Design and development of a digital shared decision-making tool for stroke prevention in atrial fibrillation.
Design and development of a digital shared decision-making tool for stroke prevention in atrial fibrillation.
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共享决策 (SDM) 是一种患者和临床医生作为合作伙伴共同制定医疗决策的方法。患者收到做出决定所需的信息，并鼓励患者平衡风险、收益和偏好。信息材料对于 SDM 至关重要。心房颤动 (AF) 是最常见的心律失常，导致 10% 的缺血性中风，但 1/3 的患者没有接受适当的抗凝治疗。决策共享可以促进治疗接受度，改善结果。开发创建新型 SDM 工具所需的组件框架，并通过 AF 中风预防的案例研究提供实际示例。我们分析了基于网络的 SDM 工具的设计价值，该工具是为了更好地告知 AF 患者抗凝知识而创建的。该工具是与患者权益倡导者、多学科研究人员和私人设计公司合作开发的。它是通过对 AF 患者进行迭代、递归测试而得到完善的。其有效性正在由斯坦福大学领导、美国心脏协会赞助的多中心临床试验中进行评估。创建斯坦福 AFib 工具时考虑的主要组成部分包括：设计和软件；内容识别；信息传递；包容性沟通、用户参与；患者反馈；临床医生经验；以及实施和传播的预期。我们还强调 SDM 背后的道德原则；多样性和包容性、语言多样性、可及性和健康素养等问题。 《斯坦福 AFib 指南》患者工具可在 https://afibguide.com 上获取，临床医生工具可在 https://afibguide.com/clinician 上获取。关注一系列重要的开发和设计因素可以促进不同文化、教育和社会经济群体对工具的采用和信息的获取。通过深思熟虑的设计，数字工具可以减少决策后悔并改善医疗保健中许多决策情况的治疗结果。
Shared decision-making (SDM) is an approach in which patients and clinicians act as partners in making medical decisions. Patients receive the information needed to decide and are encouraged to balance risks, benefits, and preferences. Informative materials are vital to SDM. Atrial fibrillation (AF) is the most common cardiac arrhythmia and responsible for 10% of ischemic strokes, however 1/3 of patients are not on appropriate anticoagulation. Decision sharing may facilitate treatment acceptance, improving outcomes. To develop a framework of the components needed to create novel SDM tools and to provide practical examples through a case-study of stroke prevention in AF. We analyze the design values of a web-based SDM tool created to better inform AF patients about anticoagulation. The tool was developed in partnership with patient advocates, multi-disciplinary investigators, and private design firms. It was refined through iterative, recursive testing in patients with AF. Its effectiveness is being evaluated in a multisite clinical trial led by Stanford University and sponsored by the American Heart Association. The main components considered when creating the Stanford AFib tool included: design and software; content identification; information delivery; inclusive communication, user engagement; patient feedback; clinician experience; and anticipation of implementation and dissemination. We also highlight the ethical principles underlying SDM; matters of diversity and inclusion, linguistic variety, accessibility, and health literacy. The Stanford AFib Guide patient tool is available at: https://afibguide.com and the clinician tool at https://afibguide.com/clinician. Attention to a range of vital development and design factors can facilitate tool adoption and information acquisition by diverse cultural, educational, and socioeconomic subpopulations. With thoughtful design, digital tools may decrease decision regret and improve treatment outcomes across many decision-making situations in healthcare.
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DOI：
10.1177/0272989x211005655
发表时间：
2021-07
期刊：
Medical decision making : an international journal of the Society for Medical Decision Making
影响因子：
--
作者：
Torres Roldan VD;Brand-McCarthy SR;Ponce OJ;Belluzzo T;Urtecho M;Espinoza Suarez NR;Toloza FJK;Thota AD;Organick PW;Barrera F;Liu-Sanchez C;Jaladi S;Prokop L;Ozanne EM;Fagerlin A;Hargraves IG;Noseworthy PA;Montori VM;Brito JP
通讯作者：
Brito JP
影响因子：
4.5
作者：
Edwards, Michelle;Wood, Fiona;Edwards, Adrian
通讯作者：
Edwards, Adrian
影响因子：
3.5
作者：
Bennett, Carol;Graham, Ian D.;O'Connor, Annette M.
通讯作者：
O'Connor, Annette M.
影响因子：
--
作者：
Kher, Akhil;Johnson, Sandra;Griffith, Robert
通讯作者：
Griffith, Robert
影响因子：
3.6
作者：
Brehaut, JC;O'Connor, AM;Feldman-Stewart, D
通讯作者：
Feldman-Stewart, D