Qualitative Analysis of Patient Decisional Needs for Medications to Treat Heart Failure

Abstract

BACKGROUND: The development of tools to support shared decision-making should be informed by patients’ decisional needs and treatment preferences, which are largely unknown for heart failure (HF) with reduced ejection fraction (HFrEF) pharmacotherapy decisions. We aimed to identify patients’ decisional needs when considering HFrEF medication options. METHODS: This was a qualitative study using semi-structured interviews. We recruited patients with HFrEF from 2 Canadian ambulatory HF clinics and clinicians from Canadian HF guideline panels, HF clinics, and Canadian HF Society membership. We identified themes through inductive thematic analysis. RESULTS: Participants included 15 patients and 12 clinicians. Six themes and associated subthemes emerged related to HFrEF pharmacotherapy decision-making: (1) patient decisional needs included lack of awareness of a choice or options, difficult decision timing and stage, information overload, and inadequate motivation, support and resources; (2) patients’ decisional conflict varied substantially, driven by unclear trade-offs; (3) treatment attribute preferences—patients focused on both benefits and downsides of treatment, whereas clinicians centered discussion on benefits; (4) quality of life—patients’ definition of quality of life depended on pre-HF activity, though most patients demonstrated adaptability in adjusting their daily activities to manage HF; (5) shared decision-making process—clinicians’ described a process more akin to informed consent; (6) decision support—multimedia decision aids, virtual appointments, and primary-care comanagement emerged as potential enablers of shared decision-making. CONCLUSIONS: Patients with HFrEF have several decisional needs, which are consistent with those that may respond to decision aids. These findings can inform the development of HFrEF pharmacotherapy decision aids to address these decisional needs and facilitate shared decision-making.

GDMT Optimization, But Make It Patient-Centered: Understanding Patient Needs During Heart Failure Medication Discussions

“…In this issue of Circulation: Heart Failure, Turgeon et al 7 conducted a qualitative needs assessment of patients and clinicians facing HFrEF pharmacotherapy decisions. Due to the dearth of information in this area, qualitative methods were ideal to explore the experiences of this population.…”

“…During the decisionmaking period in the clinic, patients reported concerns over side effects and a desire for more information on the medications. 7,11 Additionally, polypharmacy, lifestyle considerations, and cost are real factors that could impact a patient's quality of life and should be part of a wellinformed discussion. These factors may often be sidelined by a clinician who becomes overly focused on the benefits of GDMT, as highlighted in this study.…”