Developing a Conversation Aid to Support Shared Decision Making: Reflections on Designing Anticoagulation Choice |
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Authors: | Claudia L. Zeballos-Palacios Ian G. Hargraves Peter A. Noseworthy Megan E. Branda Marleen Kunneman Bruce Burnett Michael R. Gionfriddo Christopher J. McLeod Haeshik Gorr Juan Pablo Brito Victor M. Montori |
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Affiliation: | 1. Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN;2. Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN;3. Heart Rhythm Services, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN;4. Center for Pharmacy Innovation and Outcomes, Geisinger, PA;5. Thrombosis Clinic and Anticoagulation Services, Park Nicollet Health Services, St Louis Park, MN;6. Department of Medicine, Hennepin Healthcare System, Minneapolis, MN |
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Abstract: | Patient-centered care requires that treatments respond to the problematic situation of each patient in a manner that makes intellectual, emotional, and practical sense, an achievement that requires shared decision making (SDM). To implement SDM in practice, tools—sometimes called conversation aids or decision aids—are prepared by collating, curating, and presenting high-quality, comprehensive, and up-to-date evidence. Yet, the literature offers limited guidance for how to make evidence support SDM. Herein, we describe our approach and the challenges encountered during the development of Anticoagulation Choice, a conversation aid to help patients with atrial fibrillation and their clinicians jointly consider the risk of thromboembolic stroke and decide whether and how to respond to this risk with anticoagulation. |
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Keywords: | AF atrial fibrillation congestive heart failure, hypertension, age, diabetes mellitus, previous stroke, vascular disease, age, sex DOAC direct oral anticoagulant HAS-BLED hypertension, abnormal kidney or liver function, previous stroke, previous bleeding, labile INR, age, drugs INR international normalized ratio LVEF left ventricular ejection fraction SDM shared decision making TE thromboembolism TIA transient ischemic attack |
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