Lambert Nigel, Rowe Gene, Bowling Ann, Ebrahim Shah, Laurence Michael, Dalrymple Jamie, Thomson Richard
Institute for Food Research, Norwich, UK.
Health Expect. 2004 Sep;7(3):246-56. doi: 10.1111/j.1369-7625.2004.00282.x.
To elicit patients' preferences for the treatment of angina.
Angina patients were interviewed in order to elicit their personal reasons underlying preferences for various treatment options. Interviews followed a general repertory grid technique, in which seven treatment options were presented to patients in triads. Treatments considered ranged from medication to invasive revascularization therapies, with a 'no treatment' option.
Two general practices in Norwich, Norfolk.
Twenty-one patients with diagnosed angina, which was both mild and stable.
Treatment preferences verbalized by patients during interview, and the underlying reasons for these.
Attitudes voiced towards the range of treatments for angina were diverse; 27 different reasons underlying patients' preferences were identified. Patients' preferences were largely justified by reasons associated with the conditional effectiveness or otherwise of treatments. When presented with treatment triads, medication (drug) treatments were over 2.5 times more likely to be chosen as a most preferred option than invasive or surgical treatments. Although surgical treatments were generally considered to be 'effective', it was perceived that they were more appropriate for situations when the condition became life-threatening. There were occasions, however, when preferences were driven by other reasons, such as a desire to avoid surgery because it was perceived negatively as 'invasive' and 'frightening'. Drug treatments were viewed as 'quick', 'easy' and reversible. Personal experiences of the effectiveness or otherwise of treatments were frequently cited as reasons for stated preferences. However, patients often commented that they would prefer the doctor to make the decision about their treatment.
Patients choices among treatments was largely driven by perceptions of their effectiveness or otherwise. Although surgery was perceived as 'effective' it was also seen as conditionally so, dependent upon severity of the condition - which is not necessarily the case, as the risks of adverse events and surgical complications increase for emergency cases. As such, access to better information about the effectiveness and timeliness of interventions is needed. Although respondents held anxieties about treatment, particularly invasive or surgical treatments, fewer choices were driven by emotional and lifestyle factors unrelated to 'effectiveness', such as fear or ease of treatment.
了解患者对心绞痛治疗的偏好。
对心绞痛患者进行访谈，以探究他们对各种治疗方案偏好背后的个人原因。访谈采用一般的 repertory grid 技术，向患者以三元组形式呈现七种治疗方案。所考虑的治疗方法从药物治疗到侵入性血运重建疗法，还有一个“不治疗”选项。
诺福克郡诺维奇的两家普通诊所。
21 名被诊断为轻度且稳定型心绞痛的患者。
患者在访谈中表达的治疗偏好以及这些偏好背后的原因。
对心绞痛一系列治疗方法表达的态度各不相同；确定了患者偏好背后的 27 个不同原因。患者的偏好很大程度上基于与治疗的有条件有效性或其他方面相关的原因。当呈现治疗三元组时，药物治疗作为最优选的可能性是侵入性或手术治疗的 2.5 倍以上。尽管手术治疗通常被认为“有效”，但人们认为它们在病情危及生命的情况下更合适。然而，有时偏好是由其他原因驱动的，例如因为认为手术“侵入性强”且“令人恐惧”而希望避免手术。药物治疗被视为“快速”“简便”且可逆。治疗有效性或其他方面的个人经历经常被引述为既定偏好的原因。然而，患者经常表示他们希望由医生来决定他们的治疗方案。
患者在治疗之间的选择很大程度上是由对其有效性或其他方面的认知驱动的。尽管手术被认为“有效”，但也被视为有条件有效，取决于病情的严重程度——但情况不一定如此，因为急诊情况下不良事件和手术并发症的风险会增加。因此，需要获得关于干预措施有效性和及时性的更好信息。尽管受访者对治疗存在焦虑，特别是侵入性或手术治疗，但较少有选择是由与“有效性”无关的情感和生活方式因素驱动的，例如对治疗的恐惧或治疗的难易程度。
