Why do women reject bisphosphonates for osteoporosis? a videographic study

Elizabeth A. Scoville, Paula Ponce de Leon Lovaton, Nilay D Shah, Laurie J. Pencille, Victor Manuel Montori

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background: Despite access to effective, safe, and affordable treatment for osteoporosis, at-risk women may choose not to start bisphosphonate therapy. Understanding the reasons women give for rejecting a clinician's offer of treatment during consultations and how clinician's react to these reasons may help clinicians develop more effective strategies for fracture prevention and medication adherence. Methods: We conducted a videographic evaluation of encounters in the Osteoporosis Choice randomized trial of a decision aid about bisphosphonates vs. usual primary care. Eligible videos involved consultations with women with an estimated 10-year fragility fracture risk >20% who verbalized at least one reason to not take bisphosphonates. Two reviewers independently reviewed eligible videos and verbatim transcripts, classifying patient views about bisphosphonate use, clinicians reponse to those views, and patient adherence at 6 months post visit. Results: Eighteen video recordings (12 with decision aid) were eligible for analyses. We identified 37 reasons for and against bisphosphonate therapy. Eleven patients rejected treatment, offering 9 (average of 2 per patient) unique reasons against initiating bisphosphonates (most common: side effects 39% and distrust of medications in general 33%). When physicians conceded to patient views the outcome was no bisphosphonate use. Adherence to choices at 6 months was 100%. Conclusions: The expression of patient preferences is sometimes unfavorable to bisphosphonates treatment even among well-informed patients at high risk for osteoporotic fractures. At 6 months, patients who expressed concerns about these medicines behaved consistently with the decision made during the visit.

Original languageEnglish (US)
Article numbere18468
JournalPLoS One
Volume6
Issue number4
DOIs
StatePublished - 2011

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osteoporosis
Diphosphonates
Osteoporosis
Decision Support Techniques
decision support systems
Therapeutics
Referral and Consultation
Patient treatment
Video recording
Video Recording
therapeutics
Osteoporotic Fractures
Medication Adherence
Patient Preference
Patient Compliance
physicians
drug therapy
Medicine
Primary Health Care
medicine

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Why do women reject bisphosphonates for osteoporosis? a videographic study. / Scoville, Elizabeth A.; de Leon Lovaton, Paula Ponce; Shah, Nilay D; Pencille, Laurie J.; Montori, Victor Manuel.

In: PLoS One, Vol. 6, No. 4, e18468, 2011.

Research output: Contribution to journalArticle

Scoville, Elizabeth A. ; de Leon Lovaton, Paula Ponce ; Shah, Nilay D ; Pencille, Laurie J. ; Montori, Victor Manuel. / Why do women reject bisphosphonates for osteoporosis? a videographic study. In: PLoS One. 2011 ; Vol. 6, No. 4.
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