Factors influencing patient engagement in decision making for catheter ablation of atrial fibrillation: a cross-sectional survey

Abstract Aims Patient engagement in decision-making could improve healthcare quality and health outcome, which has been emphasized in atrial fibrillation (AF) management guidelines. However, patients report relatively low level of engagement in decision-making for catheter ablation (CA). Therefore, this study aims to explore the influencing factors of AF patient engagement in decision-making for CA. Methods and results A cross-sectional study was conducted. A total of 836 patients were recruited from six tertiary hospitals in Shanghai. Adapted version of the Control Preferences Scale, Chinese version of the All Aspects of Health Literacy Scale, Chinese version of the Facilitation of Patient Involvement Scale, and the Atrial Fibrillation Knowledge Questionnaire were used to measure patient engagement in decision-making, health literacy, perception of physician facilitation, and AF knowledge, respectively. Of the 750 patients who returned valid questionnaires, 20.2% of the patients reported active engagement in decision-making, 39.5% reported collaborative engagement, and 40.3% reported passive engagement. Compared with patients perceiving passive engagement, those with collaborative or active engagement were more likely to be female and have higher income, moderate European Heart Rhythm Association (EHRA) class (II and III), higher perception of physician facilitation, higher health literacy, and higher AF knowledge (P < 0.05 for all). The collaborative engagement group exhibited a shorter AF duration. Conclusion The degree of patient engagement in CA decision-making varied, with most perceiving passive engagement. Patient engagement in decision-making was influenced by gender, income, duration of AF, EHRA class, perception of physician facilitation, health literacy, and AF knowledge.