidelines for SDM in this context requires user-centered development and evaluation of SDM tools that can effectively promote high-quality SDM and improve stroke prevention in patients with AF.

Keywords: anticoagulation; atrial fibrillation; cardiovascular prevention; decision aids; shared decision making.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The investigators Juan P. Brito, Ian G. Hargraves, Victor M. Montori, and Peter A. Noseworthy participated in the development of the Anticoagulation Choice, which is one of the shared decision making tools included in this review. The rest of the authors declare no conflicts of interest regarding this work.

Figures

Figure 1
Figure 1
Eligibility of decision aids.
Figure 2
Figure 2
Quality of decision aids: IPDAS checklist.
See this image and copyright information in PMC

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