Values and preferences in oral anticoagulation in patients with atrial fibrillation, physicians' and patients' perspectives: Protocol for a two-phase study

Pablo Alonso-Coello, Victor Manuel Montori, Ivan Solà, Holger J. Schünemann, Philipe Devereaux, Cathy Charles, Mercè Roura, M. Gloria Díaz, Juan Carlos Souto, Rafael Alonso, Sven Oliver, Rafael Ruiz, Blanca Coll-Vinent, Ana Isabel Diez, Ignasi Gich, Gordon Guyatt

Research output: Contribution to journalArticle

33 Citations (Scopus)

Abstract

Background. Oral anticoagulation prevents strokes in patients with atrial fibrillation but, for reasons that remain unclear, less than 40% of all patients with atrial fibrillation receive warfarin. The literature postulates that patient and clinician preferences may explain this low utilization. Design. The proposed research seeks to answer the following questions: i) When assessed systematically, do patients' and clinicians' preferences explain the utilization of warfarin to prevent strokes associated with atrial fibrillation? ii) To what extent do patients' and clinicians' treatment preferences differ? iii) What factors explain any differences that exist in treatment preferences between patients and clinicians? To answer these questions we will conduct a two-phase study of patient and clinician preferences for health states and treatments. In the first phase of this study we will conduct structured interviews to determine their treatment preferences for warfarin vs. aspirin to prevent strokes associated with atrial fibrillation using the probability trade-off technique. In the same interview, we will conduct preference-elicitation exercises using the feeling thermometer to identify the utilities that patients place on taking medication (warfarin and aspirin), and on having a mild stroke, a severe stroke, and a major bleed. In the second phase of the study we will convene focus groups of clinicians and patients to explore their answers to the exercises in the first phase. Discussion. This is a study of patient and clinician preferences for health states and treatments. Because of its clinical importance and our previous work in this area, we will conduct our study in the clinical context of the decision to use antithrombotic agents to reduce the risk of stroke in patients with non-valvular chronic atrial fibrillation.

Original languageEnglish (US)
Article number221
JournalBMC Health Services Research
Volume8
DOIs
StatePublished - 2008

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Patient Preference
Atrial Fibrillation
Stroke
Warfarin
Physicians
Aspirin
Interviews
Exercise
Therapeutics
Thermometers
Fibrinolytic Agents
Health
Focus Groups
Emotions
Research

ASJC Scopus subject areas

  • Health Policy

Cite this

Values and preferences in oral anticoagulation in patients with atrial fibrillation, physicians' and patients' perspectives : Protocol for a two-phase study. / Alonso-Coello, Pablo; Montori, Victor Manuel; Solà, Ivan; Schünemann, Holger J.; Devereaux, Philipe; Charles, Cathy; Roura, Mercè; Díaz, M. Gloria; Souto, Juan Carlos; Alonso, Rafael; Oliver, Sven; Ruiz, Rafael; Coll-Vinent, Blanca; Diez, Ana Isabel; Gich, Ignasi; Guyatt, Gordon.

In: BMC Health Services Research, Vol. 8, 221, 2008.

Research output: Contribution to journalArticle

Alonso-Coello, P, Montori, VM, Solà, I, Schünemann, HJ, Devereaux, P, Charles, C, Roura, M, Díaz, MG, Souto, JC, Alonso, R, Oliver, S, Ruiz, R, Coll-Vinent, B, Diez, AI, Gich, I & Guyatt, G 2008, 'Values and preferences in oral anticoagulation in patients with atrial fibrillation, physicians' and patients' perspectives: Protocol for a two-phase study', BMC Health Services Research, vol. 8, 221. https://doi.org/10.1186/1472-6963-8-221
Alonso-Coello, Pablo ; Montori, Victor Manuel ; Solà, Ivan ; Schünemann, Holger J. ; Devereaux, Philipe ; Charles, Cathy ; Roura, Mercè ; Díaz, M. Gloria ; Souto, Juan Carlos ; Alonso, Rafael ; Oliver, Sven ; Ruiz, Rafael ; Coll-Vinent, Blanca ; Diez, Ana Isabel ; Gich, Ignasi ; Guyatt, Gordon. / Values and preferences in oral anticoagulation in patients with atrial fibrillation, physicians' and patients' perspectives : Protocol for a two-phase study. In: BMC Health Services Research. 2008 ; Vol. 8.
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AU - Solà, Ivan

AU - Schünemann, Holger J.

AU - Devereaux, Philipe

AU - Charles, Cathy

AU - Roura, Mercè

AU - Díaz, M. Gloria

AU - Souto, Juan Carlos

AU - Alonso, Rafael

AU - Oliver, Sven

AU - Ruiz, Rafael

AU - Coll-Vinent, Blanca

AU - Diez, Ana Isabel

AU - Gich, Ignasi

AU - Guyatt, Gordon

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N2 - Background. Oral anticoagulation prevents strokes in patients with atrial fibrillation but, for reasons that remain unclear, less than 40% of all patients with atrial fibrillation receive warfarin. The literature postulates that patient and clinician preferences may explain this low utilization. Design. The proposed research seeks to answer the following questions: i) When assessed systematically, do patients' and clinicians' preferences explain the utilization of warfarin to prevent strokes associated with atrial fibrillation? ii) To what extent do patients' and clinicians' treatment preferences differ? iii) What factors explain any differences that exist in treatment preferences between patients and clinicians? To answer these questions we will conduct a two-phase study of patient and clinician preferences for health states and treatments. In the first phase of this study we will conduct structured interviews to determine their treatment preferences for warfarin vs. aspirin to prevent strokes associated with atrial fibrillation using the probability trade-off technique. In the same interview, we will conduct preference-elicitation exercises using the feeling thermometer to identify the utilities that patients place on taking medication (warfarin and aspirin), and on having a mild stroke, a severe stroke, and a major bleed. In the second phase of the study we will convene focus groups of clinicians and patients to explore their answers to the exercises in the first phase. Discussion. This is a study of patient and clinician preferences for health states and treatments. Because of its clinical importance and our previous work in this area, we will conduct our study in the clinical context of the decision to use antithrombotic agents to reduce the risk of stroke in patients with non-valvular chronic atrial fibrillation.

AB - Background. Oral anticoagulation prevents strokes in patients with atrial fibrillation but, for reasons that remain unclear, less than 40% of all patients with atrial fibrillation receive warfarin. The literature postulates that patient and clinician preferences may explain this low utilization. Design. The proposed research seeks to answer the following questions: i) When assessed systematically, do patients' and clinicians' preferences explain the utilization of warfarin to prevent strokes associated with atrial fibrillation? ii) To what extent do patients' and clinicians' treatment preferences differ? iii) What factors explain any differences that exist in treatment preferences between patients and clinicians? To answer these questions we will conduct a two-phase study of patient and clinician preferences for health states and treatments. In the first phase of this study we will conduct structured interviews to determine their treatment preferences for warfarin vs. aspirin to prevent strokes associated with atrial fibrillation using the probability trade-off technique. In the same interview, we will conduct preference-elicitation exercises using the feeling thermometer to identify the utilities that patients place on taking medication (warfarin and aspirin), and on having a mild stroke, a severe stroke, and a major bleed. In the second phase of the study we will convene focus groups of clinicians and patients to explore their answers to the exercises in the first phase. Discussion. This is a study of patient and clinician preferences for health states and treatments. Because of its clinical importance and our previous work in this area, we will conduct our study in the clinical context of the decision to use antithrombotic agents to reduce the risk of stroke in patients with non-valvular chronic atrial fibrillation.

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