ATRIAL FIBRILLATION PATIENTS' EXPERIENCES AND PERSPECTIVES OF ANTICOAGULATION THERAPY CHANGES: A PHENOMENOLOGICAL QUALITATIVE STUDY
CCC ePoster Library. Loewen P. 10/26/19; 280508; 243
Dr. Peter Loewen
Dr. Peter Loewen
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Abstract
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BACKGROUND: Atrial fibrillation (AF) patients' experiences with changes in their oral anticoagulant (OAC) therapy are understudied. The objective of this study was to describe AF patients' experiences and perspectives of changes made to their OAC therapy (switches or discontinuations) using the phenomenological approach.

METHODS AND RESULTS: We retrospectively analyzed systematically-collected qualitative data from AF patients who experienced a therapy change (switching or stopping an OAC) as part of their participation in a large 2-year prospective observational study. We analyzed transcripts using a phenomenological approach involving: data immersion, bracketing and phenomenological reduction, delineating units of meaning, forming themes, summarizing each interview, extracting themes and making a composite summary. 56 participants met our inclusion criteria. Six themes emerged from the data: 1. reasons for switch or discontinuation of therapy, 2. Attitudes towards changes in therapy attributes, 3. challenges with taking medications after therapy change, 4. relief from perceived burden of medication after discontinuation, 5. patients' limited involvement in decision making, and 6. inadequate education and follow up. Some patients were ambivalent about changes in therapy, but most had strong, sometimes complex, underlying feelings and opinions about it. Positive experiences mostly resulted from OAC discontinuation. Negative experiences resulted from absence of shared decision making, lack of education and followup, perceived non-clinical motives behind therapy, and adherence challenges after therapy change.

CONCLUSION: Patients' experiences with therapy switches can affect their perception of their healthcare providers, and medications and hence their adherence. There are clear opportunities to address these issues through improved shared decision making and patient education/counselling.
BACKGROUND: Atrial fibrillation (AF) patients' experiences with changes in their oral anticoagulant (OAC) therapy are understudied. The objective of this study was to describe AF patients' experiences and perspectives of changes made to their OAC therapy (switches or discontinuations) using the phenomenological approach.

METHODS AND RESULTS: We retrospectively analyzed systematically-collected qualitative data from AF patients who experienced a therapy change (switching or stopping an OAC) as part of their participation in a large 2-year prospective observational study. We analyzed transcripts using a phenomenological approach involving: data immersion, bracketing and phenomenological reduction, delineating units of meaning, forming themes, summarizing each interview, extracting themes and making a composite summary. 56 participants met our inclusion criteria. Six themes emerged from the data: 1. reasons for switch or discontinuation of therapy, 2. Attitudes towards changes in therapy attributes, 3. challenges with taking medications after therapy change, 4. relief from perceived burden of medication after discontinuation, 5. patients' limited involvement in decision making, and 6. inadequate education and follow up. Some patients were ambivalent about changes in therapy, but most had strong, sometimes complex, underlying feelings and opinions about it. Positive experiences mostly resulted from OAC discontinuation. Negative experiences resulted from absence of shared decision making, lack of education and followup, perceived non-clinical motives behind therapy, and adherence challenges after therapy change.

CONCLUSION: Patients' experiences with therapy switches can affect their perception of their healthcare providers, and medications and hence their adherence. There are clear opportunities to address these issues through improved shared decision making and patient education/counselling.
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