Intention to Prescribe/Take OAC Depending on the Number of Risk Diagrams , and Period for the Estimation of the Risk.
RCT Concerning the Intention to Prescribe/Take Oral Anticoagulants for Atrial Fibrillation Depending on the Number of Risk Diagrams (w Treatment +/- w/Out Treatment), and Number of Years (1 or 5) for the Estimation of the Risk of Stroke.
調査の概要
詳細な説明
Objectives:
To answer the questions:
- Concerning the decision to prescribe (take) treatment on the basis of a decision aid, are there necessary both diagrams (that with risk without treatment, and that with risk under treatment), or it is enough only the second (risk under treatment, which normally gives all the needed information)?
- Concerning the decision to prescribe (take) treatment, is it a difference between the effects of the presentation on decision aid of the risk of stroke for the next 1 year, and the presentation of the estimated risk of stroke for the next 5 years?
- Is the decision different if physicians prescribe the anticoagulant treatment to patients, over if they should take it themselves?
Study: 2x3 factorial randomized controlled trial (RCT) for comparison:
- Between the decision aid with 2 images (without treatment + with treatment) and the one with 1 image (risk only with treatment)
- Between the effect of the presentation of the stroke risk chart for 1 year and the stroke risk chart for 5 years.
- The decision to prescribe to patients over the decision to take the treatment themselves.
The comparison will be made for the spectrum of risks (scores CHA2DS2-VASC) from 1-5.
Sample size: was calculated a sample of 948 participants (474 + 474) for p = 0.05, power = 80% statistical difference between decisions of 5% (from 95% to 90%). The study does not have enough power neither to compare the 5 groups CHA2DS2-VASC (but we will make these comparisons with exploratory purpose), nor to test interactions.
Participants: physicians participating to the National Congress of Internal Medicine, physicians participating to courses, professional manifestations.
Randomization: randomization will be done on graph type (1 or 2 pictures), duration of risk estimate (1 year and 5 years) and the size of CHA2DS2-VASC risk score (1 to 5), and target prescription (patient or the doctor himself), a total of 40 possibilities. Randomization will be done in blocks of 40.
Participants will be asked to decide, depending on the risk chart, if the patient (or himself) will be treated, ignoring the risk of bleeding.
The chart will contain the pictogram according to the CHA2DS2-VASC risk score, without communicating the actual score, and the physician will have to make the decision to treat or not, depending on the perceived risk, and not on treatment guidelines.
No. questionnaire: first digit = number of risk diagrams (1 or 2); second digit = number of years for which the risk of stroke is calculated (1 or 5); third digit = CHA2DS2-VASC score (1-5). Ex: 253: 2 decision aid diagrams (with and without treatment), with an estimated risk of stroke for the next five years, in a patient with CHA2DS2-VASC score =3.
Effect (outcome): decision to treat / not to treat the patient / physician himself, with oral anticoagulants.
Statistical analysis: It will look for differences in bivariate analysis, and multivariate = logistic regression (dependent variable = treatment decision, the independent variables = number of charts, period for risk assessment (one or 5 years), prescription target (patient or the physician himself), CHA2DS2-VASC score, time from graduation, medical/teaching grade, working in hospital / ambulatory, the size of the city the physician works in, specialty, gender, age, if the physician has/had someone close with stroke (data from questionnaires).
研究の種類
入学 (実際)
段階
- 適用できない
連絡先と場所
研究場所
-
-
-
Bucharest、ルーマニア、020125
- Colentina Clinica Hospital
-
-
参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria:
- physicians who prescribe anticoagulant treatment for atrial fibrillation (cardiology, internal medicine, family medicine, hematology) or who deal with patients with stroke (neurology, pathology) or bleeding (gastroenterology)
Exclusion Criteria:
- physicians who never prescribe anticoagulant treatments, or do not deal with patients with stroke or bleeding because of anticoagulants
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 割り当て:ランダム化
- 介入モデル:階乗代入
- マスキング:なし(オープンラベル)
武器と介入
参加者グループ / アーム |
介入・治療 |
---|---|
実験的:risk presented on 1 diagram
decision aid with risk of stroke presented on 1 diagram (risk under OAC treatment)
|
decision aid with one/two diagrams decision aid with risk over one/five years decision aid with CHA2DS2-VASC risk score 1 to 5 target of the prescription: patient / physician hinself
|
アクティブコンパレータ:risk presented on 2 diagrams
decision aid with risk of stroke presented on 2 diagrams (one presenting risk without and one presenting risk with treatment)
|
decision aid with one/two diagrams decision aid with risk over one/five years decision aid with CHA2DS2-VASC risk score 1 to 5 target of the prescription: patient / physician hinself
|
アクティブコンパレータ:1year risk estimate
risk of stroke presented over a timeframe of 1 year
|
decision aid with one/two diagrams decision aid with risk over one/five years decision aid with CHA2DS2-VASC risk score 1 to 5 target of the prescription: patient / physician hinself
|
実験的:5year risk estimate
risk of stroke presented over a timeframe of 5 years
|
decision aid with one/two diagrams decision aid with risk over one/five years decision aid with CHA2DS2-VASC risk score 1 to 5 target of the prescription: patient / physician hinself
|
他の:CHA2DS2-VASC risk score 1
CHA2DS2-VASC risk score =1
|
decision aid with one/two diagrams decision aid with risk over one/five years decision aid with CHA2DS2-VASC risk score 1 to 5 target of the prescription: patient / physician hinself
|
他の:CHA2DS2-VASC risk score 2
CHA2DS2-VASC risk score =2
|
decision aid with one/two diagrams decision aid with risk over one/five years decision aid with CHA2DS2-VASC risk score 1 to 5 target of the prescription: patient / physician hinself
|
他の:CHA2DS2-VASC risk score 3
CHA2DS2-VASC risk score =3
|
decision aid with one/two diagrams decision aid with risk over one/five years decision aid with CHA2DS2-VASC risk score 1 to 5 target of the prescription: patient / physician hinself
|
他の:CHA2DS2-VASC risk score 4
CHA2DS2-VASC risk score =4
|
decision aid with one/two diagrams decision aid with risk over one/five years decision aid with CHA2DS2-VASC risk score 1 to 5 target of the prescription: patient / physician hinself
|
他の:CHA2DS2-VASC risk score 5
CHA2DS2-VASC risk score =5
|
decision aid with one/two diagrams decision aid with risk over one/five years decision aid with CHA2DS2-VASC risk score 1 to 5 target of the prescription: patient / physician hinself
|
アクティブコンパレータ:prescription to virtual patient
prescription is done for a virtual patient
|
decision aid with one/two diagrams decision aid with risk over one/five years decision aid with CHA2DS2-VASC risk score 1 to 5 target of the prescription: patient / physician hinself
|
実験的:prescription to physician himself
prescription is done to physician himself
|
decision aid with one/two diagrams decision aid with risk over one/five years decision aid with CHA2DS2-VASC risk score 1 to 5 target of the prescription: patient / physician hinself
|
この研究は何を測定していますか?
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
Number of Participants Who Prescribed Oral Anticoagulants (OAC) According to the Number of Decision Aid Diagrams
時間枠:after seeing the decision aid (5 min)
|
after regarding the risk diagram, the physician will decide to prescribe/take or not the treatment
|
after seeing the decision aid (5 min)
|
その他の成果指標
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
Number of Participants Who Prescribed Oral Anticoagulants (OAC) According to the Timeframe for Risk Presentation (1 vs 5 Years)
時間枠:5 minutes
|
the proportion of physicians deciding to prescribe OAC after seeing risk estimation on 1 vs 5 years
|
5 minutes
|
Number of Participants Who Prescribed Oral Anticoagulants (OAC) According to the Target of Prescription (Patient vs. Physician Himself)
時間枠:5 min
|
the participant physicians were randomized to prescribe to virtual patients or to imagine that the risk seen in the diagram was that of themselves
|
5 min
|
Number of Participants Who Prescribed Oral Anticoagulants (OAC) According to the CHA2D2s-VASC Risk Score
時間枠:5 min
|
The proportion of OAC prescription for the range 1-5 of CHA2D2s-VASC scores.
CHA2D2S-VASC risk score ranges from 1-5, with higher scores indicating a greater risk of stroke.
|
5 min
|
協力者と研究者
スポンサー
捜査官
- スタディチェア:Cristian Baicus, PhD、Carol Davila University of Medicine and Pharmacy Bucharest - Colentina Hospital
研究記録日
主要日程の研究
研究開始
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (見積もり)
学習記録の更新
投稿された最後の更新 (見積もり)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。
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