Patients' and physicians' experiences of atrial fibrillation consultations and anticoagulation decision-making: a multi-perspective IPA design

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Abstract

OBJECTIVE: To explore patients' and physicians' experiences of atrial fibrillation consultations and oral anticoagulation decision-making.

DESIGN: Multi-perspective interpretative phenomenological analyses.

METHODS: Participants included small homogeneous subgroups: AF patients who accepted (n=4), refused (n=4), or discontinued (n=3) warfarin, and four physician subgroups (n=4 each group): consultant cardiologists, consultant general physicians, general practitioners and cardiology registrars. Semi-structured interviews were conducted. Transcripts were analysed using multi-perspective IPA analyses to attend to individuals within subgroups and making comparisons within and between groups.

RESULTS: Three themes represented patients' experiences: Positioning within the physician-patient dyad, Health-life balance, and Drug myths and fear of stroke. Physicians' accounts generated three themes: Mechanised metaphors and probabilities, Navigating toward the 'right' decision, and Negotiating systemic factors.

CONCLUSIONS: This multi-perspective IPA design facilitated an understanding of the diagnostic consultation and treatment decision-making which foregrounded patients' and physicians' experiences. We drew on Habermas' theory of communicative action to recommend broadening the content within consultations and shifting the focus to patients' life contexts. Interventions including specialist multidisciplinary teams, flexible management in primary care, and multifaceted interventions for information provision may enable the creation of an environment that supports genuine patient involvement and participatory decision-making.

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Original languageEnglish
Pages (from-to)436-455
Number of pages20
JournalPsychology and Health
Volume31
Issue number4
Early online date21 Nov 2015
DOIs
Publication statusPublished - 2016

Bibliographic note

This is an Accepted Manuscript of an article published by Taylor & Francis in Psychology & Health on 21/12/15, available online: http://www.tandfonline.com/10.1080/08870446.2015.1116534

    Keywords

  • atrial fibrillation, decision-making, interpretative phenomenological analysis, medication adherence, oral anticoagulation, qualitative research

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