Reasons underpinning patients' preferences for various angina treatments

Lambert, Nigel, Rowe, Gill, Bowling, Ann, Ebrahim, Shah, Laurence, Michael, Dalrymple, Jamie and Thomson, Richard (2004) Reasons underpinning patients' preferences for various angina treatments. Health Expectations, 7(3), pp. 246-256. ISSN (print) 1369-6513


Objective: To elicit patients' preferences for the treatment of angina. Design: Angina patients were interviewed in order to elicit their personal reasons underlying preferences for various treatment options. Interviews followed a general repertory grid technique, in which seven treatment options were presented to patients in triads. Treatments considered ranged from medication to invasive revascularization therapies, with a 'no treatment' option. Setting: Two general practices in Norwich, Norfolk. Subjects: Twenty-one patients with diagnosed angina, which was both mild and stable. Main outcome measures: Treatment preferences verbalized by patients during interview, and the underlying reasons for these. Results: Attitudes voiced towards the range of treatments for angina were diverse; 27 different reasons underlying patients' preferences were identified. Patients' preferences were largely justified by reasons associated with the conditional effectiveness or otherwise of treatments. When presented with treatment triads, medication (drug) treatments were over 2.5 times more likely to be chosen as a most preferred option than invasive or surgical treatments. Although surgical treatments were generally considered to be 'effective', it was perceived that they were more appropriate for situations when the condition became life-threatening. There were occasions, however, when preferences were driven by other reasons, such as a desire to avoid surgery because it was perceived negatively as 'invasive' and 'frightening'. Drug treatments were viewed as 'quick', 'easy' and reversible. Personal experiences of the effectiveness or otherwise of treatments were frequently cited as reasons for stated preferences. However, patients often commented that they would prefer the doctor to make the decision about their treatment. Conclusions: Patients choices among treatments was largely driven by perceptions of their effectiveness or otherwise. Although surgery was perceived as 'effective' it was also seen as conditionally so, dependent upon severity of the condition - which is not necessarily the case, as the risks of adverse events and surgical complications increase for emergency cases. As such, access to better information about the effectiveness and timeliness of interventions is needed. Although respondents held anxieties about treatment, particularly invasive or surgical treatments, fewer choices were driven by emotional and lifestyle factors unrelated to 'effectiveness', such as fear or ease of treatment.

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