Shared Decision-Making to Improve Uptake of and Adherence with Oral Anticoagulation Therapy for Stroke Prevention in Patients with Atrial Fibrillation: Initial Clinical Evaluation of a Web-Based Patient Decision Aid

Stroke prevention in patients with atrial fibrillation (AF) remains a persistent clinical challenge, primarily due to suboptimal uptake and long-term adherence to oral anticoagulant (OAC) therapy. Despite the established benefits of OACs in reducing stroke risk, many patients do not initiate therapy or discontinue it prematurely. This multi-method doctoral thesis aimed to examine the issue of OAC non-persistence and to explore the acceptability of a shared decision-making intervention to support anticoagulation decisions in AF care. The research was conducted in three phases. First, a retrospective cohort study utilized administrative health data to identify the predictors of nonpersistence to OAC therapy among people diagnosed with nonvalvular AF in Alberta, Canada. The overall medication persistence rate was 71% in our cohort. Medication nonpersistence was higher among patients with a lower stroke risk, those placed on warfarin and dabigatran, as well as patients with concomitant end-stage renal disease. Second, a pilot randomized clinical trial was conducted to evaluate the acceptability of a novel, evidence-based decision aid designed to support shared decision-making between patients and clinicians regarding anticoagulation. The intervention group received our novel decision aid. The decision aid was implemented in three outpatient cardiology clinics, and 35 patients were enrolled. Findings showed high patient and clinician satisfaction, as well as some perceived support for shared decision-making. The primary outcome of interest was the SDM Q– 9 score. The SDM Q-9 score was 86.7 in both the intervention and control groups. This was not statistically significant. The findings from both phases of this thesis were used to inform the design and development of a protocol for a future, larger-scale clinical trial in the primary care setting. This forthcoming study will assess the impact of the decision aid on treatment adherence and patient-reported experiences in routine practice. Overall, this thesis contributes essential knowledge about gaps in care for patients with nonvalvular AF, provides initial clinical evidence supporting a novel patient-centered decision-support intervention to close this gap, and sets the stage for future high-impact research.

Name thesis:degree_name

Doctor of Philosophy (PhD)

Discipline thesis:degree_discipline

Medicine – Community Health Sciences

Grantor dc:publisher.institution

Graduate Studies

Year dc:date.issued

2026

Author dc:creator

• Adekanye, Joel Adebayo

Advisors dc:contributor.advisor

• Wilton, Stephen Bruce
• Sajobi, Tolulope

Committee members dc:contributor.committeemember

• James, Matthew
• Santana, Maria

• Medication persistence
• Shared decision-making
• Atrial fibrillation
• Patient decision aid

Statement dc:rights

• University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.

Language dc:language.iso

en

DOI

https://dx.doi.org/10.11575/PRISM/51660

OAI identifier oai:identifier

oai:ucalgary.scholaris.ca:1880/125369