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Zeng A, Tang Q, O'Hagan E, McCaffery K, Ijaz K, Quiroz JC, Kocaballi AB, Rezazadegan D, Trivedi R, Siette J, Shaw T, Makeham M, Thiagalingam A, Chow CK, Laranjo L. Use of digital patient decision-support tools for atrial fibrillation treatments: a systematic review and meta-analysis. BMJ Evid Based Med 2024:bmjebm-2023-112820. [PMID: 38950915 DOI: 10.1136/bmjebm-2023-112820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2024] [Indexed: 07/03/2024]
Abstract
OBJECTIVES To assess the effects of digital patient decision-support tools for atrial fibrillation (AF) treatment decisions in adults with AF. STUDY DESIGN Systematic review and meta-analysis. ELIGIBILITY CRITERIA Eligible randomised controlled trials (RCTs) evaluated digital patient decision-support tools for AF treatment decisions in adults with AF. INFORMATION SOURCES We searched MEDLINE, EMBASE and Scopus from 2005 to 2023.Risk-of-bias (RoB) assessment: We assessed RoB using the Cochrane Risk of Bias Tool 2 for RCTs and cluster RCT and the ROBINS-I tool for quasi-experimental studies. SYNTHESIS OF RESULTS We used random effects meta-analysis to synthesise decisional conflict and patient knowledge outcomes reported in RCTs. We performed narrative synthesis for all outcomes. The main outcomes of interest were decisional conflict and patient knowledge. RESULTS 13 articles, reporting on 11 studies (4 RCTs, 1 cluster RCT and 6 quasi-experimental) met the inclusion criteria. There were 2714 participants across all studies (2372 in RCTs), of which 26% were women and the mean age was 71 years. Socioeconomically disadvantaged groups were poorly represented in the included studies. Seven studies (n=2508) focused on non-valvular AF and the mean CHAD2DS2-VASc across studies was 3.2 and for HAS-BLED 1.9. All tools focused on decisions regarding thromboembolic stroke prevention and most enabled calculation of individualised stroke risk. Tools were heterogeneous in features and functions; four tools were patient decision aids. The readability of content was reported in one study. Meta-analyses showed a reduction in decisional conflict (4 RCTs (n=2167); standardised mean difference -0.19; 95% CI -0.30 to -0.08; p=0.001; I2=26.5%; moderate certainty evidence) corresponding to a decrease in 12.4 units on a scale of 0 to 100 (95% CI -19.5 to -5.2) and improvement in patient knowledge (2 RCTs (n=1057); risk difference 0.72, 95% CI 0.68, 0.76, p<0.001; I2=0%; low certainty evidence) favouring digital patient decision-support tools compared with usual care. Four of the 11 tools were publicly available and 3 had been implemented in healthcare delivery. CONCLUSIONS In the context of stroke prevention in AF, digital patient decision-support tools likely reduce decisional conflict and may result in little to no change in patient knowledge, compared with usual care. Future studies should leverage digital capabilities for increased personalisation and interactivity of the tools, with better consideration of health literacy and equity aspects. Additional robust trials and implementation studies are warranted. PROSPERO REGISTRATION NUMBER CRD42020218025.
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Affiliation(s)
- Aileen Zeng
- Westmead Applied Research Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Queenie Tang
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Edel O'Hagan
- Westmead Applied Research Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Kiran Ijaz
- Affective Interactions lab, School of Architecture, Design and Planning, The University of Sydney, Sydney, New South Wales, Australia
| | - Juan C Quiroz
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Ahmet Baki Kocaballi
- School of Computer Science, Faculty of Engineering & Information Technology, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Dana Rezazadegan
- Department of Computing Technologies, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Ritu Trivedi
- Westmead Applied Research Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Joyce Siette
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Penrith, New South Wales, Australia
| | - Timothy Shaw
- Westmead Applied Research Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Meredith Makeham
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Aravinda Thiagalingam
- Westmead Applied Research Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Clara K Chow
- Westmead Applied Research Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Liliana Laranjo
- Westmead Applied Research Centre, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
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Aref HAT, Turk T, Dhanani R, Xiao A, Olson J, Paul P, Dennett L, Yacyshyn E, Sadowski CA. Development and evaluation of shared decision-making tools in rheumatology: A scoping review. Semin Arthritis Rheum 2024; 66:152432. [PMID: 38554593 DOI: 10.1016/j.semarthrit.2024.152432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 04/01/2024]
Abstract
INTRODUCTION Shared decision-making (SDM) tools are facilitators of decision-making through a collaborative process between patients/caregivers and clinicians. These tools help clinicians understand patient's perspectives and help patients in making informed decisions based on their preferences. Despite their usefulness for both patients and clinicians, SDM tools are not widely implemented in everyday practice. One barrier is the lack of clarity on the development and evaluation processes of these tools. Such processes have not been previously described in the field of rheumatology. OBJECTIVE To describe the development and evaluation processes of shared decision-making (SDM) tools used in rheumatology. METHODS Bibliographic databases (e.g., EMBASE and CINAHL) were searched for relevant articles. Guidelines for the PRISMA extension for scoping reviews were followed. Studies included were: addressing SDM among adults in rheumatology, focusing on development and/or evaluation of SDM tool, full texts, empirical research, and in the English language. RESULTS Of the 2030 records screened, forty-six reports addressing 36 SDM tools were included. Development basis and evaluation measures varied across the studies. The most commonly reported development basis was the International Patient Decision Aids Standards (IPDAS) criteria (19/36, 53 %). Other developmental foundations reported were: The Ottawa Decision Support Framework (ODSF) (6/36, 16 %), Informed Medical Decision Foundation elements (3/36, 8 %), edutainment principles (2/36, 5.5 %), and others (e.g. DISCERN and MARKOV Model) (9/31,29 %). The most commonly used evaluation measures were the Decisional Conflict Scale (18/46, 39 %), acceptability and knowledge (7/46, 15 %), and the preparation for decision-making scale (5/46,11 %). CONCLUSION For better quality and wider implementation of such tools, there is a need for detailed, transparent, systematic, and consistent reporting of development methods and evaluation measures. Using established checklists for reporting development and evaluation is encouraged.
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Affiliation(s)
- Heba A T Aref
- Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, University of Alberta, Alberta, Canada
| | - Tarek Turk
- Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Alberta, Canada
| | - Ruhee Dhanani
- Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, University of Alberta, Alberta, Canada
| | - Andrew Xiao
- Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Alberta, Canada
| | - Joanne Olson
- Faculty of Nursing, College of Health Sciences, University of Alberta, Alberta, Canada
| | - Pauline Paul
- Faculty of Nursing, College of Health Sciences, University of Alberta, Alberta, Canada
| | - Liz Dennett
- Geoffrey and Robyn Sperber Health Sciences Library, University of Alberta, Alberta, Canada
| | - Elaine Yacyshyn
- Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Alberta, Canada
| | - Cheryl A Sadowski
- Faculty of Pharmacy and Pharmaceutical Sciences, College of Health Sciences, University of Alberta, Alberta, Canada.
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Boriani G, Tartaglia E, Imberti JF. A call to action: The need to apply guidelines recommendations with ABC or SOS to improve stroke prevention and cardiovascular outcomes in patients with atrial fibrillation. Eur J Intern Med 2024; 122:42-44. [PMID: 38310009 DOI: 10.1016/j.ejim.2024.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 02/05/2024]
Affiliation(s)
- Giuseppe Boriani
- Department of Biomedical, Cardiology Division, Metabolic and Neural Sciences, Italy University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.
| | - Enrico Tartaglia
- Department of Biomedical, Cardiology Division, Metabolic and Neural Sciences, Italy University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Jacopo F Imberti
- Department of Biomedical, Cardiology Division, Metabolic and Neural Sciences, Italy University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
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