Shared decision making for anticoagulation reduces anxiety and improves adherence in patients with atrial fibrillation

Hsiao Hui Chiu, Shih Lin Chang*, Hao Min Cheng, Tze Fan Chao, Yenn Jiang Lin, Li Wei Lo, Yu Feng Hu, Fa Po Chung, Jo Nan Liao, Ta Chuan Tuan, Chin Yu Lin, Ting Yung Chang, Ling Kuo, Chih Min Liu, Yung Nan Tsai, Yu Ting Huang, Yuh Lih Chang, Ju Chieh Wung, Shih Ann Chen

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: Treatment with oral anticoagulants (OACs) could prevent stroke in atrial fibrillation (AF), but side effects developed due to OACs may cause patients anxiety during decision making. This study aimed to investigate whether shared decision making (SDM) reduces anxiety and improves adherence to stroke prevention measures in patients with AF. Methods: A one-group pretest–posttest design using a questionnaire survey was applied at the outpatient cardiology clinic between July 2019 until September 2020. A Patient Decision Aid (PDA) tool was used for the completion of the questionnaire survey after health education and counseling. Ten questions were included for patients’ recognition of SDM, and a 5-point scoring method was used, where “very much” was scored as 5 points, and “totally not” was scored as 1 point. Results: Fifty-two patients with AF were enrolled. In terms of patients’ recognition of SDM, points of more than 4.17 out of 5 were noted, indicating recognition above the level of “very much.” The patients’ anxiety scores before SDM were 3.56 (1.2), with a decrease of 0.64 points (p < 0.001) to 2.92 (1.3) after SDM. After SDM, the number of patients who decided to take OAC increased from 76.9% to 88.5%, and the 15.4% answering “unclear” decreased to 1.9% (p = 0.006). The patients’ anxiety levels after SDM were associated with gender (p = 0.025). Conclusions: The approach using SDM enhanced our understanding of the pros and cons of OAC treatment and, in patients with AF, decreased anxiety about therapeutic decisions and increased willingness to accept treatment options.

Original languageEnglish
Article number163
JournalBMC medical informatics and decision making
Issue number1
StatePublished - Dec 2023


  • Anxiety
  • Atrial fibrillation
  • CHADS-VASc scores
  • Oral anticoagulants
  • Shared decision making
  • Stroke


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