Decision analysis for newly diagnosed hypertensive patients: a qualitative investigation
Introduction
Decision aids (DA) are tools to facilitate patient involvement [1] in decisions about their health care and can be seen as one way of operationalising the principles of informed shared decision-making [2]. This shared model of treatment decision-making promotes active patient involvement in the decision-making process [3] and can be seen as an approach distinct from the traditional paternalistic model of doctor–patient interactions. The goals of decision aids vary; they can clarify patients’ goals or may communicate risk, improve patient knowledge or facilitate various behavioural outcomes such as compliance with treatment [4]. A systematic review revealed that decision aids increase knowledge, lower the uncertainty surrounding the decision-making process and allow more active patient participation in decision-making [1]. Decision aids have been developed in many therapeutic areas including atrial fibrillation [5], hormone replacement therapy [6] and benign prostatic hyperplasia [7].
When assessing the effectiveness of decision aids, the traditional approach has been to use a variety of quantitative outcome measures such as patient uncertainty surrounding decision-making (the Decisional Conflict Scale), patient knowledge, anxiety, compliance with treatment, functional status, symptom resolution or satisfaction [8], [9], [10], [11], [12]. A qualitative approach can complement such quantitative outcomes by enabling a broader perspective on how patients view a decision aid. Few studies have, however, adopted a combined qualitative and quantitative approach [13]. In a recent randomised controlled trial we investigated whether a decision analytic decision aid was associated with changes in decisional conflict, knowledge, anxiety, treatment intentions and actual treatment choice in newly diagnosed hypertensive patients [14]. This study found that patients who received the decision aid had lower decisional conflict, greater knowledge about hypertension and no increase in state anxiety than those who did not receive the decision aid. The present qualitative study builds upon the quantitative findings to explore patients’ perceptions of the decision aid, to include the role of information in guiding patient decision-making, their views on the decision aid’s use and potential wider application in general practice and its impact upon their decision-making on whether or not to take tablets.
Section snippets
Methods
Fifteen follow-up interviews were conducted with participants from the main trial [14]. To be eligible for the trial, patients had to be between 30 and 80 years old, not currently taking anti-hypertensive medication and to have had a sustained raised blood pressure at a level where their general practitioner (GP) was considering initiating pharmacological treatment. The presence of cardiovascular disease was not an explicit exclusion criteria. Two interventions were investigated: a computerised
Attitudes to information
One of the aims of the interviews was to explore how respondents viewed their relationship with their general practitioner and whether they wanted a shared, as opposed to paternalistic, decision-making style in their doctor–patient interactions. This issue was approached by asking respondents whether they liked to sit and discuss issues with their doctor or whether they preferred to be told what to do. A few respondents felt they were able to discuss issues with their doctor, but most either
Discussion and conclusion
Semi-structured interviews were conducted with 15 newly diagnosed hypertensive patients to explore respondents’ perceptions of a decision analytic decision aid, including their views on where to access additional clinical information, the decision aid’s ease of use and the decision aid’s effect upon their preferences for taking medication. Respondents’ information-seeking attitudes featured prominently, with most seeking additional clinical information from friends, family, leaflets, books or
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Therapeutic concordance improves blood pressure control in patients with resistant hypertension
2023, Pharmacological ResearchCitation Excerpt :The objective of this clinical approach is to transform the patient from a mere passive receiver to an informed active participant who plays an unambiguous role in the entire treatment process [48]. A qualitative study conducted by Weiss and colleagues [49] examined the implementation of decision analysis to facilitate the involvement of patients in decisions about their healthcare, and reported that only a few newly diagnosed hypertensive patients felt they were able to discuss issues with their doctor, and that most felt the physician did not have enough time. Barriers in consultations and decision-making have been reported by both physicians and patients [50,51], albeit more recent findings suggest that health professionals should be aware of the potential impact of patients’ feelings of guilt on consultations relating to the asymptomatic disease of hypertension [52,53].
More work needed on decision analysis for shared decision-making: A scoping review
2022, Journal of Clinical EpidemiologyCitation Excerpt :Fourth, included studies either did not have an experimental design or were subject to a high risk of bias, affecting confidence in observed effect estimates [66]. In addition, due to the design of included studies, it was difficult to determine what components of the decision analysis intervention (i.e., provision of information, preference elicitation exercises, review of decision analysis model output) were useful or if any of the observed benefits were due to patients’ desire for more support and/or information, regardless of the format [46]. While we focused on formal decision analytic models (i.e., decision trees and Markov models) for this review, there exist other types of decision models that have been used to incorporate patient preferences and probability of outcomes in clinical decision-making [67–69].
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