Physicians’ views on patient participation in choice of oral anticoagulants in atrial fibrillation—a qualitative study

Abstract

Direct oral anticoagulants provide an alternative to vitamin K antagonists for the anticoagulation therapy in atrial fibrillation (AF). The availability of several treatment options with different attributes makes shared decision-making appropriate for the choice of anticoagulation therapy. The aim of this study was to understand how physicians choose an oral anticoagulant (OAC) for patients with AF and how physicians view patients' participation in this decision. Semi-structured interviews with 17 Finnish physicians (eight general practitioners and nine specialists) working in the public sector were conducted. An interview guide on experience, prescribing and opinions about oral anticoagulants was developed based on previous literature. The data were thematically analysed using deductive and inductive approaches. Based on the interviews, patient's opinion was the most influential factor in decision-making when there were no clinical factors limiting the choice between OACs. Of patient's preferences, the most important was the attitude towards co-payments of OACs. Patients' opinions on monitoring of treatment, dosing and antidote availability were also mentioned by the interviewees. The choice of an OAC in AF was patient-centred as all interviewees expressed that patient's opinion affects the choice. K E Y W O R D Satrial fibrillation, direct oral anticoagulants, interview, prescription of drugs, warfarin

Clinicians’ views and experiences of prescribing oral anticoagulants for stroke prevention in atrial fibrillation: A qualitative meta-synthesis

“…[14] Ten studies were high quality in relation to the majority (five or more) of the nine graded fields of the qualitative CASP checklist. [17][18][19][20][21][22][23][24][25][26] Poorly described facets included the relationship between researcher and participant; [17][18][19][20][21][22][23][25][26][27][28][29] explanation of the study to participants and handling of their data; [17, 19-21, 23-25, 27-29] rigour of data analysis [18-23, 25, 27-29] and appropriateness of recruitment strategies. [19,21,22,25,[27][28][29] For further details of study quality see S2 Table in S1 File.…”

“…Data were included from at least 248 clinicians. Included studies were conducted in the UK, [19,21,22,24] Finland, [29] Australia, [17,20,27] the USA [18,23,25,26] and Canada. [28] Participating clinicians were from primary, [17, 19, 20, 22-25, 28, 29] secondary [18-21, 23, 25, 26, 28, 29] and tertiary care.…”

“…[28] Participating clinicians were from primary, [17, 19, 20, 22-25, 28, 29] secondary [18-21, 23, 25, 26, 28, 29] and tertiary care. [18,21,25,27] Qualitative methodologies included focus groups, [22] semi-structured interviews, [19,20,[24][25][26]29] in-depth interviews with a semi-structured guide [18] and interviews and reviews of healthcare file notes. [27] Mixedmethods studies included semi-structured interviews exploring decision-making in relation to vignettes, [21] surveys and interviews [23,28] and questionnaires with both qualitative and quantitative responses.…”

“…"11 physicians considered high-quality warfarin treatment as effective as DOACs, although 11 physicians felt DOACs to be safer than warfarin. In addition 10 physicians mentioned that they did not see great differences between different DOACs or that they have not been directly compared and, therefore, none of them can be said to be better than the others' [29] Different types of clinicians described different opinions of NOACs and warfarin.…”

“…"three physicians felt that patients adhere better to their treatment when they have participated in the decision-making" [29] Some clinicians began discussing their beliefs regarding the importance of a patient-centred approach; however, their thoughts then led on to the importance of making the right decision and revealed a much more paternalistic style that many patients were reportedly happy with.…”