de Castro Kim Paul, Chiu Harold Henrison, De Leon-Yao Ronna Cheska, Almelor-Sembrana Lorraine, Dans Antonio Miguel
Department of Medicine, Philippine General Hospital, University of the Philippines, Manila, Philippines.
Department of Adult Cardiology, Philippine Heart Center, Quezon City, Philippines.
JMIR Cardio. 2021 Aug 12;5(2):e23464. doi: 10.2196/23464.
Atrial fibrillation (AF) is one of the most common predisposing factors for ischemic stroke worldwide. Because of this, patients with AF are prescribed anticoagulant medications to decrease the risk. The availability of different options for oral anticoagulation makes it difficult for some patients to decide a preferred choice of medication. Clinical guidelines often recommend enhancing the decision-making process of patients by increasing their involvement in health decisions. In particular, the use of patient decision aids (PDAs) in patients with AF was associated with increased knowledge and increased likelihood of making a choice. However, the majority of available PDAs are from Western countries.
We aimed to develop and pilot test a PDA to help patients with nonvalvular AF choose an oral anticoagulant for stroke prevention in the local setting. Outcomes were (1) reduction in patient decisional conflict, (2) improvement in patient knowledge, and (3) patient and physician acceptability.
We followed the International Patient Decision Aid Standards (IPDAS) to develop a mobile app-based PDA for anticoagulation therapy in patients with nonvalvular AF. Focus group discussions identified decisional needs, which were subsequently incorporated into the PDA to compare choices for anticoagulation. Based on recommendations, the prototype PDA was rendered by at least 30 patients and 30 physicians. Decisional conflict and patient knowledge were tested before and after the PDA was implemented. Patient acceptability and physician acceptability were measured after each encounter.
Anticoagulant options were compared by the PDA using three factors that were identified (impact on stroke and bleeding risk, and price). The comparisons were presented as tables and graphs. The prototype PDA was rendered by 30 doctors and 37 patients for pilot testing. The mean duration of the encounters was 15 minutes. The decisional conflict score reduced by 35 points (100-point scale; P<.001). The AF knowledge score improved from 10 to 15 (P<.001). The PDA was acceptable for both patients and doctors.
Our study showed that an app-based PDA for anticoagulation therapy in patients with nonvalvular AF (1) reduced patient decisional conflict, (2) improved patient knowledge, and (3) was acceptable to patients and physicians. A PDA is potentially acceptable and useful in our setting. A randomized controlled trial is warranted to test its effectiveness compared to usual care. PDAs for other conditions should also be developed.
心房颤动（AF）是全球缺血性卒中最常见的诱发因素之一。因此，房颤患者会被开具抗凝药物以降低风险。口服抗凝药物有多种选择，这使得一些患者难以决定首选药物。临床指南通常建议通过增加患者对健康决策的参与度来加强患者的决策过程。特别是，在房颤患者中使用患者决策辅助工具（PDA）与知识增加及做出选择的可能性增加有关。然而，大多数现有的PDA来自西方国家。
我们旨在开发并进行初步测试一种PDA，以帮助非瓣膜性房颤患者在当地选择用于预防卒中的口服抗凝药物。结果包括：（1）减少患者的决策冲突；（2）提高患者的知识水平；（3）患者和医生的可接受性。
我们遵循国际患者决策辅助标准（IPDAS），为非瓣膜性房颤患者开发了一款基于移动应用程序的抗凝治疗PDA。焦点小组讨论确定了决策需求，随后将其纳入PDA以比较抗凝治疗的选择。根据建议，至少30名患者和30名医生对PDA原型进行了评估。在实施PDA之前和之后测试决策冲突和患者知识。每次接触后测量患者可接受性和医生可接受性。
PDA使用确定的三个因素（对卒中和出血风险的影响以及价格）比较抗凝治疗选择。比较结果以表格和图表形式呈现。30名医生和37名患者对PDA原型进行了初步测试。每次接触的平均时长为15分钟。决策冲突评分降低了35分（满分100分；P<0.001）。房颤知识评分从10分提高到15分（P<0.001）。PDA对患者和医生均可接受。
我们的研究表明，一款用于非瓣膜性房颤患者抗凝治疗的基于应用程序的PDA：（1）减少了患者的决策冲突；（2）提高了患者的知识水平；（3）患者和医生均可接受。在我们的环境中，PDA可能是可接受且有用的。有必要进行一项随机对照试验，以测试其与常规护理相比的有效性。还应开发针对其他病症的PDA。
