Shared Decision Making Tools for People Facing Stroke Prevention Strategies in Atrial Fibrillation: A Systematic Review and Environmental Scan.
Shared Decision Making Tools for People Facing Stroke Prevention Strategies in Atrial Fibrillation: A Systematic Review and Environmental Scan.
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DOI：
10.1177/0272989x211005655
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发表时间：
2021-07
期刊：
影响因子：
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通讯作者：
Brito JP
中科院分区：
文献类型：
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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
共享决策(SDM)工具可以帮助实施针对考虑卒中预防策略的房颤(AF)患者的指南建议。我们试图确定所有可用于这一目的的SDM工具的特征，并检查它们的质量和临床影响。从最初到2020年5月，我们搜索了多个书目数据库、社交媒体和SDM工具库，并联系了已确定的SDM工具的作者。符合条件的工具必须提供有关华法林和≥1直接口服抗凝剂的信息。我们提取了工具的特征，评估了他们对国际患者决策辅助标准的遵守情况，并获得了关于他们在促进SDM方面的有效性的信息。我们发现了14个SDM工具。大多数工具提供了有关备选办法的最新信息，但很少包括实际考虑因素(例如，自付费用)。这些SDM工具中的五个，都是患者在遭遇之前使用的，在高偏见风险的试验中进行了测试，并被发现在患者知识和决策冲突方面产生了微小的改善。有几种SDM工具可用于房颤的卒中预防，但它们是否能促进高质量的SDM尚不清楚。在这种情况下，SDM指南的实施需要以用户为中心的SDM工具的开发和评估，这些工具可以有效地促进高质量的SDM，并改善房颤患者的卒中预防。
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. 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. 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. 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.