Oral anticoagulation in atrial fibrillation, the patients and physicians experiences of the consultation: a qualitative study

Christian Borg Xuereb, Rachel L. Shaw, Gregory Y.H. Lip, Deirdre A. Lane

Research output: Contribution to journalMeeting abstract

Abstract

Background: Oral anticoagulation (OAC) reduces stroke risk in patients with atrial fibrillation (AF), however it is still underutilized and sometimes refused by patients. This project was divided in two inter-related studies. Study 1 explored the experiences that influence prescription of OAC by physicians. Study 2 explored the experiences which influence patients' decisions to accept, decline or discontinue OAC.
Methods: Semi-structured individual interviews were conducted in both studies. In Study 1four sub-groups of physicians (n = 16) experienced with OAC in AF were interviewed: consultant cardiologists, consultant general physicians, general practitioners and cardiology registrars. In Study 2 three sub-groups of patients (n = 11) diagnosed with AF were interviewed; those who accepted, refused, and who discontinued warfarin.
Results: Study 1: Two over-arching themes emerged from doctors' experiences: (1) communicating information and (2) challenges with OAC prescription for AF. Physicians still adopt a paternalistic approach to decision-making. They should instead motivate patients to take part in treatment discussions and choices should reflect the patient's needs and concerns. Physician education should focus more on communication skills, individualised care and time-management as these are critical for patient adherence. Continuous OAC education for AF should adopt a multi-disciplinary approach. Further, interpreters should also be educated on medical communication skills. Study 2: Three over-arching themes comprised patients' experiences: (1) the initial consultation, (2) life after the consultation, and (3) patients' reflections. Patient education during the initial consultation was critical in increasing patient's knowledge of OAC. On-going patient education is imperative to maintain adherence. Patients valued physicians' concern for their needs during decision-making. Patients who had experience of stroke were more receptive to education aimed towards stroke risk reduction rather than bleeding risk. Patients' perceptions of warfarin are also influenced by the media.
Comment: Qualitative research is crucial in exploring barriers to treatment as it provides an excellent insight into patients' experiences of healthcare. A patient-centred approach should be adopted and incorporated into physicians' education. Education and patient involvement in the decision-making process is essential to promote treatment acceptance and long-term adherence
LanguageEnglish
Article numberC0320
PagesS193
Number of pages1
JournalThrombosis Research
Volume130
Issue numberSuppl.1
DOIs
Publication statusPublished - Oct 2012
Event22nd International Congress on Thrombosis - Nice, France
Duration: 6 Oct 20129 Oct 2012

Fingerprint

Atrial Fibrillation
Referral and Consultation
Physicians
Patient Education
Education
Decision Making
Stroke
Warfarin
Consultants
Prescriptions
Communication
Time Management
Patient Participation
Qualitative Research
Risk Reduction Behavior
Patient Compliance
Cardiology
General Practitioners
Therapeutics
Interviews

Bibliographical note

Abstracts and proceedings of the 22nd International Congress on Thrombosis. Nice, France, 6 – 9 October, 2012.

Cite this

Xuereb, Christian Borg ; Shaw, Rachel L. ; Lip, Gregory Y.H. ; Lane, Deirdre A. / Oral anticoagulation in atrial fibrillation, the patients and physicians experiences of the consultation : a qualitative study. In: Thrombosis Research. 2012 ; Vol. 130, No. Suppl.1. pp. S193.
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Oral anticoagulation in atrial fibrillation, the patients and physicians experiences of the consultation : a qualitative study. / Xuereb, Christian Borg; Shaw, Rachel L.; Lip, Gregory Y.H.; Lane, Deirdre A.

In: Thrombosis Research, Vol. 130, No. Suppl.1, C0320, 10.2012, p. S193.

Research output: Contribution to journalMeeting abstract

TY - JOUR

T1 - Oral anticoagulation in atrial fibrillation, the patients and physicians experiences of the consultation

T2 - Thrombosis Research

AU - Xuereb, Christian Borg

AU - Shaw, Rachel L.

AU - Lip, Gregory Y.H.

AU - Lane, Deirdre A.

N1 - Abstracts and proceedings of the 22nd International Congress on Thrombosis. Nice, France, 6 – 9 October, 2012.

PY - 2012/10

Y1 - 2012/10

N2 - Background: Oral anticoagulation (OAC) reduces stroke risk in patients with atrial fibrillation (AF), however it is still underutilized and sometimes refused by patients. This project was divided in two inter-related studies. Study 1 explored the experiences that influence prescription of OAC by physicians. Study 2 explored the experiences which influence patients' decisions to accept, decline or discontinue OAC.Methods: Semi-structured individual interviews were conducted in both studies. In Study 1four sub-groups of physicians (n = 16) experienced with OAC in AF were interviewed: consultant cardiologists, consultant general physicians, general practitioners and cardiology registrars. In Study 2 three sub-groups of patients (n = 11) diagnosed with AF were interviewed; those who accepted, refused, and who discontinued warfarin.Results: Study 1: Two over-arching themes emerged from doctors' experiences: (1) communicating information and (2) challenges with OAC prescription for AF. Physicians still adopt a paternalistic approach to decision-making. They should instead motivate patients to take part in treatment discussions and choices should reflect the patient's needs and concerns. Physician education should focus more on communication skills, individualised care and time-management as these are critical for patient adherence. Continuous OAC education for AF should adopt a multi-disciplinary approach. Further, interpreters should also be educated on medical communication skills. Study 2: Three over-arching themes comprised patients' experiences: (1) the initial consultation, (2) life after the consultation, and (3) patients' reflections. Patient education during the initial consultation was critical in increasing patient's knowledge of OAC. On-going patient education is imperative to maintain adherence. Patients valued physicians' concern for their needs during decision-making. Patients who had experience of stroke were more receptive to education aimed towards stroke risk reduction rather than bleeding risk. Patients' perceptions of warfarin are also influenced by the media.Comment: Qualitative research is crucial in exploring barriers to treatment as it provides an excellent insight into patients' experiences of healthcare. A patient-centred approach should be adopted and incorporated into physicians' education. Education and patient involvement in the decision-making process is essential to promote treatment acceptance and long-term adherence

AB - Background: Oral anticoagulation (OAC) reduces stroke risk in patients with atrial fibrillation (AF), however it is still underutilized and sometimes refused by patients. This project was divided in two inter-related studies. Study 1 explored the experiences that influence prescription of OAC by physicians. Study 2 explored the experiences which influence patients' decisions to accept, decline or discontinue OAC.Methods: Semi-structured individual interviews were conducted in both studies. In Study 1four sub-groups of physicians (n = 16) experienced with OAC in AF were interviewed: consultant cardiologists, consultant general physicians, general practitioners and cardiology registrars. In Study 2 three sub-groups of patients (n = 11) diagnosed with AF were interviewed; those who accepted, refused, and who discontinued warfarin.Results: Study 1: Two over-arching themes emerged from doctors' experiences: (1) communicating information and (2) challenges with OAC prescription for AF. Physicians still adopt a paternalistic approach to decision-making. They should instead motivate patients to take part in treatment discussions and choices should reflect the patient's needs and concerns. Physician education should focus more on communication skills, individualised care and time-management as these are critical for patient adherence. Continuous OAC education for AF should adopt a multi-disciplinary approach. Further, interpreters should also be educated on medical communication skills. Study 2: Three over-arching themes comprised patients' experiences: (1) the initial consultation, (2) life after the consultation, and (3) patients' reflections. Patient education during the initial consultation was critical in increasing patient's knowledge of OAC. On-going patient education is imperative to maintain adherence. Patients valued physicians' concern for their needs during decision-making. Patients who had experience of stroke were more receptive to education aimed towards stroke risk reduction rather than bleeding risk. Patients' perceptions of warfarin are also influenced by the media.Comment: Qualitative research is crucial in exploring barriers to treatment as it provides an excellent insight into patients' experiences of healthcare. A patient-centred approach should be adopted and incorporated into physicians' education. Education and patient involvement in the decision-making process is essential to promote treatment acceptance and long-term adherence

U2 - 10.1016/j.thromres.2012.08.241

DO - 10.1016/j.thromres.2012.08.241

M3 - Meeting abstract

VL - 130

SP - S193

JO - Thrombosis Research

JF - Thrombosis Research

SN - 0049-3848

IS - Suppl.1

M1 - C0320

ER -