The impact of patients' preferences on the treatment of atrial fibrillation: observational study of patient based decision analysis.

Abstract:

OBJECTIVE:To investigate the impact of patients' preferences for the treatment of atrial fibrillation, by using individualised decision analysis combining probability and utility assessments into a decision tree. DESIGN:Observational study based on interviews with patients. SETTING:Eight general practices in Avon. PARTICIPANTS:260 randomly selected patients aged 70-85 years with atrial fibrillation. MAIN OUTCOME MEASURES:Patients' treatment preferences regarding anticoagulation treatment (warfarin) after individualised 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% to 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 (kappa=0.25 or less). 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, individualised decision analysis is valuable in a sizeable proportion of elderly patients with atrial fibrillation. Taking account of patients' preferences would lead to fewer prescriptions for warfarin than under published guideline recommendations. Decision analysis as a shared decision making tool should be evaluated in a randomised controlled trial.

journal_name

BMJ

authors

Protheroe J,Fahey T,Montgomery AA,Peters TJ

doi

10.1136/bmj.320.7246.1380

keywords:

subject

Has Abstract

pub_date

2000-05-20 00:00:00

pages

1380-4

issue

7246

eissn

0959-8138

issn

1756-1833

journal_volume

320

pub_type

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