Patients’ and physicians’ experiences of atrial fibrillation consultations and anticoagulation decision-making: A multi-perspective IPA design

Abstract

Objective: To explore patients’ and physicians’ experiences of atrial fibrillation (AF) consultations and oral anticoagulation decision-making.

Design: Multi-perspective interpretative phenomenological analyses.

Methods: Participants included small homogeneous subgroups: AF patients who accepted (n = 4), refused (n = 4) or discontinued (n = 3) warfarin, and four physician subgroups (n = 4 each group): consultant cardiologists, consultant general physicians, general practitioners and cardiology registrars. Semi-structured interviews were conducted. Transcripts were analysed using multi-perspective interpretative phenomenological analysis (IPA) analyses to attend to individuals within subgroups and making comparisons within and between groups.

Results: Three themes represented patients’ experiences: Positioning within the physician–patient dyad, Health–life balance, and Drug myths and fear of stroke. Physicians’ accounts generated three themes: Mechanised metaphors and probabilities, Navigating toward the ‘right’ decision and Negotiating systemic factors.

Conclusions: This multi-perspective IPA design facilitated an understanding of the diagnostic consultation and treatment decision-making which foregrounded patients’ and physicians’ experiences. We drew on Habermas’ theory of communicative action to recommend broadening the content within consultations and shifting the focus to patients’ life contexts. Interventions including specialist multidisciplinary teams, flexible management in primary care and multifaceted interventions for information provision may enable the creation of an environment that supports genuine patient involvement and participatory decision-making.

Keywords:

• atrial fibrillation
• oral anticoagulation
• medication adherence
• decision-making
• qualitative research
• interpretative phenomenological analysis

Acknowledgements

We would like to thank all patients and physicians who took part for sharing their experiences of AF and OAC and the cardiology registrars who helped to identify potential patient participants.

Disclosure statement

DAL has received investigator-initiated educational grants from Bayer Healthcare and Boehringer Ingelheim and Bristol-Myers-Squibb and has served as a speaker for Boehringer Ingelheim, Bayer, and Bristol-Myers- Squibb/Pfizer. She is also a member of the AEGEAN study Steering Committee. CBX and RLS have no conflict of interest.

Funding

CBX's PhD studentship was partly funded by an investigator-initiated educational grant awarded to Dr Lane by Bayer Healthcare.

Notes

1. See the disease description from Patient Information UK: http://patient.info/doctor/atrial-fibrillation-pro (accessed 23/07/15).

2. New drugs, non-vitamin K antagonist oral anticoagulants (dabigatran, apixaban, rivaroxaban, and edoxaban), are also recommended for stroke prevention in atrial fibrillation patients by NICE.

3. Pseudonyms were not used for physicians as this would compromise their anonymity.

4. See for example the NHS Choices website: http://www.nhs.uk/CHOICEINTHENHS/Pages/Choicehome.aspx (accessed 31/07/15).