Effects of patients' preferences on the treatment of atrial fibrillation: Observational study of patient-based decision analysis

Joanne Protheroe, Tom Fahey, Alan A. Montgomery, Tim J. Peters

    Research output: Contribution to journalArticlepeer-review

    Abstract

    Objective: To investigate the effect of patients' preferences in the treatment of atrial fibrillation by using individualized decision analysis in which probability and utility assessments are combined into a decision tree. Design: Observational study based on interviews with patients. Setting: 8 general practices in Avon, England. Participants: 260 randomly selected patients aged 70 to 85 years with atrial fibrillation. Main outcome measures: Patients' treatment preferences regarding anticoagulation treatment (warfarin sodium) after individualized decision analysis; comparison of these preferences with treatment guidelines on the basis of comorbidity and absolute risk and compared with current prescription. Results: Of 195 eligible patients, 97 participated in decision making using decision analysis. Among these 97, the decision analysis indicated that 59 (61%; 95% confidence interval, 50%-71%) would prefer anticoagulation treatment, considerably fewer than those who would be recommended treatment according to guidelines. There was marked disagreement between the decision analysis and guideline recommendations (κ≥0.25). Of 38 patients whose decision analysis indicated a preference for anticoagulation, 17 (45%) were being prescribed warfarin; on the other hand, 28 (47%) of 59 patients were not being prescribed warfarin, although the results of their decision analysis suggested they wanted to be. Conclusions: In the context of shared decision making, individualized decision analysis is valuable in a sizable proportion of elderly patients with atrial fibrillation. Taking account of patients' preferences would lead to fewer prescriptions for warfarin than under published recommendations. Decision analysis as a shared decision-making tool should be evaluated in a randomized controlled trial.
    Original languageEnglish
    Pages (from-to)311-315
    Number of pages4
    JournalWestern Journal of Medicine
    Volume174
    Issue number5
    DOIs
    Publication statusPublished - May 2001

    Keywords

    • Aged
    • Aged, 80 and over
    • therapeutic use: Anticoagulants
    • drug therapy: Atrial Fibrillation
    • epidemiology: Cerebrovascular Accident
    • Comparative Study
    • Confidence Intervals
    • Decision Support Techniques
    • England
    • Evidence-Based Medicine
    • Female
    • Follow-Up Studies
    • Humans
    • Male
    • Patient Participation
    • statistics & numerical data: Patient Satisfaction
    • Probability
    • Questionnaires
    • Research Support, Non-U.S. Gov't
    • Risk Assessment
    • Sampling Studies
    • Treatment Outcome
    • therapeutic use: Warfarin

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