Development of a tool to improve the quality of decision making in atrial fibrillation.
Development of a tool to improve the quality of decision making in atrial fibrillation.
复制标题
开发一种工具，以提高房颤中决策的质量。
DOI：
10.1186/1472-6947-11-59
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发表时间：
2011-10-06
影响因子：
3.5
通讯作者：
Fried TR
中科院分区：
文献类型：
--
作者：
Fraenkel L;Street RL Jr;Fried TR
关于降低非瓣膜性房颤（NVAF）相关卒中风险的适当治疗的决策涉及权衡不同治疗方案的获益、风险和不便。本文的目的是描述NVAF的决策支持工具的开发，该工具基于提供卒中和出血的个体化风险估计，以及准备患者与医生就其价值和潜在治疗方案进行沟通。我们根据国际患者决策辅助标准的原则开发了一个工具。该工具的重点是病人和医生的二元决策单位，并强调改善两者之间的互动。它是建立在认识到，病人的价值观，以一个特定的治疗决策的应用是复杂的，最终的治疗选择是最好的，通过病人-临床医生沟通的过程。该工具提供了结合患者疾病感知的教育，以解释NVAF和卒中之间的关系，然后提供个性化的风险估计，使用单独的风险计算器在临床上有意义的时间段（5年）内与无治疗、阿司匹林和华法林相关的卒中和出血得出。还描述了卒中和出血结局的后遗症。鼓励患者用语言表达他们如何评估与每种选择相关的增量风险和获益，并写下具体问题与他们的医生讨论。作为决策支持工具的一部分，包括医生提示，鼓励患者讨论他们的意见。在对11名参与者（平均年龄78 ± 9岁，64% ≤高中学历）进行的试点测试中，8名（72%）将完成的难易程度评为“非常容易”，9名（81%）将信息量评为“刚刚好”。“根据患者的合并症，减少NVAF卒中的不同治疗方案的风险和益处差异很大。该工具有助于提供个性化的结果数据，并鼓励患者与医生就这些风险和益处进行沟通。未来的研究将探讨使用该工具是否与提高决策质量有关。
Decision-making about appropriate therapy to reduce the stroke risk associated with non-valvular atrial fibrillation (NVAF) involves the consideration of trade-offs among the benefits, risks, and inconveniences of different treatment options. The objective of this paper is to describe the development of a decision support tool for NVAF based on the provision of individualized risk estimates for stroke and bleeding and on preparing patients to communicate with their physicians about their values and potential treatment options. We developed a tool based on the principles of the International Patient Decision Aids Standards. The tool focuses on the patient-physician dyad as the decision-making unit and emphasizes improving the interaction between the two. It is built on the recognition that the application of patient values to a specific treatment decision is complex and that the final treatment choice is best made through a process of patient-clinician communication. The tool provides education incorporating patients ' illness perceptions to explain the relationship between NVAF and stroke, and then presents individualized risk estimates, derived using separate risk calculators for stroke and bleeding over a clinically meaningful time period (5 years) associated with no treatment, aspirin, and warfarin. Sequelae of both stroke and bleeding outcomes are also described. Patients are encouraged to verbalize how they value the incremental risks and benefits associated with each option and write down specific concerns to address with their physician. A physician prompt to encourage patients to discuss their opinions is included as part of the decision support tool. In pilot testing with 11 participants (mean age 78 ± 9 years, 64% with ≤ high-school education), 8 (72%) rated ease of completion as "very easy," and 9 (81%) rated amount of information as "just right." The risks and benefits of different treatment options for reduction of stroke in NVAF vary widely according to patients' comorbidities. This tool facilitates the provision of individualized outcome data and encourages patients to communicate with their physicians about these risks and benefits. Future studies will examine whether use of the tool is associated with improved quality of decision making.
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影响因子：
3.6
作者：
Man-Son-Hing, M;Gage, BF;Laupacis, A
通讯作者：
Laupacis, A
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