Date of Award
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Doctor of Philosophy (Ph.D.) Nursing
With the advent of patient-centered care, individuals with Afib are asked to participate in the shared decision-making (SDM) process. Choosing therapies in thromboembolic risk reduction is complex, involves trade-offs along with considering risks and benefits of therapeutics. Afib affects between 2.7 million and 6.1 million American adults (January et al., 2014), and with the growing elderly population that number is expected to double by 2030 (Colilla et al., 2013). In 2016 Medicare required a SDM process for individuals considering left atrial appendage for stroke prevention. There have been no studies reported examining individual characteristics and participating in SDM in individuals with Afib. The purpose of this study was to explore and investigate relationships between individual characteristics such as demographics, clinical features, decisional self-efficacy (DSE) decisional conflict (DC), and control preference (CP) on perceived participation in SDM in individuals with Afib. This study examined relationships between constructs of decisional needs (e.g., individual characteristics) as described by the Ottawa Decisional Support Framework (O'Connor, 2006) and SDM. The sample was drawn from an online Afib support group (StopAfib.org). The survey tools included demographics, Decisional Self-Efficacy (DSE) Scale, SURE test, CPS Scale, FRAIL scale, SDM Q9, and Satisfaction with Decision Instrument. IRB approval was through Molloy College. Greater participation in SDM were reported in participants: 75 years or older (p = .023), men (p = .002), individuals reporting permanent Afib (p = .049), CHA2DS2-VASc score of =/>3 (p = .043), individuals receiving an educational packet or DA (p < .01), greater DSES (p < .01), and individuals with less DC (p < .01). Greater DSE (p < .01) and receiving a decisional aid (p = .029) were the most predictive variables for participating in SDM (p < .01). This study provided insight into clinical characteristics as potential facilitators and barriers in SDM in individuals with Afib. The results of this study have broad implications for providing individualized care through the development of comprehensive needs assessment to facilitate SDM.
Nadraus, Patricia, "Individual Characteristics and Shared Decision Making for Stroke Prevention in Atrial Fibrillation" (2020). Theses & Dissertations. 112.