Trial reportQuality & safety in health care2002
Development and description of a decision analysis based decision support tool for stroke prevention in atrial fibrillation.
Trial report in Quality & safety in health care, 2002. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Features of Computer-Based Decision Aids: Systematic Review, Thematic Synthesis, and Meta-Analyses.Journal of medical Internet research · 2016Pooled it
- Using a Clinical Decision Support System to Improve Anticoagulation in Patients with Nonvalve Atrial Fibrillation in China's Primary Care Settings: A Feasibility Study.International journal of clinical practice · 2023Trial
- Impact of a Multifaceted Intervention on Promoting Adherence to Screening Colonoscopy Among Persons in HIV Primary Care: A Pilot Study.Clinical and translational science · 2015Trial
- A patient decision aid to support shared decision-making on anti-thrombotic treatment of patients with atrial fibrillation: randomised controlled trial.Quality & safety in health care · 2007Trial
- Qualitative methods in a randomised controlled trial: the role of an integrated qualitative process evaluation in providing evidence to discontinue the intervention in one arm of a trial of a decision support tool.Quality & safety in health care · 2007Trial
- Medical communication and technology: a video-based process study of the use of decision aids in primary care consultations.BMC medical informatics and decision making · 2007Trial
- Instruments for Value Elucidation in Older Adults in Clinical Practice-A Scoping Review.Journal of the American Geriatrics Society · 2025Article
- Practical applications of methods to incorporate patient preferences into medical decision models: a scoping review.BMC medical informatics and decision making · 2025Article
- Systematic review to understand users perspectives on AI-enabled decision aids to inform shared decision making.NPJ digital medicine · 2024Article
- Characterizing atrial fibrillation symptom improvement following de novo catheter ablation.European journal of cardiovascular nursing · 2024Article
- Designing for patient decision-making: Design challenges generated by patients with atrial fibrillation during evaluation of a decision aid prototype.Frontiers in digital health · 2022Article
- Returning Cardiac Rhythm Data to Patients: Opportunities and Challenges.Cardiac electrophysiology clinics · 2021Review
- Developing an Atrial Fibrillation Guideline Support Tool (AFGuST) for shared decision making.Current medical research and opinion · 2015Article
- Health state descriptions to elicit stroke values: do they reflect patient experience of stroke?BMC health services research · 2014Review
- A review of decision support, risk communication and patient information tools for thrombolytic treatment in acute stroke: lessons for tool developers.BMC health services research · 2013Review
- Communication and decision making in cancer care: setting research priorities for decision support/patients' decision aids.Medical decision making : an international journal of the Society for Medical Decision MakingArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThere is an increasing move towards clinical decision making that engages the patient, which has led to the development and use of decision aids to support better decisions. The treatment of patients in atrial fibrillation (AF) with warfarin to prevent stroke is a decision that is sensitive to patient preferences as shown by a previous decision analysis.
aimTo develop a computerised decision support tool, building upon a previous decision analysis, which would engage individual patient preferences in reaching a shared decision on whether to take warfarin to prevent stroke.
methodsThe development process had two main phases: (1) the development phase which employed focus groups and repeated interviews with GPs/practice nurses and patients alongside an iterative development of a computerised tool; (2) the training and testing phase in which GPs and practice nurses underwent training in the use of the tool, including the use of simulated patients. The tool was then used in a feasibility study in a small number of patients with AF to inform the design of a subsequent randomised controlled trial.
resultsThe prototype tool had three components: (1) derivation of an individual patient's values for relevant health states using a standard gamble; (2) presentation/discussion of a patient's risks of stroke using the Framingham equation and the benefits/risks of warfarin from a systematic literature review; and (3) decision making component incorporating the outcome of a Markov decision analysis model. Older patients could be taken through the decision analysis based computerised tool, and patients and clinicians welcomed information on risks and benefits of treatments. The tool required time and training to use. Patients' decisions in the feasibility phase did not necessarily coincide with the output of the decision analysis model, but decision conflict appeared to be reduced and both patients and GPs were satisfied with the process.
conclusionsIt is feasible to develop a decision analysis based computer software package that is acceptable to elderly patients and clinicians, but it requires time and expertise to use. It is most likely that a tool of this type will best be used by a small number of clinicians who have developed experience of its use and can maintain their skills.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.