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

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

doi:10.1136/ewjm.174.5.311

Cited by 103 publications

(20 citation statements)

References 26 publications

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“…An additional nine studies could also be characterised as multicentre studies but they applied a convenience sample of patients (mean number of patients 182) [29–37]. As previously, the majority of surveyed patients were OAC users, and the preference elicitation technique used most commonly was conjoint analysis.…”

Section: Resultsmentioning

confidence: 99%

“…Interestingly, studies comparing the general willingness of patients to accept OAC treatment with clinical guidelines concluded that significantly fewer patients (61 %) would be willing to accept such a therapy than is recommended in clinical guidelines [29]. Furthermore, several studies found that patients and physicians evaluate stroke and bleeding risks differently, with physicians interpreting bleeding risks as more important and stroke risk as less important than patients do [27, 32, 35].…”

Section: Resultsmentioning

confidence: 99%

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Patient Preferences for Oral Anticoagulation Therapy in Atrial Fibrillation: A Systematic Literature Review

Wilke

Bauer

Mueller

et al. 2016

Patient

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Objectives Since the introduction of non-vitamin K antagonist (VKA) oral anticoagulants (NOACs), an additional treatment option, apart from VKAs, has become available for stroke prevention in patients with atrial fibrillation (AF). For various reasons, it is important to consider patients' preferences regarding type of medication, particularly in view of the established relationship between preferences towards treatment, associated burden of treatment, and treatment adherence. This review aimed to systematically analyse the scientific literature assessing the preferences of AF patients with regard to long-term oral anticoagulant (OAC) treatment. Methods We searched the MEDLINE, Scopus and EMBASE databases (from 1980 to 2015), added records from reference lists of publications found, and conducted a systematic review based on all identified publications. Outcomes of interest included any quantitative information regarding the opinions or preferences of AF patients towards OAC treatment, ideally specified according to different clinical or convenience attributes describing different OAC treatment options. Results Overall, 27 publications describing the results of studies conducted in 12 different countries were included in our review. Among these, 16 studies analysed patient preferences towards OACs in general. These studies predominantly assessed which benefits (mainly lower stroke risk) AF patients would require to tolerate harms (mainly higher bleeding risk) associated with an OAC. Most studies showed that patients were willing to accept higher bleeding risks if a certain threshold in stroke risk reduction could be reached. Nevertheless, most of the publications also showed that the preferences of AF patients towards OACs may differ from the perspective of clinical guidelines or the perspective of physicians. The remaining 11 studies included in our review assessed the preferences of AF patients towards specific OAC medication options, namely NOACs versus VKAs. Our review showed that AF patients prefer easy-to-administer treatments, such as treatments that are applied once daily without any food/drug interactions and without the need for bridging and frequent blood controls. Conclusion Stroke risk reduction and a moderate increase in the risk of bleeding are the most important attributes for an AF patient when deciding whether they are for or against OAC treatment. If different anticoagulation options have similar clinical characteristics, convenience attributes matter to patients. In this review, AF patients favour attribute levels that describe NOAC treatment.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Patient Preferences for Oral Anticoagulation Therapy in Atrial Fibrillation: A Systematic Literature Review

Wilke

Bauer

Mueller

et al. 2016

Patient

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“…[17][18][19] This is significant because 30 to 40 percent of critical medical decisions are made by doctors for their patients. [20][21][22][23][24] This rate increases when patients are acutely unwell, elderly, or dealing with cancer. 21,22 To date, the analysis of medical decision-making has largely ignored the complexities of decisions in gastrointestinal disorders.…”

mentioning

confidence: 99%

“…[20][21][22][23][24] This rate increases when patients are acutely unwell, elderly, or dealing with cancer. 21,22 To date, the analysis of medical decision-making has largely ignored the complexities of decisions in gastrointestinal disorders. Several Markov-type analyses for scenarios in Crohn_s disease 25,26 calculated the likely benefit of one treatment over another, yet these did not incorporate any elements of what patients themselves actually prefer.…”

mentioning

confidence: 99%

Patient Preferences Between Surgical and Medical Treatment in Crohn's Disease

Byrne¹,

Solomon²,

Young³

et al. 2007

Diseases of the Colon &Amp; Rectum

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“…5 These individualised treatment plans might diVer from the treatment indicated by general guidelines, as was reported by Protheroe et al in a study on the treatment of atrial fibrillation. 6 It is to be expected that the increasing amount of epidemiological and genetic evidence about individual risk factors for a disease or treatment will lead to more individualised treatment plans for patients, and hence to more appropriate treatment decisions and a better quality of care. Trials often do not have enough patients included to allow analysis of subgroups, as is the case in the small aneurysm trial.…”

mentioning

confidence: 99%

Improving the quality of surgeons' treatment decisions: a comparison of clinical decision making with a computerised evidence based decision analytical model

Timmermans

Bockel

Kievit

2001

Quality in Health Care

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Objectives-The purpose of this study is to demonstrate to what extent an evidence based decision model can improve physicians' decisions and whether a selective use of the decision model is feasible. Methods-Four experienced vascular surgeons were asked to make a treatment decision for 137 "paper patient" cases with asymptomatic abdominal aneurysms. Their decisions were compared with the optimal treatment as calculated by a computerised evidence based decision analytical model. Results-Surgeons agreed with the model's advice based on life expectancy in 81% of the cases, and decided to operate in only 12% of the cases for which there was no agreement. Surgeons' decisions diVered from the decision model's calculated optimal treatment, in particular, for older patients with aneurysms of intermediate size and with many risk factors, and for younger patients with small aneurysms and few risk factors. Not all these decisions, however, were reported to be more diYcult. Conclusion-Use of a decision analytical model might lead to more appropriate decisions and a better quality of care. Selective use of the decision tool for diYcult decisions only would be more eYcient but is not yet feasible because reported decision diYculty is not strongly related to disagreement with the decision tool.

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

Cited by 103 publications

References 26 publications

Patient Preferences for Oral Anticoagulation Therapy in Atrial Fibrillation: A Systematic Literature Review

Patient Preferences for Oral Anticoagulation Therapy in Atrial Fibrillation: A Systematic Literature Review

Patient Preferences Between Surgical and Medical Treatment in Crohn's Disease

Improving the quality of surgeons' treatment decisions: a comparison of clinical decision making with a computerised evidence based decision analytical model

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