Informed Decision Making for Anticoagulation Therapy for Atrial Fibrillation.
Informed Decision Making for Anticoagulation Therapy for Atrial Fibrillation.
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抗凝疗法的理智决策用于心房颤动。
DOI：
10.1177/0272989x221121350
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发表时间：
2023-02
期刊：
影响因子：
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通讯作者：
Rothberg MB
中科院分区：
文献类型：
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作者：
Martinez KA;Linfield DT;Shaker V;Rothberg MB
房颤(AF)患者必须在华法林和直接口服抗凝剂(DOAC)之间做出选择，这是一个涉及到重要权衡的决定。我们的目标是了解内科医生是否让患者参与抗凝药物的知情决策。我们在Verilogue Point-of-Practice数据库中对医生和抗凝治疗患者之间的对话录音进行了分析。我们评估了知情决策的七个要素的存在，以及对财务成本的讨论。在与21名医生的37次会诊中，92%的人开出了DOAC处方，8%的人开出了华法林处方。70%的人符合讨论利弊的标准，70%的人讨论替代方案，43%的人提出了决定，30%的人包括对患者理解的评估，22%的人包括对患者在决策制定中的角色的解释，22%的人包括对患者偏好的评估，19%的人包括对不确定性的讨论。两次遭遇(5%)包含所有七种元素，9次(24%)不包含任何元素。在43%的就诊中，医生与患者讨论了治疗费用。我们在一次会面中评估了明智的决策制定。医生和患者可能有过其他讨论，但我们的数据没有记录这些讨论。医生经常提出替代方案，但通常不会让患者参与知情的决策。DOAC处方的高比率可能是医生偏好的结果，因为很少评估患者的偏好。需要支持医生让患者参与抗凝治疗的知情决策的策略。
Patients with atrial fibrillation (AF) must decide between warfarin and direct oral anticoagulants (DOACs), a decision involving important tradeoffs. Our objective was to understand whether physicians engage patients in informed decision making for anticoagulants. We performed an analysis of recorded conversations between physicians and anticoagulation-naiïve patients in the Verilogue Point-of-Practice Database. We assessed presence of seven elements of informed decision making, as well as discussion of financial costs. Of 37 encounters with 21 physicians, 92% resulted in a DOAC prescription and 8% resulted in a warfarin prescription. Seventy percent met criteria for discussion of pros and cons, 70% for discussion of the alternatives, 43% presented the decision, 30% included an assessment of patient understanding, 22% included an explanation of the patient’s role in decision making, 22% included an assessment of patient preferences, and 19% included a discussion of uncertainty. Two encounters (5%) included all seven elements and 9 (24%) included none. Physicians discussed treatment costs with patients in 43% of encounters. We assessed informed decision making in a single encounter. Physicians and patients may have had other discussions which were not captured in our data. Physicians often presented the alternatives, but did not generally engage patients in informed decision making. The high rate of DOAC prescriptions is likely the result of physician preferences, as patient preferences were rarely assessed. Strategies to support physicians in engaging patients in informed decision making for anticoagulation are needed.