Perception of Clinician Prescribing Practices and Preference for Engagement in Shared Decision Making in Older Adults with Atrial Fibrillation

Background: With increasing access to online health information, it is pertinent to understand how patients perceive clinician prescribing practices and how this perception may influence preference for shared decision-making (SDM)-engagement for chronic disease management.

Objective: Examine the prevalence and association between patient perception of clinician prescribing practices and preference for SDM-engagement for stroke prevention in older adults with atrial fibrillation (AF).

Methods: Patients aged 65+years with AF were enrolled in a cross-sectional study from two academic-centers in Massachusetts and Florida (2025-2026). Two statements obtained from a validated questionnaire assessed patient perception of clinician prescribing practices: “Doctors/other providers are too quick to prescribe medications” and “Doctors/other providers often give medication when advice would be better”, with responses collected on a 7-point Likert scale. Affirmative responses were categorized as “Agree”. To evaluate preference for greater SDM engagement, participants were asked “Would you have liked to be more involved in deciding which anticoagulant to take?”. Affirmative responses indicated greater preference for SDM-engagement. Pearson’s chi-square test examined bivariate associations between perception of clinician prescribing practices and preference for greater SDM engagement for stroke prevention.

Results: Among participants (n=93; mean age:76 years, 49% women, 69% White), 44% reported clinicians were too quick to prescribe medications and often gave medications when advice would be better, respectively. Approximately, one in three participants reported preference for more SDM-engagement in choosing the type of anticoagulant. Patients who reported that clinicians were too quick to prescribe medications (χ² test = 6.00, p=0.01) and often prescribed medications when advice would be better (χ² test=5.55, p=0.02), indicated preference for greater SDM-engagement in choosing the type of anticoagulant for stroke prevention.

Conclusions: Clinician approaches to SDM should prioritize patient-centered communication to help patients understand the rationale behind treatment recommendations, especially stroke prevention in AF management where complex decisions should align with healthcare goals.