Lane Deirdre A, Barker Rachel V, Lip Gregory Y H
University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, B18 7QH, United Kingdom.
Curr Pharm Des. 2015;21(5):533-43. doi: 10.2174/1381612820666140825125715.
Patients' beliefs about their health (and illness), medications and healthcare they receive are important determinants of whether or not they accept recommended treatments; influence their coping responses in relation to their illness; make them adhere to recommended therapy and ultimately affect health outcomes. Incorporation of patients' preferences for therapy should now be considered an integral part of the decision-making process. This gradual shift in health-care practice from paternalistic to shared-decision making, whereby there is a two-way exchange of information between the patient and healthcare provider and both are involved in the treatment decision, requires a reasonable level of understanding and knowledge of the condition and its treatment by the patient. However, patients with atrial fibrillation (AF) often have poor knowledge about their condition and the benefits and risks of AF and AF treatments. Physicians and other healthcare providers may have doubts over a patient's ability to adhere to certain treatment regimens, particularly oral anticoagulation, due in part to the lack of patient knowledge, and this may be an important determinant of whether such treatments are even considered as therapeutic options. Further, patients often hold misconceptions about AF and treatment options, which may act as barriers to their acceptance of the condition and adherence to therapy. This review will summarise the literature on the knowledge of patients about AF and its management, how patients' values and preferences can impact on their treatment choices, the ideal components of patient education, the impact of educational interventions on patients' knowledge and perceptions of AF, and where appropriate highlight specific issues facing lone AF patients.
患者对自身健康(及疾病)、所服用药物和接受的医疗保健的看法,是决定他们是否接受推荐治疗的重要因素;影响他们针对疾病的应对方式;促使他们坚持推荐的治疗方法,并最终影响健康结果。现在,将患者对治疗的偏好纳入决策过程应被视为其中不可或缺的一部分。医疗保健实践从家长式决策逐渐转向共同决策,即患者与医疗保健提供者之间进行双向信息交流,双方共同参与治疗决策,这要求患者对病情及其治疗有一定程度的理解和认识。然而,心房颤动(AF)患者通常对自己的病情以及房颤及其治疗的益处和风险了解甚少。医生和其他医疗保健提供者可能会怀疑患者坚持某些治疗方案的能力,尤其是口服抗凝治疗,部分原因是患者缺乏相关知识,而这可能是此类治疗是否被视为治疗选择的一个重要决定因素。此外,患者对房颤和治疗选择常常存在误解,这可能成为他们接受病情并坚持治疗的障碍。本综述将总结关于患者对房颤及其管理的了解、患者的价值观和偏好如何影响其治疗选择、患者教育的理想组成部分、教育干预对患者对房颤的知识和认知的影响等方面的文献,并在适当情况下突出独居房颤患者面临的具体问题。