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Cardiovascular medicine
Research
Shared decision-making about cardiovascular disease medication in older people: a qualitative study of patient experiences in general practice
  1. Jesse Jansen1,2,
  2. Shannon McKinn1,
  3. Carissa Bonner1,2,
  4. Danielle Marie Muscat1,
  5. Jenny Doust3,
  6. Kirsten McCaffery1,2
  1. 1Faculty of Medicine and Health, School of Public Health, Sydney Health Literacy Lab, The University of Sydney, Sydney, New South Wales, Australia
  2. 2Faculty of Medicine and Health, School of Public Health, Wiser Healthcare, The University of Sydney, Sydney, New South Wales, Australia
  3. 3Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
  1. Correspondence to Shannon McKinn; shannon.mckinn{at}sydney.edu.au

Abstract

Objectives To explore older people’s perspectives and experiences with shared decision-making (SDM) about medication for cardiovascular disease (CVD) prevention.

Design, setting and participants Semi-structured interviews with 30 general practice patients aged 75 years and older in New South Wales, Australia, who had elevated CVD risk factors (blood pressure, cholesterol) or had received CVD-related lifestyle advice. Data were analysed by multiple researchers using Framework analysis.

Results Twenty eight participants out of 30 were on CVD prevention medication, half with established CVD. We outlined patient experiences using the four steps of the SDM process, identifying key barriers and challenges: Step 1. Choice awareness: taking medication for CVD prevention was generally not recognised as a decision requiring patient input; Step 2. Discuss benefits/harms options: CVD prevention poorly understood with emphasis on benefits; Step 3. Explore preferences: goals, values and preferences (eg, length of life vs quality of life, reducing disease burden vs risk reduction) varied widely but generally not discussed with the general practitioner; Step 4. Making the decision: overall preference for directive approach, but some patients wanted more active involvement. Themes were similar across primary and secondary CVD prevention, different levels of self-reported health and people on and off medication.

Conclusions Results demonstrate how older participants vary widely in their health goals and preferences for treatment outcomes, suggesting that CVD prevention decisions are preference sensitive. Combined with the fact that the vast majority of participants were taking medications, and few understood the aims and potential benefits and harms of CVD prevention, it seems that older patients are not always making an informed decision. Our findings highlight potentially modifiable barriers to greater participation of older people in SDM about CVD prevention medication and prevention in general.

  • primary care
  • qualitative research
  • preventive medicine
  • cardiology

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-026342

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    Footnotes

    • Contributors JJ contributed to the conception and design of the study, the analysis and interpretation of data, drafting and critically revising the manuscript. SM contributed to the acquisition, analysis and interpretation of data, drafting and critically revising the manuscript. CB contributed to the conception and design of the study, analysis and interpretation of data, and critically revising the manuscript. DM contributed to interpretation of data, and critically revising the manuscript. JD contributed to the conception and design of the study, and critically revising the manuscript. KM contributed to the conception and design of the study, interpretation of the data, and critically revising the manuscript. All authors approved the final version for publication, and all authors agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding The study was funded by the National Health and Medical Research Council (NHMRC), through grants awarded to the Screening and Test Evaluation Program (no. 633003) and Bond University (no. 511217). CB was supported by an Australian Postgraduate Award. JJ and KM were supported by NHMRC fellowships. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

    • Competing interests None declared.

    • Ethics approval Ethics approval was obtained through the Sydney Local Health District Human Research Ethics Committee (Protocol No X11-0200 & HREC/11/RPAH/294).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data underlying our findings cannot be made publicly available for ethical reasons; public availability would compromise our participants’ privacy. Data requests may be sent to the corresponding author at shannon.mckinn@sydney.edu.au.

    • Patient consent for publication Not required.