A Nurse-Led Multi-Component Behavioral Activation Program to Improve Treatment Decision-Making and Health Outcomes in Patients With Atrial Fibrillation

Abstract

Introduction: Atrial fibrillation (AF) is a complex condition that requires a multifaceted management approach to reduce disease- and treatment-related complications. However, under-prescription of oral anticoagulant (OAC), non-adherence, suboptimal anticoagulation and risk factor control leave patients to increased risks of adverse outcomes. Methods: This mixed-methods study comprised a randomized controlled trial and an exploratory qualitative study. Community-dwelling patients with AF but no OAC treatment (N = 89) were randomized to receive either the Nurse-led Multi-component Behavioral Activation (N-MBA) program or standard care. The N-MBA program equipped patients as an active agent to manage their AF. Firstly, the nurse enabled patients to be aware of their stroke risk by using a decision-aid, then empowered them to discuss OAC use with physicians actively and be responsible for the medication and lifestyle-related self-care for stroke prevention. A purposive subsample (n=10) from the N-MBA program were interviewed for their engagement experience. Results: As compared with those received the standard care, the N-MBA group showed significantly greater intention to use OAC, and their OAC treatment option was more compatible with physician’s decision at immediate post-test (p = .002). They also reported greater improvements on health-related quality of life (HRQoL) (immediate post-test: p = .023; 6-month post-test: p = .047) and AF knowledge (immediate post-test: p = .004) after attending the program. The N-MBA program was highly receptive with excellent attendance (92%) and mean satisfaction score (4.94/5.00 ± 0.88). The participants expressed that the decision-aid enabled them to make the OAC treatment decision through better understanding of their stroke risk, pros and cons of different treatments. Through attending the interactive health counseling, they found themselves as more assertive to discuss the treatment options with their physicians. Together with the prompt access of a nurse for advice, they perceived themselves as capable to perform AF-related self-care. Conclusions: The preliminary analysis showed that the N-MBA program is feasible and effective to optimize treatment decision making and HRQoL in AF patients.