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Baicus C, Delcea C, Dima A, Oprisan E, Jurcut C, Dan GA. Influence of decision aids on oral anticoagulant prescribing among physicians: a randomised trial. Eur J Cl; in Invest, 47 (9), pp. 649-58, 2017.

Abstract: BACKGROUND: Oral anticoagulants (OAC) are underused in treatment of atrial
fibrillation (AF), with differences in patient and physician preferences. For
risk communication, the graphic showing risks on treatment contains all the
information, therefore, the graphic showing risks without treatment may not be
necessary. Here, our objective was to assess whether decision aids require
information of risks without treatment and specifically whether presentation of
5-year stroke risk in patients with AF increases use of OACs compared with
presentation of 1-year risk and whether decisions on treatment are different when
physicians decide their own treatment vs. that of the patient.
DESIGN: Randomised controlled trial with 23 factorial design, performed at 12
university hospitals, one internal medicine course and one national medical
RESULTS: Of 968 physicians who participated, 83·3% prescribed anticoagulation
therapy. Treatment decisions were not influenced by the number of graphics or by
the time frame of risk estimation, with risk differences of 0·5% (95% confidence
interval, -4·0% to 5·4%) and 3·4% (-1·3% to 8·1%). However, physician-to-patient
prescription rates were 5·4% (0·2-10·6%) more frequent after seeing the 5-year
risk graphic. Physician-to-self intentions to prescribe occurred less frequently,
with risk difference of 15·4% (10·8-20%). Physicians considered the baseline risk
and the absolute risk reduction only when prescribing to patients but not to
CONCLUSIONS: Risks could be communicated using decision aids with only one
graphic. Showing the risk of stroke at 5 years could increase the prescription of
OACs to patients with AF. Faced with the same risk of stroke, physicians
prescribed less to themselves than to patients.

Keywords: Anticoagulants; atrial fibrillation; factorial randomised trial; shared decision making; stroke

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Posted by Cristian Baicus


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