Borg Xuereb Christian, Shaw Rachel L, Lane Deirdre A
a School of Health and Life Sciences , Aston University , Birmingham , UK.
b Faculty of Social Wellbeing, Department of Psychology , University of Malta , Msida , Malta.
Psychol Health. 2016;31(4):436-55. doi: 10.1080/08870446.2015.1116534. Epub 2015 Dec 21.
To explore patients' and physicians' experiences of atrial fibrillation (AF) consultations and oral anticoagulation decision-making.
Multi-perspective interpretative phenomenological analyses.
Participants included small homogeneous subgroups: AF patients who accepted (n = 4), refused (n = 4) or discontinued (n = 3) warfarin, and four physician subgroups (n = 4 each group): consultant cardiologists, consultant general physicians, general practitioners and cardiology registrars. Semi-structured interviews were conducted. Transcripts were analysed using multi-perspective interpretative phenomenological analysis (IPA) analyses to attend to individuals within subgroups and making comparisons within and between groups.
Three themes represented patients' experiences: Positioning within the physician-patient dyad, Health-life balance, and Drug myths and fear of stroke. Physicians' accounts generated three themes: Mechanised metaphors and probabilities, Navigating toward the 'right' decision and Negotiating systemic factors.
This multi-perspective IPA design facilitated an understanding of the diagnostic consultation and treatment decision-making which foregrounded patients' and physicians' experiences. We drew on Habermas' theory of communicative action to recommend broadening the content within consultations and shifting the focus to patients' life contexts. Interventions including specialist multidisciplinary teams, flexible management in primary care and multifaceted interventions for information provision may enable the creation of an environment that supports genuine patient involvement and participatory decision-making.
探讨患者和医生在房颤（AF）会诊及口服抗凝药决策方面的经历。
多视角解释现象学分析。
参与者包括同质的小亚组：接受华法林治疗的房颤患者（n = 4）、拒绝使用华法林的房颤患者（n = 4）或停用华法林的房颤患者（n = 3），以及四个医生亚组（每组n = 4）：心内科顾问医生、全科顾问医生、全科医生和心内科住院医生。进行了半结构化访谈。使用多视角解释现象学分析（IPA）对访谈记录进行分析，以关注亚组内的个体，并在组内和组间进行比较。
三个主题代表了患者的经历：医患二元关系中的定位、健康与生活平衡以及药物误区与对中风的恐惧。医生的描述产生了三个主题：机械隐喻与概率、朝着“正确”决策前进以及应对系统因素。
这种多视角IPA设计有助于理解诊断会诊和治疗决策，突出了患者和医生的经历。我们借鉴哈贝马斯的交往行为理论，建议拓宽会诊内容，并将重点转向患者的生活背景。包括专科多学科团队、初级保健中的灵活管理以及多方面信息提供干预措施在内的干预手段，可能有助于营造一个支持患者真正参与和共同决策的环境。
