A meta-synthesis of qualitative studies exploring patients' and healthcare professionals views of atrial fibrillation and oral anticoagulant therapy

Background Atrial Fibrillation (AF) is associated with a five-fold increase in the risk of stroke. Oral-anticoagulant therapy (OAC) is the recommended treatment for patients with AF in medium to high risk of stroke. The aim of the meta-synthesis was to systematically find and synthesise qualitative studies that explored views and experiences of patients and/or health professionals involved with atrial fibrillation and/or warfarin therapy.
Methods: A systematic search strategy was developed and carried out on several electronic databases. Furthermore additional strategies to maximise identification of studies were used such as reference chaining and citation searches. The Critical Appraisal Skills Programme (CASP) tool was used to appraise the studies. Qualitative data and authors’ conclusions were extracted and tabulated. These data were then synthesised through a processes of descriptive and interpretative thematic analysis.
Results: Ten studies were included following the systematic search, inclusion and quality criteria. Four third-order constructs emerged: (1)diagnosing AF and the communication of information, (2) deciding on OAC therapy, (3) challenges revolving around patient issues, and (4)healthcare challenges. Synthesis uncovered perspectives that could not be achieved through individual studies. Interpretative synthesis of the qualitative evidence indicates that the patient-physician relationship during the consultation plays a major role in motivating the patients, minimising barriers and enhancing warfarin acceptance. Patients and physician have opposing views on the experience of decision making, which requires further exploration and changes in practice. The findings also show that the need for support and education is critical for optimal care giving and compliance to treatment.
Comment: Outcomes of workload pressure on both health professionals and patients should be investigated. The need for on-going support and education to patients and physicians is critical to achieve best practice and treatment adherence. Qualitative research in this field highlights the need for health professionals to understand and attend better to the concerns of the patient.