title: A pilot randomized controlled trial of a decision support tool to improve the quality of communication and decision-making in individuals with atrial fibrillation.
abstract: OBJECTIVE
  To design a tool for nonvalvular atrial fibrillation (NVAF) to inform individuals of their individual stroke and bleeding risks, assist in clarifying priorities, and promote communication.
  
  
  METHODS
  Clustered randomized controlled trial.
  
  
  METHODS
  Primary care clinics.
  
  
  METHODS
  Individuals with NVAF (N = 135).
  
  
  METHODS
  Completion of tool before regularly scheduled visit.
  
  
  METHODS
  Primary outcomes included the 100-point informed and values clarity subscales of the decisional conflict scale (lower scores indicate individual is more informed and has greater clarity). Secondary outcomes included knowledge, patient-clinician communication, and change in treatment.
  
  
  RESULTS
  Sixty-nine individuals were enrolled in the intervention group and 66 in the control group. After their visit, intervention participants had lower scores on the informed (mean difference = -11.9, 95% confidence interval (CI) = -21.1 to -2.7) and values clarity subscales (mean difference = -14.6, 95% CI = -22.6 to -6.6). Greater proportions of intervention participants knew medications for reducing stroke risk (61% vs 31%, P < .001) and side effects (49% vs 37%, P = .07). Stroke (71% vs 12%) and bleeding risk (69% vs 20%) were discussed more frequently in the intervention than control group (P < .001). Five intervention participants expressed a preference for medication that was not concordant with their current treatment plan. There was no change in treatment plan in either group.
  
  
  CONCLUSIONS
  The tool was effective in improving perceived and actual knowledge and values clarity and in increasing physician-patient communication but did not change treatment.
authors.affiliation: Department of Medicine, Yale University, New Haven, Connecticut, USA.
authors.forename: Liana
authors.initials: L
authors.lastname: Fraenkel
authors.forename: Richard L
authors.initials: RL
authors.lastname: Street
authors.forename: Virginia
authors.initials: V
authors.lastname: Towle
authors.forename: John R
authors.initials: JR
authors.lastname: O'Leary
authors.forename: Lynne
authors.initials: L
authors.lastname: Iannone
authors.forename: Peter H
authors.initials: PH
authors.lastname: Van Ness
authors.forename: Terri R
authors.initials: TR
authors.lastname: Fried
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000523:psychology*; D003142:Communication; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male