AF and Stroke Prevention Decision Aid Leaflet – Patient
This decision aid enables patients and clinicians decide on whether anticoagulation is the appropriate treatment and if so which anticoagulant.
It has been produced by Patient, an online medical resource that supplies evidence based information on a wide range of medical and health topics to patients and health professionals.
This case study has been shared by Ben Foster, Patient Services, EMIS.
Date of publication: November 2013`
Format of the resource: online decision aid, viewable here http://patient.info/decision-aids/atrial-fibrillation-stroke-prevention
Quality marks: The leaflet and www.patient.info have been certified by the Information Standard. The website has HONcode certification.
About the resource and its production
This resource has been created for patients with atrial fibrillation and their clinician.
The Decision Aid came about as a result of feedback to Patient from a clinician:
“I have searched everywhere for a decent patient leaflet that explains to patients who already know they have AF, the pros and cons of starting on anticoagulation, Chads2vas etc. It doesn’t exist. I was talking to a member of the NWL cardiovascular network and discovered that they too were lamenting the lack of such advice and had also done a search.” Dr Nicola Burbidge (NHS Hounslow CCG)
As well as creating the decision aid, a patient information leaflet called http://patient.info/health/preventing-stroke-when-you-have-atrial-fibrillation was authored and released at the same time.
This is a decision aid to help the patient, together with their clinician, decide on whether or not anticoagulation treatment is appropriate for them, and if so which anticoagulant. As such the information had to be correct with a good evidence base.
The reference sources used in the production of the decision aid are available at the bottom of the leaflet (although it should be noted that on patient.info the reader will need to choose to display them).
The Information Standard logo is displayed on the decision aid which requires it to be reviewed after 3 years. The authorship details, version number, last released date and next review date are in the decision aid footer. Also the organisation’s Clinical Content Editor routinely checks reputable guideline producers for updated and new guidance, so that this, and any resource on Patient can be updated sooner if a change in evidence or guidelines makes this necessary.
Being a decision aid document the information had to be kept as succinct as possible. The bulk of the information is provided in a simple, three column table. The table has clear, separate rows discussing particular points that need to be considered.
Patient is a freely accessible website that is used by members of the public and health professionals. So it was important that it is a 100% medically correct, but written at a level most members of the public could understand.
We have a robust authoring system and the decision aid, and parallel patient information leaflet, were authored and released to Patient within two months of the request being received.
The tabular format of the decision aid meant it wasn’t sensible to author it in the normal way in our authoring system. We were able to adapt by creating it as a Word document, converting this into a PDF and then embedding the PDF into a new document in the authoring system at which point the medical proofreader and clinical content editor could provide comments. The footer authorship details, including The Information Standard logo, were also dynamically added.
Challenges along the way
As this was a new way of producing information for us we had to adapt our processes.
Normally any changes suggested by the medical proofreader and/or clinician peer reviewer can be made within the authoring system. In this case the changes were made to the Word document, a revised PDF created and said revision uploaded to the server to overwrite the previous version of the PDF. This was done twice so in all there were three versions of the decision aid before it went live, and these have been kept on file.
With regard to the actual information in the decision aid, a balancing act was needed between having it correct, yet simple to understand.
We have a full audit trail of the comments and responses/actions from the author, which can be provided should anyone reading this case study be interested in seeing them, however the following provides an example:
Clinical content editor: “’Warfarin reduces the risk of stroke to 16 people in every 1,000.’ I know you have the sentences above the table saying 50 out of 1000 may have stroke if no anticoagulant, but I think it will be more effective if included in the table, followed by the reduction. Some may skip the first few sentences thinking the important stuff is only in the table.”
Author’s response: “Have added several figures (for dabigatran) but the figures are otherwise complex (in view of different individual risk of stroke) and conclusions variable between different reviews, different authorities and (because of money) different health regions, so I have kept it fairly simple.”
My top tip, which is relevant to all authored content not just this case study, is to get in place the most robust authoring system possible.
Awards for Patient (formerly www.patient.co.uk)
- Most popular health & wellbeing website in the Website of the Year Awards 2013
- Best Health Website Award in the Website of the Year Awards 2014
- Highly Commended Award in The Good Web Guide Website of the Year Awards 2014