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Interactional resistance between patients with atrial fibrillation and cardiologists in consultation on treatment with warfarin: the value of shared decision-making
Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.ORCID iD: 0000-0003-3817-4981
Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
Jönköping University, School of Health Science, HHJ, Dep. of Nursing Science.
2012 (English)In: The International Journal of Person Centered Medicine, ISSN 2043-7730, E-ISSN 2043-7749, Vol. 2, no 3, 427-436 p.Article in journal (Refereed) Published
Abstract [en]

Rationale: Atrial fibrillation (AF) increases the risk of stroke and it can be reduced by treatment with warfarin. Some patients consider that warfarin is a stressful treatment with undesired effects and the perceived barriers include unwillingness to take it. Knowledge of patients resisting warfarin treatment may be useful for the potential threat to maintaining shared decision-making in the consultation as a central tenet of person-centered medicine.

Aims and objectives: To identify how patients resist treatment with warfarin and how cardiologists respond to patients’ resistance. The co-constructive perspective of this work analyses the consultations by emphasizing the clinical communication strategies of both patients and cardiologists.

Method: Eleven videotaped consultations, in 4 different hospitals, were selected for analysis. Treatment interactions regarding warfarin between patients with AF and cardiologists were analysed, according to the methodology of conversation analysis.

Results: There were 4 types of resistance from patients for accepting treatment with warfarin. These included “Giving reasons for their resistance”, “Suggestion of another treatment option by the patient”, “Stating a treatment preference” and “Questioning or challenging the cardiologist’s treatment recommendation”. The cardiologists’ responses to the patients’ resistance included “Repeating the treatment recommendation”, “Negotiation with the patient”, “Providing additional information on the recommended treatment” and “Extending the explanation for the purpose of taking the treatment”.

Conclusions: By showing resistance, patients are thought to want to participate in their treatment decisions and an awareness of patients’ resistance to treatment enables cardiologists to address the patients’ experience-based views on their treatment and individual concerns as part of clinical strategies to increase the person-centeredness of medical intervention.

Place, publisher, year, edition, pages
2012. Vol. 2, no 3, 427-436 p.
Keyword [en]
Atrial fibrillation, communication, patient choice, patient participation, person-centered medicine, resistance interaction, shared decision-making, warfarin
National Category
Nursing
Identifiers
URN: urn:nbn:se:hj:diva-19821OAI: oai:DiVA.org:hj-19821DiVA: diva2:567795
Available from: 2012-11-14 Created: 2012-11-14 Last updated: 2015-06-11Bibliographically approved
In thesis
1. Communication Patterns in Consultations Between Patients with Atrial Fibrillation and Health Professionals
Open this publication in new window or tab >>Communication Patterns in Consultations Between Patients with Atrial Fibrillation and Health Professionals
2012 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

Background

Patients’ preferences, needs and desires are important when discussing treatment. In consultations between patients with atrial fibrillation (AF) and health professionals, knowledge, understanding and insight about communication patterns are of vital importance for strengthening patient involvement in decision-making about their care and treatment.

Aim

The general aim of this thesis was to describe communication patterns in consultations between patients with AF and health professionals.

Specific aims

(1) To describe (i) the topics patients with AF and their nurses and physicians discuss; (ii) the use of discursive space in consultations between these participants; and (iii) the frequencies with which patients and nurses/physicians introduce the identified topics.

(2) To describe the types of patient resistance to accepting treatment with warfarin and how cardiologists respond to such resistance.

Methods

An inductive design was used. In study I, the sample consisted of 23 consultations between patients with AF (13 women and 10 men) and health professionals (5 women and 5 men) who were employed in six different cardiologic outpatient clinics. Content analysis was used to obtain a description of topics discussed. The patterns of dominance for the various topics and participant were explored from the framework of an analysis of dominance (I). In study II, the sample consisted of 11 consultations between patients with AF (7 women and 4 men) and cardiologists (2 women and 3 men). Conversation analysis was used to describe interactions concerning resistance to treatment with warfarin.

Findings

Study I. Four topics were introduced by both nurses and physicians during the consultations. These were “pathophysiology”, “treatment”, “diagnostic procedures”, and “activity”. In the nurse–patient consultations an additional topic, “routines related to the physician’s responsibilities”, emerged. With respect to the number of words and turns, the distribution of the discourse space was almost equal between nurses and patients, and unequal between physicians and patients. The patients were the dominant initiators of the topic “activity”, which refers to adaptation of activities in daily life in relation to AF.

Study II. There were four types of patient resistance to accepting treatment with warfarin. These included “Giving reasons for their resistance”, “Suggesting other treatment options”, “Stating treatment preferences” and “Questioning or challenging the cardiologist’s treatment recommendations”. The cardiologists’ responses to the patients’ resistance included “Repeating the treatment recommendation”, “Negotiation with the patient”, “Providing additional information about the recommended treatment” and “Extending their explanation of the purpose of the treatment”.

Conclusions

The medical-driven agenda dominated over the patient-driven agenda in consultations between health care professionals and patients with AF. During conversations in consultations with nurses, the patients initiated discussion of living with AF and were more talkative than they were with physicians. An awareness of types of patient resistance to treatment would enable cardiologists to consider patients’ experience-based views about their treatment;

Place, publisher, year, edition, pages
Jönköping: School of Health Science, 2012. 96 p.
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 35
Keyword
Atrial fibrillation, communication, consultation, dominance, patient participation, resistance interaction, shared decision-making, warfarin
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hj:diva-19834 (URN)978-91-85835-34-8 (ISBN)
Presentation
2012-12-14, Forum Humanum, HHJ (School of Health Sciences), 09:30
Opponent
Supervisors
Available from: 2012-11-22 Created: 2012-11-16 Last updated: 2012-12-04Bibliographically approved

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