Planning treatment for patients with atrial fibrillation, an irregular and often rapid heart rate, is complex. The risk of stroke has to be balanced against the downsides of medications such as bleeding and costs. A new Mayo Clinic study has found when clinicians and patients make care plans together, quality of care and outcomes remain high, the visit length is unaffected, and clinicians overwhelmingly prefer this method. The findings were published recently in JAMA Internal Medicine.
This patient-centered approach, called shared decision making, was supported by 88% of clinicians who used this method in the study. Comparatively, just 62% of clinicians were satisfied with the standard method of care, the researchers found.
“More and more we hear about the potential benefits of having patients and clinicians working together to figure out what to do,” says Marleen Kunneman, Ph.D., a researcher in shared decision making at Mayo Clinic and Leiden University, and lead author of the study. “This is one of the largest trials ever to show the value this has for clinicians caring for patients at risk of stroke, and we’re hopeful it will lead to greater adoption of this method.”
Patients with atrial fibrillation are at a higher risk of stroke than the general population. Blood-thinning medications can reduce that risk but many patients don’t take them and some don’t stay on these drugs long enough to benefit. Dr. Kunneman and colleagues completed a randomized clinical trial between Jan. 30, 2017, and June 27, 2019, enrolling 922 patients with atrial fibrillation and their 151 clinicians. The researchers compared care as usual with and without a freely available shared decision making tool. This tool was designed at Mayo Clinic to support conversations about stroke prevention in patients with atrial fibrillation.
Patients were quite satisfied with care as usual, the researchers say. Use of the tool promoted better decision making conversations between patients and clinicians. The researchers found that promoting better conversations, contrary to perception, did not make appointments longer. Use of the tool did not change the proportion of patients who chose to take blood thinners to prevent strokes. Co-authors were from Mayo Clinic, Hennepin Health, Park Nicolette Health Partners, the University of Alabama at Birmingham, the University of Colorado, and the University of Mississippi Medical Center.
“Innovations are often introduced into the work of patients and clinicians without evaluating them simply because they make sense. In this case, the results are surprisingly favorable, particularly given the rates of dissatisfaction and burnout affecting clinicians,” says Victor Montori, M.D., a Mayo Clinic researcher and the study’s senior author. “This collaboration across institutions demonstrates how the best health care organizations care while learning and how clinical trials embedded in clinical practice accelerate this learning. And this is best for care.”
A follow-up study will estimate the extent to which shared decision making improves patients’ adherence to their medication plan.
The clinical trial was funded by the National Heart, Lung, and Blood Institute of the National Institute of Health. The study was supported in part by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.