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, 9 (8), e030385

Collaborative Design of a Decision Aid for Stroke Survivors With Multimorbidity: A Qualitative Study in the UK Engaging Key Stakeholders


Collaborative Design of a Decision Aid for Stroke Survivors With Multimorbidity: A Qualitative Study in the UK Engaging Key Stakeholders

Talya Porat et al. BMJ Open.


Objectives: Effective secondary stroke prevention strategies are suboptimally used. Novel development of interventions to enable healthcare professionals and stroke survivors to manage risk factors for stroke recurrence are required. We sought to engage key stakeholders in the design and evaluation of an intervention informed by a learning health system approach, to improve risk factor management and secondary prevention for stroke survivors with multimorbidity.

Design: Qualitative, including focus groups, semistructured interviews and usability evaluations. Data was audio recorded, transcribed and coded thematically.

Participants: Stroke survivors, carers, health and social care professionals, commissioners, policymakers and researchers.

Setting: Stroke survivors were recruited from the South London Stroke Register; health and social care professionals through South London general practices and King's College London (KCL) networks; carers, commissioners, policymakers and researchers through KCL networks.

Results: 53 stakeholders in total participated in focus groups, interviews and usability evaluations. Thirty-seven participated in focus groups and interviews, including stroke survivors and carers (n=11), health and social care professionals (n=16), commissioners and policymakers (n=6) and researchers (n=4). Sixteen participated in usability evaluations, including stroke survivors (n=8) and general practitioners (GPs; n=8). Eight themes informed the collaborative design of DOTT (Deciding On Treatments Together), a decision aid integrated with the electronic health record system, to be used in primary care during clinical consultations between the healthcare professional and stroke survivor. DOTT aims to facilitate shared decision-making on personalised treatments leading to improved treatment adherence and risk control. DOTT was found acceptable and usable among stroke survivors and GPs during a series of evaluations.

Conclusions: Adopting a user-centred data-driven design approach informed an intervention that is acceptable to users and has the potential to improve patient outcomes. A future feasibility study and subsequent clinical trial will provide evidence of the effectiveness of DOTT in reducing risk of stroke recurrence.

Keywords: Decision Support System; Learning Health System; Primary Care; Shared Decision Making; Stakeholder Engagment; Stroke Medicine.

Conflict of interest statement

Competing interests: None declared.


Figure 1
Figure 1
A diagrammatic summary of the development and evaluation of DOTT, including the data that fed the different stages and the outputs. DOTT, deciding on treatments together; DSS, decision support systems; GPs, general practitioners; SEM, stakeholder engagement meeting (consisting three focus groups); FG, focus group; SH, stakeholders; IPDAS, International Patient Decision Aids Standards; SDM model, shared decision-making model for clinical practice; SRPFG, Stroke Research Patient and Family Group.
Figure 2
Figure 2
An example screen from DOTT prototype displaying the stroke survivor’s predicted stroke risk before and after a selected treatment (eg, control of blood pressure). DOTT, deciding on treatments together.

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    1. Katan M, Luft A. Global burden of stroke. Semin Neurol 2018;38:208–11. 10.1055/s-0038-1649503 - DOI - PubMed
    1. King’s College London. The burden of stroke in Europe, the challenge for policy makers for the Stroke Alliance for Europe (SAFE), 2015.
    1. Mohan KM, Wolfe CD, Rudd AG, et al. Risk and cumulative risk of stroke recurrence: a systematic review and meta-analysis. Stroke 2011;42:1489–94. 10.1161/STROKEAHA.110.602615 - DOI - PubMed
    1. Stroke Association UK, State of the Nation, stroke statistics. 2018.
    1. Kernan WN, Ovbiagele B, Black HR, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014;45:2160–236. 10.1161/STR.0000000000000024 - DOI - PubMed

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