| Background and objectives: Atrial fibrillation(AF)is the most common heart arrhythmia seen in clinical practice,which seriously affects the quality of life of patients and increases the risk of stroke and heart failure.Treatment decision making for AF patients is complicate due to an increasing number of treatment option and a complex decisional context where tradeoffs between benefits and risks vary depending on options,patient value and preferences.Several AF management guidelines highlight that patient should be involved in treatment decision making.However,how to effectively involve patient in treatment decision making still needs further research and exploration.Understanding the process of treatment decision making is crucial to promoting patient engagement in treatment decision making.Therefore,this study adopted qualitative and quantitative research methods combining information board technology(psychological experiment technology for tracking decision-making process)to comprehensively analyze the process,influencing factors and information processing feature of patient engagement in treatment decisionmaking for atrial fibrillation,which will contribute to develop the intervention for promoting AF patient engagement in treatment decision making and provide guidance for clinical treatment decision-making communication.Methods: This study includes the following three parts: 1.Qualitative research on the process of patient treatment decision-making for AF: semi-structured interviews with 18 AF patients were conducted to analyze the process and features of treatment decision making,understand patients’ evaluation of treatment information and weighing treatment options,and explore possible influencing factors of patient engagement in decision-making.2.A cross-sectional survey on influencing factors of AF patient engagement in treatment decision making: research variables were identified on the basis of the literature review and the results of the qualitative research.A convenient sample of 330 AF inpatients and outpatients was recruited from two tertiary hospitals in Shanghai.Univariate analysis and multinomial Logistic regression analysis were employed to explore the impact of individual factors(demographics,disease related factors,health literacy,willingness of engagement in decision making),interpersonal factors(trust in physicians and perception of facilitation of engagement)and decision context factors(patients’ knowledge of AF)on patient engagement in treatment decision making.And this survey also aims to analyze the influence of AF patient engagement in treatment decision-making on their decision-making conflict.3.The information processing feature of AF patient treatment decision making based on information board technology: two kinds of common treatment decision-making tasks were identified on the basis of qualitative research-the choice of anticoagulant and the choice of treatment options.Information board technology was used to track AF patients’ process of decision making in two decision-making tasks and record the decision-making time,the amount,depth and patterns of search.The research aims to analyze the influence of patients’ decision-making engagement preferences(passive,collaborative,active)and task type(the choice of anticoagulant and the choice of treatment options)on information processing feature and to explore the relationship among patients’ decision-making engagement preferences,information processing mode,decision satisfaction and decision conflict.Results: 1.Three themes were identified: "multiple stages of AF patients’ treatment decisionmaking ","AF patient engagement in treatment decision-making was influenced by various factors" and “information is the basis for the treatment decision of AF patients”.(1)Multiple stages of AF patients’ treatment decision-making indicated that the process of treatment decision-making included five stages: formation of treatment decision-making problem,acquisition of treatment information,evaluation of treatment options,selection of treatment options and post-evaluation of treatment decision-making.(2)AF patient engagement in treatment decision-making was influenced by various factors,including individual factors(severity of the disease,disease cognition,willingness of engagement),interpersonal factors(family support,healthcare professional support,trust in healthcare providers)and decision-making context factor(AF related information).(3)That information is the basis for the treatment decision of AF patients was manifested that patients had high demand for decisional information,focused on different decisional information,received information from several resource,used and analyzed information differently.2.A total of 295 patients was investigated.(1)In terms of patient decision-making engagement preferences,43.1% of AF patients preferred a collaborative role,35.9% favored a passive role and 21.0% favored an active role.In reality,37.3% of AF patients played a passive role,35.3% played a collaborative role,and 27.5% played an active role.Kappa test indicated that there was a general consistency between patients’ preference for decision-making engagement and the actual decision engagement(Kappa value =0.551,P<0.05).(2)○1 Univariate analyses suggested that there were significant differences in the distribution of patients’ actual treatment decision-making engagement among different gender,age,residency,type of atrial fibrillation,CHA2DS2 VASC score,the number of hospitalizations caused by AF,EHRA grading and preference for decision-making engagement(all with P<0.05).There were statistically significant differences in duration of AF,health literacy,trust in physicians,facilition of engagement,illness perception and AF knowledge among AF patients with different actual decisionmaking engagement(all with P<0.05).○2 Multinomial Logistic regression analysis indicated that duration of AF,trust in physicians,age under 65,and passive decisionmaking participation preferences were associated with AF patients against collaboration role in decision making;facilitation of engagement and collaborative decision-making enagement preferences were associated with AF patients for collaboration role in decision making.Age under 65,trust in physicians,passive and collaborative decision-making participation preferences were associated with AF patients against active role in decision making;facilitation of engagement and health literacy were associated with AF patients for active role in decision making.(3)There were statistically significant differences in patients’ AF knowledge,quality of life and deicision conflict among AF patients with different actual decision-making engagement(all with P<0.05).Patients with collaborative role in decision making experienced less decision conflict than patients with active or passive role in decision making(all with P < 0.05).3.(1)There was a significant difference between the subjective and objective of evaluation of the importance of information clues both in two types of decisionmaking tasks.The average processing time of information clues such as treatment purpose,treatment effect,treatment risk,and considerations were significantly different between different decision-making tasks(all with P < 0.05).(2)○1 The average decision time for “the choice of anticoagulant” task was(107285.41±67706.45)ms,and the average decision time for “the choice of treatment options” task was(114355.60±64199.89)ms.The depth and pattern of searching for “the choice of anticoagulant” task was(0.93±0.73),(0.19±0.47)respectively,the depth and pattern of searching for “the choice of treatment options” task was(1.08±0.69),(0.14±0.55)respectively.○2 In terms of average decision time,depth of search and pattern of search,the main effects of decision-making engagement preference and task type were significant(P<0.05),and the interaction effects were not significant(P>0.05).(3)In “the choice of treatment options” task,patients’ decision conflict was influenced by decision-making engagement preference and depth of search.Conclusions: 1.The process of patient treatment decision-making for AF includes formation of treatment decision-making problem,acquisition of treatment information,evaluation of treatment option,selection of treatment option and post-decision making evaluation.AF patients had high demand for decisional information,focused on different decisional information,received information from several resource,used and analyzed information differently.2.There was a general consistency between AF patient decision-making engagement preferences and actual role in decision-making.Patients’ actual role in decision making for AF was influenced by age,duration of AF,patients’ trust in physicians,decision-making engagement preference and facilitation of engagement.Patients with collaborative role in decision making experienced less decision conflict than patients with active or passive role in decision making 3.There were significant differences between the subjective and objective evaluation of the importance of information clues in the process of treatment decision-making.The average decision-making time and depth of searching for “the choice of treatment option” task was higher than that of “the choice of the anticoagulant” task.there was difference in the distribution of patients’ searching pattern between two tasks.Patients with preference for collaborative decision making engagement need longer decision time and deeper depth of searching than Patients with preference for passive decision making engagement.In “the choice of treatment option” task,patients’ decision conflict was influenced by preference for decision-making engagement and depth of searching.4.Healthcare professionals should provide targeted information support based on the different information concerns of each stage of patients’ treatment decision-making to meet patients’ information needs,respect patients’ willingness to involve in decisionmaking to make rational decisions.Nurses are supposed to pay attention to patients’ emotions in the process of decision-making,identify decision-making conflicts,and provide psychological care. |
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