Patients' and physicians' perceptions and attitudes about oral anticoagulation and atrial fibrillation: a qualitative systematic review
Por:
Dalmau, GM, Sant Arderiu, E, Montes, MBE, Sola, I, Saco, SP, Coello, PA
Publicada:
13 ene 2017
Resumen:
Background: Oral anticoagulant therapy reduces the risk of stroke in patients with atrial fibrillation, but many patients are still not prescribed this therapy. The causes of underuse of vitamin K antagonists oral anticoagulants are not clear but could be related, in part, to patients' and physicians' perceptions and attitudes towards the benefits and downsides of this treatment. The purpose of this systematic review was to evaluate and synthesize patients' and physicians' perceptions and attitudes towards the benefits and downsides of vitamin K antagonist, in order to explore potential factors related with its underuse.
Methods: We included studies that used qualitative or mixed methods and focused on patients' and/or physicians' perceptions and attitudes towards oral anticoagulation. We systematically searched PubMed, EMBASE, ISI WoK, and PsycINFO from their inception until May 2013. Two reviewers independently assessed the quality of the included studies and synthesized results using a thematic analysis approach.
Results: We included a total of nine studies. In four studies, the quality assessed was excellent and in five was moderate. We identified three themes that were of interest to both physicians and patients: information to reinforce anticoagulation use, balance of benefits and downsides, roles in decision-making and therapy management. Three additional themes were of interest to patients: knowledge and understanding, impact on daily life, and satisfaction with therapy. The main difficulties with the use of anticoagulant treatment according to physicians were the perceived uncertainty, need of individualised decision-making, and the feeling of delegated responsibility as their main concerns. The main factors for patients were the lack of information and understanding.
Conclusion: Physicians' and patients' perceptions and attitudes might be potential factors in the underuse of treatment with vitamin K antagonists. Improving the quality and usability of clinical guidelines, developing tools to help with the decision-making, enhancing coordination between primary care and hospital care, and improving information provided to patients could help improve the underuse of anticoagulation.
Filiaciones:
Dalmau, GM:
Biomed Res Inst St Pau IIB St Pau, Iberoamer Cochrane Ctr, St Antoni Ma Claret 167, Barcelona 08025, Spain
Sant Arderiu, E:
CAP Casanova, CAPSE, Barcelona, Spain
Montes, MBE:
SAP Litoral Esquerra, Inst Catala Salut, Barcelona, Spain
Sola, I:
Biomed Res Inst St Pau IIB St Pau, Iberoamer Cochrane Ctr, St Antoni Ma Claret 167, Barcelona 08025, Spain
CIBERESP, Barcelona, Spain
Saco, SP:
Biomed Res Inst St Pau IIB St Pau, Iberoamer Cochrane Ctr, St Antoni Ma Claret 167, Barcelona 08025, Spain
Coello, PA:
Biomed Res Inst St Pau IIB St Pau, Iberoamer Cochrane Ctr, St Antoni Ma Claret 167, Barcelona 08025, Spain
CIBERESP, Barcelona, Spain
Gold, Green Published
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