Equity lens on implementation of digital patient decision support tools for atrial fibrillation (AF) treatment: A systematic review

Abstract

Background: Clinical guidelines highlight shared decision-making (SDM) in AF treatment decisions is key. Digital patient decision-support tools may support equitable participation in SDM by considering patients' characteristics and needs during implementation.   Purpose: To systematically review trials of digital patient decision-support tools for AF treatment decisions, examining factors that influence implementation with an equity lens.   Methods: We conducted a systematic review following Cochran methods. We searched MEDLINE, EMBASE and Scopus from 2005 to 2023. Eligible randomised controlled trials and quasi experimental trials that evaluated digital patient decision-support tools for AF treatment decisions were included. Equity-related considerations of implementation outcomes included co-design process, characteristics of participants (i.e. socioeconomic status), readability score of tools.   Results: Thirteen articles reporting on eleven studies (5 RCTs and 6 quasi-experimental trials) met the inclusion criteria (2,714 participants; mean age 71¬±4.2 years; 26% women; 92% with non-valvular AF, remaining unreported). Nine tools involved patients in their co-design. In the 5 studies that reported educational levels, 62% of participants had college or postgraduate studies. One study reported adequate health literacy in 92% of participants. One study reported the readability of decision aid content was below 8th grade reading level.   Conclusion: Despite demonstrated efficacy in reducing decisional conflict and improving patient knowledge, digital patient decision-support tools were not consistently adapted to enhance equity during implementation. Implementation frameworks that focus on adaption of interventions to the participants' priorities could improve this.