gms | German Medical Science

Background/research question: While evidence-based treatment options can reduce the risk of recurrent stroke, medication adherence among people with stroke (PwS) remains variable. Research suggests that shared decision-making (SDM) using patient decision aids (PtDAs) improves knowledge and value congruent decision-making and may support adherence. StrokeCompass aims to develop and pilot an interprofessional SDM programme based on nurse-led coaching using a PtDA on recurrent stroke prevention.

Methods: The web-based PtDA was developed by an inter-professional team through a mixed methods design, following established guidelines for evidence-based patient information (EBPI) and PtDA. Information and decision-making needs of PwS were addressed through a scoping review, a multiple case study and a web-based survey. Evidence on stroke prevention was gathered through a systematic literature review (guidelines, meta-analyses). In addition to the website, a short paper-based PtDA was produced. An initial pretest with experts and selected PwS used questionnaires and semi-structured interviews. Quantitative data were analysed descriptively, qualitative data were evaluated via template analysis. A second pretest focusing on clinical feasibility will be completed by November 2024.

Results: The web-based PtDA covers drug-based stroke prevention, including benefits and side effects, lifestyle interventions and life after stroke. Ten experts (neurologists, nurses, patient representatives) reviewed the content. After launch, the website was tested by another group of experts (n=6), selected PwS (n=6) and nursing students (n=9). The content coverage and depth of information were rated as good. However, some felt the content might be too extensive for people with acute stroke. Requests for additional content, mainly related to coping with post-stroke life, were fulfilled. After initial revisions, the comprehensibility of the text and graphics was rated highly. Website design and navigation were optimised for accessibility.

Conclusion: The web-based PtDA for secondary stroke prevention has been well received by both experts and PwS. While comprehensibility, user-friendliness and content coverage were rated positively, concerns about excessive reading volume justify the creation of an additional short paper version for the acute clinical setting. The second pretest will provide further insights into the feasibility of the PtDA in stroke units.

Competing interests: Götz Thomalla has received honoraria as consultant or speaker from Acandis, Alexion, Astra Zeneca, Bayer, Boehringer Ingelheim, Daiichi Sankyo, and Stryker, and is Chairman of the Board of Directors of the European Stroke Organisation and Speaker of the Commission on Cerebrovascular Diseases of the German Neurological Society.

The remaining authors have no conflicts of interest to declare.