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

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.

Keywords

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