Abstract
Objectives—To explore older people's experiences of health care in relation to their medical condition (ischaemic heart disease), their understanding of health risks, treatment preferences, and the impact of different treatments on their quality of life.
Design—Qualitative study based on five focus groups.
Setting—Five local heart support groups across London.
Participants—38 patients aged 56 and over who were members of local heart support groups, diagnosed with ischaemic heart disease.
Main outcome measure—Analysis of patients' narratives to identify key themes and issues using the framework method of qualitative data analysis.
Results—Cardiac patients would prefer to follow the cardiologist's recommendation for treatment, based on their medical expertise. If offered a choice, many said they would prefer to take medication, at least initially, as they would rather not undergo surgery. However, they accepted that, depending on their medical condition, they might not have a choice. Other factors that participants said affected their choice of treatments included their state of health, treatment outcomes, families' feelings, their age, and the previous number of operations they had undergone. They found it difficult to discuss risk in terms of numbers; most felt that a 3% risk of death from surgery was low. Instead, they discussed risk in terms of likelihood of treatment restoring quality of life. Patients expressed the fear that medication was not a cure and that surgical revascularisation is a traumatic experience that does not necessarily last forever. Participants felt that they needed further information on the impact of surgery and medication to make a more informed choice. Other barriers they felt they had faced in being treated were problems in accessing cardiologists and age discrimination.
Conclusion—It was apparent from these focus groups that few patients were involved in medical decision making about their treatment. Most preferred the doctor to make the decision and did want to be involved. Despite their experiences as cardiac patients, they required much more information about treatment options for their condition before being able to make informed choices, where appropriate. Improved access to specialist care (cardiologists) and equal treatment by age are also required before patients' preferences can be elicited in practice.
Key Words: patient preference; treatment choice; decision making; patient-caregiver communication; ischaemic heart disease; geriatrics
Full Text
The Full Text of this article is available as a PDF (127.3 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Aggarwal R. K., Ray S. G., Connelly D. T., Coulshed D. S., Charles R. G. Trends in pacemaker mode prescription 1984-1994: a single centre study of 3710 patients. Heart. 1996 May;75(5):518–521. doi: 10.1136/hrt.75.5.518. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Barakat K., Wilkinson P., Deaner A., Fluck D., Ranjadayalan K., Timmis A. How should age affect management of acute myocardial infarction? A prospective cohort study. Lancet. 1999 Mar 20;353(9157):955–959. doi: 10.1016/S0140-6736(98)07114-1. [DOI] [PubMed] [Google Scholar]
- Bowling A. Ageism in cardiology. BMJ. 1999 Nov 20;319(7221):1353–1355. doi: 10.1136/bmj.319.7221.1353. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Bowling A., Bond M., McKee D., McClay M., Banning A. P., Dudley N., Elder A., Martin A., Blackman I. Equity in access to exercise tolerance testing, coronary angiography, and coronary artery bypass grafting by age, sex and clinical indications. Heart. 2001 Jun;85(6):680–686. doi: 10.1136/heart.85.6.680. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Dudley N. J., Burns E. The influence of age on policies for admission and thrombolysis in coronary care units in the United Kingdom. Age Ageing. 1992 Mar;21(2):95–98. doi: 10.1093/ageing/21.2.95. [DOI] [PubMed] [Google Scholar]
- Elder A. T., Shaw T. R., Turnbull C. M., Starkey I. R. Elderly and younger patients selected to undergo coronary angiography. BMJ. 1991 Oct 19;303(6808):950–953. doi: 10.1136/bmj.303.6808.950. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Gardner K., Chapple A. Barriers to referral in patients with angina: qualitative study. BMJ. 1999 Aug 14;319(7207):418–421. doi: 10.1136/bmj.319.7207.418. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Guadagnoli E., Ward P. Patient participation in decision-making. Soc Sci Med. 1998 Aug;47(3):329–339. doi: 10.1016/s0277-9536(98)00059-8. [DOI] [PubMed] [Google Scholar]
- McLaughlin T. J., Soumerai S. B., Willison D. J., Gurwitz J. H., Borbas C., Guadagnoli E., McLaughlin B., Morris N., Cheng S. C., Hauptman P. J. Adherence to national guidelines for drug treatment of suspected acute myocardial infarction: evidence for undertreatment in women and the elderly. Arch Intern Med. 1996 Apr 8;156(7):799–805. [PubMed] [Google Scholar]
- Pilote L., Miller D. P., Califf R. M., Rao J. S., Weaver W. D., Topol E. J. Determinants of the use of coronary angiography and revascularization after thrombolysis for acute myocardial infarction. N Engl J Med. 1996 Oct 17;335(16):1198–1205. doi: 10.1056/NEJM199610173351606. [DOI] [PubMed] [Google Scholar]
- Robinson A., Thomson R. Variability in patient preferences for participating in medical decision making: implication for the use of decision support tools. Qual Health Care. 2001 Sep;10 (Suppl 1):i34–i38. doi: 10.1136/qhc.0100034... [DOI] [PMC free article] [PubMed] [Google Scholar]
- Stemmer E. A., Aronow W. S. Surgical management of coronary arterial disease in the elderly. Coron Artery Dis. 1998;9(5):279–290. doi: 10.1097/00019501-199809050-00006. [DOI] [PubMed] [Google Scholar]
- Stone P. H., Thompson B., Anderson H. V., Kronenberg M. W., Gibson R. S., Rogers W. J., Diver D. J., Théroux P., Warnica J. W., Nasmith J. B. Influence of race, sex, and age on management of unstable angina and non-Q-wave myocardial infarction: The TIMI III registry. JAMA. 1996 Apr 10;275(14):1104–1112. [PubMed] [Google Scholar]