Shared decision making for anticoagulation reduces anxiety and improves adherence in patients with atrial fibrillation

BMC Medical Informatics and Decision Making

Research

Hsiao-Hui Chiu¹  Shih-Lin Chang²  Ju-Chieh Wung³  Yuh-Lih Chang⁴  Yung-Nan Tsai⁵  Yu-Ting Huang⁵  Hao-Min Cheng⁶  Ting-Yung Chang⁷  Fa-Po Chung⁷  Tze-Fan Chao⁷  Yenn-Jiang Lin⁷  Li-Wei Lo⁷  Jo-Nan Liao⁷  Ling Kuo⁷  Chih-Min Liu⁷  Chin-Yu Lin⁷  Yu-Feng Hu⁷  Ta-Chuan Tuan⁷  Shih-Ann Chen⁸ 

[1] Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan;Department of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan;Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan;Department of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan;Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan;Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan;Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan;Department of Pharmacy, National Yang Ming Chiao Tung University, Taipei, Taiwan;Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan;Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan;School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan;School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan;Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan;School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan;Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan;Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan;College of Medicine, Chung Hsing University, Taichung, Taiwan;

关键词: Oral anticoagulants;    Atrial fibrillation;    Anxiety;    Shared decision making;    CHADS-VASc scores;    Stroke;   

DOI  :  10.1186/s12911-023-02260-x

 received in 2022-06-06, accepted in 2023-08-07,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundTreatment with oral anticoagulants (OACs) could prevent stroke in atrial fibrillation (AF), but side effects developed due to OACs may cause patients anxiety during decision making. This study aimed to investigate whether shared decision making (SDM) reduces anxiety and improves adherence to stroke prevention measures in patients with AF.MethodsA one-group pretest–posttest design using a questionnaire survey was applied at the outpatient cardiology clinic between July 2019 until September 2020. A Patient Decision Aid (PDA) tool was used for the completion of the questionnaire survey after health education and counseling. Ten questions were included for patients’ recognition of SDM, and a 5-point scoring method was used, where “very much” was scored as 5 points, and “totally not” was scored as 1 point.ResultsFifty-two patients with AF were enrolled. In terms of patients’ recognition of SDM, points of more than 4.17 out of 5 were noted, indicating recognition above the level of “very much.” The patients’ anxiety scores before SDM were 3.56 (1.2), with a decrease of 0.64 points (p < 0.001) to 2.92 (1.3) after SDM. After SDM, the number of patients who decided to take OAC increased from 76.9% to 88.5%, and the 15.4% answering “unclear” decreased to 1.9% (p = 0.006). The patients’ anxiety levels after SDM were associated with gender (p = 0.025).ConclusionsThe approach using SDM enhanced our understanding of the pros and cons of OAC treatment and, in patients with AF, decreased anxiety about therapeutic decisions and increased willingness to accept treatment options.

【 授权许可】

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© BioMed Central Ltd., part of Springer Nature 2023