Format

Send to

Choose Destination
See comment in PubMed Commons below
BMJ. 2000 May 20;320(7246):1380-4.

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

Author information

1
Division of Primary Health Care, Department of Social Medicine, University of Bristol, Bristol BS8 2PR.

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.

PMID:
10818030
PMCID:
PMC27382
[Indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for HighWire Icon for PubMed Central
    Loading ...
    Support Center