Qualitative analysis of patient-centered decision attributes associated with initiating hepatitis C treatment

BMC Gastroenterology

Fasiha Kanwal¹  Donna L. Smith⁴  Aanand D. Naik¹  Jack A. Clark³  Jeffrey M. Pyne²  Alison B. Hamilton⁵  Jessica L. Zuchowski⁶ 

[1] Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston 77030, TX, USA;Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4300 West 7th Street, Little Rock 72205, AR, USA;Department of Health Policy and Management, Boston University School of Public Health, 715 Albany St. #358w, Boston 02118, MA, USA;VA HSR&D Center for Innovations in Quality, Effectiveness & Safety, Michael E DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston 77030, TX, USA;Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles 90095, CA, USA;VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, 16111 Plummer St. Bldg. 25, North Hills 91343, CA, USA

关键词: Veterans;    Shared decision-making aid;    Decision attributes;    Anti-viral treatment;    Chronic hepatitis C viral infection (CHC);   

Others  :  1234390
DOI  :  10.1186/s12876-015-0356-5

 received in 2014-09-04, accepted in 2015-09-23,  发布年份 2015

【 摘 要 】

Background

In this era of a constantly changing landscape of antiviral treatment options for chronic viral hepatitis C (CHC), shared clinical decision-making addresses the need to engage patients in complex treatment decisions. However, little is known about the decision attributes that CHC patients consider when making treatment decisions. We identify key patient-centered decision attributes, and explore relationships among these attributes, to help inform the development of a future CHC shared decision-making aid.

Methods

Semi-structured qualitative interviews with CHC patients at four Veterans Health Administration (VHA) hospitals, in three comparison groups: contemplating CHC treatment at the time of data collection (Group 1), recently declined CHC treatment (Group 2), or recently started CHC treatment (Group 3). Participant descriptions of decision attributes were analyzed for the entire sample as well as by patient group and by gender.

Results

Twenty-nine Veteran patients participated (21 males, eight females): 12 were contemplating treatment, nine had recently declined treatment, and eight had recently started treatment. Patients on average described eight (range 5–13) decision attributes. The attributes most frequently reported overall were: physical side effects (83 %); treatment efficacy (79 %), new treatment drugs in development (55 %); psychological side effects (55 %); and condition of the liver (52 %), with some variation based on group and gender. Personal life circumstance attributes (such as availability of family support and the burden of financial responsibilities) influencing treatment decisions were also noted by all participants. Multiple decision attributes were interrelated in highly complex ways.

Conclusions

Participants considered numerous attributes in their CHC treatment decisions. A better understanding of these attributes that influence patient decision-making is crucial in order to inform patient-centered clinical approaches to care (such as shared decision-making augmented with relevant decision-making aids) that respond to patients’ needs, preferences, and circumstances.

【 授权许可】

   
2015 Zuchowski et al.

【 图 表 】

Fig. 1.

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