{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,3,8]],"date-time":"2025-03-08T05:29:51Z","timestamp":1741411791656,"version":"3.38.0"},"reference-count":21,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2025,3,7]],"date-time":"2025-03-07T00:00:00Z","timestamp":1741305600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000968","name":"American Heart Association","doi-asserted-by":"publisher","award":["18SFRN34120036"],"award-info":[{"award-number":["18SFRN34120036"]}],"id":[{"id":"10.13039\/100000968","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000968","name":"American Heart Association","doi-asserted-by":"publisher","award":["18SFRN34240003"],"award-info":[{"award-number":["18SFRN34240003"]}],"id":[{"id":"10.13039\/100000968","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec040\">\n<jats:title>\nIntroduction\n<\/jats:title>\n<jats:p>Before the initiation of the ENHANCE-AF clinical trial, which tested a novel digital shared decision-making tool to guide the use of anticoagulants in stroke prevention for patients with atrial fibrillation, this study aimed to identify the most appropriate, patient-selected primary outcome and to examine whether outcome selection varied by demographic and clinical characteristics.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec041\">\n<jats:title>\nMethods\n<\/jats:title>\n<jats:p>Our cross-sectional survey asked 100 participants with atrial fibrillation to rank two alternative scales based on the scales\u2019 ability to reflect their experiences with decision-making for anticoagulation. The Decisional Conflict Scale (DCS), a 16-item scale, measures perceptions of uncertainty in choosing options. The 5-item Decision Regret Scale (DRS) focuses on remorse after a healthcare decision. We included adults with non-valvular AFib and CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>VASc scores of at least 2 for men and 3 for women. Multivariable logistic regression with backward selection identified characteristics independently associated with scale choice.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec042\">\n<jats:title>\nResults\n<\/jats:title>\n<jats:p>The DCS was chosen over the DRS by 77% [95% confidence interval (CI) 68 to 85%] of participants. All subgroups designated a preference for the DCS. Those with higher CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>VASc scores (\u22655, n\u2009=\u200926) selected the DCS 54% of the time compared with 86% of those with lower scores (&lt;5, n\u2009=\u200974; <jats:italic>p<\/jats:italic> =\u2009 0.002). Multiple logistic regression confirmed a weaker preference for the DCS among those with higher CHA<jats:sub>2<\/jats:sub>DS<jats:sub>2<\/jats:sub>VASc scores.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec043\">\n<jats:title>\nConclusions\n<\/jats:title>\n<jats:p>Individuals with atrial fibrillation preferred the DCS over the DRS for measuring their decision-making experiences. As a result of this survey, the DCS was designated as the ENHANCE-AF clinical trial\u2019s primary endpoint.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0318858","type":"journal-article","created":{"date-parts":[[2025,3,7]],"date-time":"2025-03-07T18:21:53Z","timestamp":1741371713000},"page":"e0318858","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Patient-Selection\u00a0of a Clinical Trial Primary Outcome: The ENHANCE-AF Outcomes\u00a0Survey"],"prefix":"10.1371","volume":"20","author":[{"given":"Randall S.","family":"Stafford","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9729-1251","authenticated-orcid":true,"given":"Eli 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