B-PO04-198 ATRIAL FIBRILLATION ABLATION SHARED DECISION-MAKING TOOL IMPROVED PATIENT KNOWLEDGE BUT NOT SATISFACTION WITH THE DECISION-MAKING PROCESS

Abstract

Shared decision-making (SDM) tools are increasingly employed for procedural decisions. SDM tools are required prior to implantable cardioverter defibrillator and Watchman implantation, though their benefit beyond traditional pre-procedural counseling is uncertain. We developed a SDM tool for atrial fibrillation ablation (AFA), then tested its impact on patient procedural knowledge and patient satisfaction with decision-making involvement. Patients scheduled for an initial AFA were included. Each patient had previously participated in a traditional office visit discussion reviewing risks, benefits, and alternatives. Patients were randomized to experimental and control groups. A separate pre-procedure virtual visit allowed physician and patient to review the SDM tool or a control tool. The control tool outlined the patient experience during the ablation, without additional risk/benefit information. The assigned tool was then mailed to the patient. All patients completed a quiz immediately pre-ablation including 10 true-false questions testing AFA risk and benefit knowledge, and 5 questions assessing patient satisfaction and perceived involvement in procedural decision-making. Student’s t-tests were used to compare groups. 16 patients were randomized to the SDM tool and 11 to the control group. The two groups were similar in age, educational level, and ethnicity. The experimental group included 31% women, the control group, 55% (p=0.25). Virtual visit duration was 10.8 minutes for SDM patients and 8.6 for controls (p=0.04). The experimental group performed better on knowledge-based questions (66% correct vs 54% correct, p=0.04). Patient satisfaction did not differ significantly between groups, with the experimental group averaging 4.69/5 and the control 4.45 (p=0.08). The AFA SDM tool significantly improved patient procedural knowledge compared to traditional pre-procedural discussion alone. Virtual visits with SDM patients were longer than control patient visits, with the SDM tool triggering additional discussion. Prolonged virtual visits and improved patient understanding did not significantly enhance patient satisfaction with the decision-making process.