Development of Complementary Encounter and Patient Decision Aids for Shared Decision Making about Stroke Prevention in Atrial Fibrillation.

Introduction: Decision aids (DAs) are helpful instruments used to support shared decision making (SDM). Patients with atrial fibrillation (AF) face complex decisions regarding stroke prevention strategies. While a few DAs have been made for AF stroke prevention, an encounter DA (EDA) and patient DA (PDA) have not been created to be used in conjunction with each other before. Design: Using iterative user-centered design, we developed 2 DAs for anticoagulation choice and stroke prevention in AF. Prototypes were created, and we elicited feedback from patients and experts via observations of encounters, usability testing, and semistructured interviews. Results: User testing was done with 33 experts (in AF and SDM) and 51 patients from 6 institutions. The EDA and PDA underwent 1 and 4 major iterations, respectively. Major differences between the DAs included AF pathophysiology and a preparation to meet with the clinician in the PDA as well as different language throughout. Content areas included personalized stroke risk, differences between anticoagulants, and risks of bleeding. Based on user feedback, developers 1) addressed feelings of isolation with AF, 2) improved navigation options, 3) modified content and flow for users new to AF and those experienced with AF, 4) updated stroke risk pictographs, and 5) added structure to the preparation for decision making in the PDA. Limitations: These DAs focus only on anticoagulation for stroke prevention and are online, which may limit participation for those less comfortable with technology. Conclusions: Designing complementary DAs for use in tandem or separately is a new method to support SDM between patients and clinicians. Extensive user testing is essential to creating high-quality tools that best meet the needs of those using them. Highlights: First-time complementary encounter and patient decision aids have been designed to work together or separately.User feedback led to greater structure and different experiences for patients naïve or experienced with anticoagulants in patient decision aids.Online tools allow for easier dissemination, use in telehealth visits, and updating as new evidence comes out.

Randomized evaluation of decision support interventions for atrial fibrillation: Rationale and design of the RED-AF study.

BACKGROUND: Shared decision making (SDM) improves the likelihood that patients will receive care in a manner consistent with their priorities. To facilitate SDM, decision aids (DA) are commonly used, both to prepare a patient before their clinician visit, as well as to facilitate discussion during the visit. However, the relative efficacy of patient-focused or encounter-based DAs on SDM and patient outcomes remains largely unknown. We aim to directly estimate the comparative effectiveness of two DA's on SDM observed in encounters to discuss stroke prevention strategies in patients with atrial fibrillation (AF). METHODS: The study aims to recruit 1200 adult patients with non-valvular AF who qualify for anticoagulation therapy, and their clinicians who manage stroke prevention strategies, in a 2x2 cluster randomized multi-center trial at six sites. Two DA's were developed as interactive, online, non-linear tools: a patient decision aid (PDA) to be used by patients before the encounter, and an encounter decision aid (EDA) to be used by clinicians with their patients during the encounter. Patients will be randomized to PDA or usual care; clinicians will be randomized to EDA or usual care. RESULTS: Primary outcomes are quality of SDM, patient decision making, and patient knowledge. Secondary outcomes include anticoagulation choice, adherence, and clinical events. CONCLUSION: This trial is the first randomized, head-to-head comparison of the effects of an EDA versus a PDA on SDM. Our results will help to inform future SDM interventions to improve patients' AF outcomes and experiences with stroke prevention strategies.

Age-Related Differences in the Cognitive, Visual, and Temporal Demands of In-Vehicle Information Systems.

In-vehicle information systems (IVIS) refer to a collection of features in vehicles that allow motorists to complete tasks (often unrelated to driving) while operating the vehicle. These systems may interfere, to a greater extent, with older drivers' ability to attend to the visual and cognitive demands of the driving environment. The current study sought to examine age-related differences in the visual, cognitive and temporal demands associated with IVIS interactions. Older and younger drivers completed a set of common tasks using the IVIS of a representative sample of six different vehicles while they drove along a low-density residential street. Evaluation measures included a Detection Response Task (DRT), to assess both cognitive and visual attention, and subjective measures following each condition using the NASA Task Load Index (TLX). Two age cohorts were evaluated: younger drivers between 21 and 36 years of age, and older drivers between 55 and 75 years of age. Participants completed experimental tasks involving interactions with the IVIS to achieve a specific goal (i.e., using the touch screen to tune the radio to a station; using voice commands to find a specified navigation destination, etc.). Performance of tasks varied according to different modes of interaction available in the vehicles. Older drivers took longer to complete tasks, were slower to react to stimuli, and reported higher task demand when interacting with IVIS. Older drivers stand to benefit the most from advancements in-vehicle technology, but ironically may struggle the most to use them. The results document significant age-related costs in the potential for distraction from IVIS interactions on the road.

Assessing the visual and cognitive demands of in-vehicle information systems.

BACKGROUND: New automobiles provide a variety of features that allow motorists to perform a plethora of secondary tasks unrelated to the primary task of driving. Despite their ubiquity, surprisingly little is known about how these complex multimodal in-vehicle information systems (IVIS) interactions impact a driver's workload. RESULTS: The current research sought to address three interrelated questions concerning this knowledge gap: (1) Are some task types more impairing than others? (2) Are some modes of interaction more distracting than others? (3) Are IVIS interactions easier to perform in some vehicles than others? Depending on the availability of the IVIS features in each vehicle, our testing involved an assessment of up to four task types (audio entertainment, calling and dialing, text messaging, and navigation) and up to three modes of interaction (e.g., center stack, auditory vocal, and the center console). The data collected from each participant provided a measure of cognitive demand, a measure of visual/manual demand, a subjective workload measure, and a measure of the time it took to complete the different tasks. The research provides empirical evidence that the workload experienced by drivers systematically varied as a function of the different tasks, modes of interaction, and vehicles that we evaluated. CONCLUSIONS: This objective assessment suggests that many of these IVIS features are too distracting to be enabled while the vehicle is in motion. Greater consideration should be given to what interactions should be available to the driver when the vehicle is in motion rather than to what IVIS features and functions could be available to motorists.

Visual and Cognitive Demands of CarPlay, Android Auto, and Five Native Infotainment Systems.

OBJECTIVE: The present research compared and contrasted the workload associated with using in-vehicle information systems commonly available in five different automotive original equipment manufacturers (OEMs) with that of CarPlay and Android Auto when used in the same vehicles. BACKGROUND: A growing trend is to provide access to portable smartphone-based systems (e.g., CarPlay and Android Auto) that support an expansion of various in-vehicle infotainment system features and functions. METHOD/RESULTS: The study involved on-road testing of 24 participants in each configuration of five vehicles crossed with the three different infotainment systems: the embedded portion of the native OEM systems, CarPlay, and Android Auto. Our analysis found that workload was significantly greater for the embedded portion of the native OEM systems than for CarPlay and Android Auto. The strengths and weaknesses of each CarPlay and Android Auto traded off in such a way that the overall demand associated with using the two systems did not differ. CONCLUSION: CarPlay and Android Auto provided more functionality and resulted in lower levels of workload than the embedded portion of the native OEM infotainment systems. APPLICATION: Potential applications of this research include refinements to CarPlay and Android Auto to address variations in workload as a function of task type, the modality of interaction, and OEM implementation of the system.