Implementation of a Patient Decision Aid for Atrial Fibrillation Ablation Improves Patient Procedural Knowledge but Does Not Impact Perceived Involvement With the Shared Decision-Making Process

Authors

Nicholas Sommers, Medical College of Wisconsin, Milwaukee, WIFollow
Jason C. Rubenstein, Medical College of Wisconsin, Milwaukee, WIFollow
Abdur Rahman Ahmad, Medical College of Wisconsin, Milwaukee, WIFollow
James Oujiri, Medical College of Wisconsin, Milwaukee, WIFollow
Ridhima Kapoor, Medical College of Wisconsin, Milwaukee, WIFollow
Graham Adsit, Medical College of Wisconsin, Milwaukee, WIFollow
Marcie Berger, Medical College of Wisconsin, Milwaukee, WIFollow

Publication Date

7-16-2024

Keywords

shared decision-making, atrial fibrillation, ablation, quality improvement

Abstract

Purpose: Shared decision-making (SDM) is a method for a patient and physician to cooperatively consider a diagnostic or therapeutic option, ultimately empowering the patient to make an informed decision. Atrial fibrillation (AF) ablation is a procedure that would benefit from SDM given the risk of serious adverse events, the high rate of arrhythmia recurrence, and alternative treatment options. Implementing a patient decision aid (PDA) may help facilitate AF ablation SDM by succinctly conveying important information to patients.

Methods: Patients scheduled for initial AF catheter ablation were randomized to a virtual SDM visit utilizing a PDA, which covered procedural risks and benefits, or a virtual control visit with a tool outlining periprocedural processes. Preoperatively, patients completed a questionnaire assessing procedural risk and benefit knowledge, as well as perceived involvement with the decision-making process. Unpaired t-tests were used to compare groups.

Results: The SDM group scored significantly better overall on knowledge-based questions compared to the control group (69% correct [n = 34] vs 53% [n = 32]; P = 0.00013). In particular, the SDM group was significantly more likely to answer questions correctly about stroke risk (P = 0.01), anticoagulation (P = 0.01), and potential need for additional procedures (P = 0.03 and P = 0.03). Perceived involvement in the decision-making process was overall not improved with PDA use (4.7 vs 4.6 out of 5; P = 0.72).

Conclusions: The addition of a PDA for AF ablation significantly improved procedural knowledge but did not impact patients’ perceived involvement in the decision-making process compared to traditional preprocedural discussion alone.

Recommended Citation

Sommers N, Rubenstein JC, Ahmad A, et al. Implementation of a patient decision aid for atrial fibrillation ablation improves patient procedural knowledge but does not impact perceived involvement with the shared decision-making process. J Patient Cent Res Rev. 2024;11:74-80.