Shared decision-making about cardiovascular disease medication in older people: a qualitative study of patient experiences in general practice

Jansen, Jesse; McKinn, Shannon; Bonner, Carissa; Muscat, Danielle M; Doust, Jenny; McCaffery, Kirsten

doi:10.1136/bmjopen-2018-026342

Cited by 24 publications

(45 citation statements)

References 61 publications

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“…Decisions about high blood pressure treatment are often guideline‐based and in this study were viewed as straightforward transactions and often proceeded without discussion of uncertainty about the best course of action, or explicit acknowledgement that there was a choice. A recent qualitative study highlighted that older participants vary widely in their health goals and preferences for treatment outcomes from treatment of cardiovascular conditions 39 . Acknowledging options explicitly may support patients to consider their values and preferences.…”

Section: Discussionmentioning

confidence: 99%

“…A recent qualitative study highlighted that older participants vary widely in their health goals and preferences for treatment outcomes from treatment of cardiovascular conditions. 39 Acknowledging options explicitly may support patients to consider their values and preferences. Recent NICE guidance 40 (published after data collection for this study) includes decision aids for choice of first anti-hypertensive medication; in this study, no decision aids were used.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

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Shared decision making in consultations for hypertension: Qualitative study in general practice

Johnson

Turner

Feder

et al. 2021

Health Expectations

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Background Hypertension is mainly managed in primary care. Shared decision making is widely recommended as an approach to treatment decision making. However, no studies have investigated; in detail, what happens during primary care consultations for hypertension. Aim To understand patients’ and clinicians’ experience of shared decision making for hypertension in primary care, in order to propose how it might be better supported. Design Longitudinal qualitative study. Setting Five general practices in south‐west England. Method Interviews with a purposive sample of patients with hypertension, and with the health‐care practitioners they consulted, along with observations of clinical consultations, for up to 6 appointments. Interviews and consultations were audio‐recorded and observational field notes taken. Data were analysed thematically. Results Forty‐six interviews and 18 consultations were observed, with 11 patients and nine health‐care practitioners (five GPs, one pharmacist and three nurses). Little shared decision making was described by participants or observed. Often patients’ understanding of their hypertension was limited, and they were not aware there were treatment choices. Consultations provided few opportunities for patients and clinicians to reach a shared understanding of their treatment choices. Opportunities for patients to engage in choices were limited by structured consultations and the distribution of decisions across consultations. Conclusion For shared decision making to be better supported, consultations need to provide opportunities for patients to learn about their condition, to understand that there are treatment choices, and to discuss these choices with clinicians. Patient or Public Contribution A patient group contributed to the design of this study.

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Section: Discussionmentioning

confidence: 99%

Section: Comparison With Existing Literaturementioning

confidence: 99%

Shared decision making in consultations for hypertension: Qualitative study in general practice

Johnson

Turner

Feder

et al. 2021

Health Expectations

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“…This is not surprising, as older people have long heard persuasive, positive messages about the benefits of screening, and have great faith in the importance of adhering to preventive healthcare as a way of looking after themselves. 45 Consequently, the idea of not needing screening anymore may be difficult to consider, 39 hindering the uptake of new information about the potential harms of continuing. 29 46 Despite these challenges, our findings suggest that a more confronting, less preferred communication strategy may be more effective than more preferred strategies to enable older adults to consider the option of stopping screening.…”

Section: Discussionmentioning

confidence: 99%

Effect of different communication strategies about stopping cancer screening on screening intention and cancer anxiety: a randomised online trial of older adults in Australia

et al. 2020

Self Cite

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ObjectiveTo assess different strategies for communicating to older adults about stopping cancer screening.Design4 (recommendation statement about stopping screening)×(2; time) online survey-based randomised controlled trial.SettingAustralia.Participants271 English-speaking participants, aged 65–90, screened for breast/prostate cancer at least once in past decade.InterventionsTime 1: participants read a scenario in which their general practitioner (GP) informed them about the potential benefits and harms of cancer screening, followed by double-blinded randomisation to one of four recommendation statements to stop screening: control (‘this screening test would harm you more than benefit you’), health status (‘your other health issues should take priority’), life expectancy framed positively (‘this test would not help you live longer’) and negatively (‘you may not live long enough to benefit’). Time 2: in a follow-up scenario, the GP explained why guidelines changed over time (anchoring bias intervention).MeasuresPrimary outcomes: screening intention and cancer anxiety (10-point scale, higher=greater intention/anxiety), measured at both time points. Secondary outcomes: trust (in their GP, the information provided, the Australian healthcare system), decisional conflict and knowledge of the information presented.Results271 participants’ responses analysed. No main effects were found. However, screening intention was lower for the negatively framed life expectancy versus health status statement (6.0 vs 7.1, mean difference (MD)=1.1, p=0.049, 95% CI 0.0 to 2.2) in post hoc analyses. Cancer anxiety was lower for the negatively versus positively framed life expectancy statement (4.8 vs 5.8, MD=1.0, p=0.025, 95% CI 0.1 to 1.9). The anchoring bias intervention reduced screening intention (MD=0.8, p=0.044, 95% CI 0.6 to 1.0) and cancer anxiety (MD=0.3, p=0.002, 95% CI 0.1 to 0.4) across all conditions.ConclusionOlder adults may reduce their screening intention without reporting increased cancer anxiety when clinicians use a more confronting strategy communicating they may not live long enough to benefit and add an explicit explanation why the recommendation has changed.Trial registration numberAustralian New Zealand Clinical Trials Registry (ACTRN12618001306202; Results).

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“…Parents wanted to know that the recommendations would be considered practical and useful by carers, whereas the people with glaucoma placed a stronger emphasis on the knowledge of the healthcare professionals involved in the guideline development. This may be related to the age of the two groups, the glaucoma group consisted largely of older adults who tend to prefer a more directive approach to shared decision-making [33]. Stigma associated with the diagnosis of autism [34], and the role of the parents in caring and advocating for their children may also have contributed to this preference.…”

Section: Discussionmentioning

confidence: 99%

User Testing of a Scottish Intercollegiate Guideline Network Public Guideline for the Parents of Children with Autism.

Fearns¹,

Walker²,

Graham³

et al. 2021

Preprint

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Background: The Scottish Intercollegiate Guidelines Network (SIGN) is the leading national clinical guideline producer in Scotland. Improved design and dissemination of guidelines produced for the public can empower people to take an active role in self-management and shared decision-making. The aim of this study was to test a public version of a guideline with the parents of children and young people with autism, implement improvements, and identify what works in making it usable and accessible. Methods: Parents were recruited from across Scotland. User testing involved a formal ‘think aloud’ process and semi-structured interview that guided users through the booklet. Sessions took place individually and were recorded and transcribed. Key findings were identified and themed using the honeycomb user experience model.Results: Fourteen user-testing sessions were conducted. Key facilitators for usability and desirability of the guideline included the chunking of text, consistent use of colour and the use of boxes to highlight important information. Simple language, written in a tone of partnership, helped to engage parents. Value arose from the guidelines ability to explain the process of diagnosis and make parents feel empowered in their relationship with healthcare professionals. There was a lack of consensus on the usefulness of rating the strength of evidence and recommendations. Conclusion: There was a marked similarity between what was important to the parents and what is important for other groups. The involvement of patients and carers in the guidelines development was key to its credibility. One size does not fit all in presenting evidence-based recommendations to the public and it is a challenge to provide sufficient information while avoiding information overload. Recommendations and evidence levels are suitable for use in public versions, but these should be kept as simple as possible.

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Shared decision-making about cardiovascular disease medication in older people: a qualitative study of patient experiences in general practice

Cited by 24 publications

References 61 publications

Shared decision making in consultations for hypertension: Qualitative study in general practice

Shared decision making in consultations for hypertension: Qualitative study in general practice

Effect of different communication strategies about stopping cancer screening on screening intention and cancer anxiety: a randomised online trial of older adults in Australia

User Testing of a Scottish Intercollegiate Guideline Network Public Guideline for the Parents of Children with Autism.

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