Decisional conflict
Overall levels of decisional conflict were low; the total DCS score was 13.3 (SD 17.8) out of 100. The informed subscale of the DCS was the highest at 20.2 (SD 30.8) indicating lower levels of perceived information in the decision-making process (Table 2 ). Qualitative data also supported generally low feelings of decision conflict about having an ablation, but patients who described low conflict also described limited agency in the decision-making process:“Very easy [decision]. I don’t have a hard time making decisions. That decision, whatever the doctor gives me as advice, that’s my decision.” -Patient 4. Other patients who took a more active role in decision-making reported wanting more time to do research on ablation and carefully consider risks and benefits. The greatest source of decisional conflict for patients was fear of serious complications and difficulties quantifying risks associated with the ablation. However for many patients, the decision to have an ablation was driven by symptom burden; when symptoms became unbearable or uncontrolled by medications, they felt ablations were the clear next step for them: “I went through [the symptoms] for a number of months before it. But then I decided to go ahead with the ablation… I went to the ER [twice]. And I just began realizing that I wasn’t going to choose to live like this.” -Patient 2.
Clinicians agreed that symptoms drive decision-making. They reported difficulties encouraging asymptomatic patients who had uncontrolled AF to consider ablations compared to symptomatic patients: “For the patient who’s symptomatic, I think they’re much more open to getting treatment because they’re looking for relief… And whether they understand the health benefits or not, it doesn’t seem to be that important in what they decide to do because they just want to feel better. Whereas the patient who has no symptoms but, you know, has a very uncontrolled rhythm, there may be a non-significant risk of danger. And sometimes it’s much more difficult convincing them they need treatment, whether it’s ablation or otherwise, because they feel okay.” - Clinician 4.