Kennelly C, Bowling A
College of Health, St Margaret's House, London E2 9PL, UK.
Qual Health Care. 2001 Sep;10 Suppl 1(Suppl 1):i23-8. doi: 10.1136/qhc.0100023...
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.
Qualitative study based on five focus groups.
Five local heart support groups across London.
38 patients aged 56 and over who were members of local heart support groups, diagnosed with ischaemic heart disease.
Analysis of patients' narratives to identify key themes and issues using the framework method of qualitative data analysis.
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.
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.
探讨老年人在医疗保健方面与自身病情（缺血性心脏病）相关的经历、他们对健康风险的理解、治疗偏好以及不同治疗方法对其生活质量的影响。
基于五个焦点小组的定性研究。
伦敦的五个当地心脏支持小组。
38名年龄在56岁及以上、被诊断患有缺血性心脏病且是当地心脏支持小组成员的患者。
采用定性数据分析的框架方法分析患者的叙述，以确定关键主题和问题。
心脏病患者更愿意遵循心脏病专家基于其医学专业知识给出的治疗建议。如果有选择的机会，许多人表示他们至少在最初会更倾向于服药，因为他们不想接受手术。然而，他们也承认，根据自身病情，他们可能没有选择的余地。参与者表示，影响他们治疗选择的其他因素包括他们的健康状况、治疗效果、家人的感受、年龄以及他们之前接受手术的次数。他们发现很难用数字来讨论风险；大多数人认为手术有3%的死亡风险很低。相反，他们从治疗恢复生活质量的可能性方面来讨论风险。患者表示担心药物不能治愈疾病，而手术血管重建是一种创伤性经历，而且不一定能一劳永逸。参与者认为他们需要更多关于手术和药物影响的信息，以便做出更明智的选择。他们觉得在接受治疗过程中面临的其他障碍包括看心脏病专家的困难以及年龄歧视。
从这些焦点小组中可以明显看出，很少有患者参与关于自身治疗的医疗决策。大多数人更希望由医生来做决定，而不想参与其中。尽管他们有作为心脏病患者的经历，但在能够做出明智选择之前，他们需要更多关于自身病情治疗方案的信息。在实际中能够了解患者的偏好之前，还需要改善获得专科护理（心脏病专家）的机会以及消除年龄歧视。
