Mayo Clinic Evidence-Based Practice Center, Rochester, Minnesota, USA.
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA.
Headache. 2023 Feb;63(2):185-201. doi: 10.1111/head.14430. Epub 2023 Jan 5.
We aimed to identify migraine treatment features preferred by patients and treatment outcomes most valued by patients.
The values and preferences of people living with migraine are critical for both the choice of acute therapy and management approach of migraine.
We conducted a qualitative evidence synthesis. Two reviewers independently selected studies, appraised methodological quality, and undertook a framework synthesis. We developed summary of findings tables following the approach of Grading of Recommendations, Assessment, Development and Evaluations Confidence in the Evidence from Reviews of Qualitative Research to assess confidence in the findings.
Of 1691 candidate references, we included 19 studies (21 publications) involving 459 patients. The studies mostly recruited White women from North America (11 studies) and Europe (8 studies). We identified eight themes encompassing features preferred by patients in a migraine treatment process. Themes described a treatment process that included shared decision-making, a tailored approach, trust in health-care professionals, sharing of knowledge and diversity of treatment options, a holistic approach that does not just address the headache, ease of communication especially for complex treatments, a non-undermining approach, and reciprocity with mutual respect between patient and provider. In terms of the treatment itself, seven themes emerged including patients' preferences for nonpharmacologic treatment, high effectiveness, rapidity of action, long-lasting effect, lower cost and more accessibility, self-management/self-delivery option that increases autonomy, and a mixed preference for abortive versus prophylactic treatments. The treatment outcomes that have high value to patients included maintaining or improving function; avoiding side effects, potential for addiction to medications, and pain reoccurrence; and avoiding non-headache symptoms such as nausea, vomiting, and sensitivity to light or sounds.
Patient values and preferences were individually constructed, varied widely, and could be at odds with conventional medical perspectives and evidence of treatment effects. Considering the availability of numerous treatments for acute migraine, it is necessary that decision-making incorporates patient values and preferences identified in qualitative research. The findings of this qualitative synthesis can be used to facilitate an individually tailored approach, strengthen the patient-health-care system relationship, and guide choices and decisions in the context of a clinical encounter or a clinical practice guideline.
我们旨在确定患者首选的偏头痛治疗特征和最看重的治疗结果。
患有偏头痛的人价值观和偏好对于急性治疗的选择和偏头痛的管理方法都至关重要。
我们进行了定性证据综合。两位评审员独立选择研究，评估方法学质量，并进行框架综合。我们按照从定性研究中评价证据的推荐、评估、发展和评估的置信度方法制定总结发现表，以评估发现的置信度。
在 1691 个候选参考文献中，我们纳入了 19 项研究（21 篇文献），涉及 459 名患者。这些研究大多招募了来自北美（11 项研究）和欧洲（8 项研究）的白人女性。我们确定了患者在偏头痛治疗过程中首选的八项主题。这些主题描述了一个治疗过程，包括共同决策、量身定制的方法、对医疗保健专业人员的信任、知识共享和治疗选择的多样性、不仅仅针对头痛的整体方法、特别是对于复杂治疗方法的轻松沟通、不贬低的方法以及患者与提供者之间相互尊重的互惠关系。就治疗本身而言，出现了七个主题，包括患者对非药物治疗、高疗效、起效快、长效、低成本和更易获得、增加自主性的自我管理/自我给药选择以及对急性治疗和预防性治疗的混合偏好的偏好。对患者具有高价值的治疗结果包括保持或改善功能；避免副作用、对药物成瘾的潜在风险、疼痛复发；以及避免非头痛症状，如恶心、呕吐和对光或声音敏感。
患者的价值观和偏好因人而异，差异很大，并且可能与传统的医学观点和治疗效果证据相冲突。考虑到急性偏头痛有许多治疗方法，决策必须纳入定性研究中确定的患者价值观和偏好。这项定性综合研究的结果可用于促进个体化方法、加强患者-医疗保健系统关系，并在临床遇到或临床实践指南的背景下指导选择和决策。
