Interactional resistance between patients with atrial fibrillation and cardiologists in consultation on treatment with warfarin: the value of shared decision-making

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Published: Sep 11, 2012
DOI: https://doi.org/10.5750/ijpcm.v2i3.263
Keywords:
Atrial fibrillation communication patient choice patient participation person-centered medicine resistance interaction shared decision- making warfarin

Main Article Content

Eleni Siouta
Lecturer, Department of Nursing Science, School of Health Sciences, Jönköping University,Jönköping, Sweden
Berith Hedberg
Care Controller, Ryhov County Hospital, Jönköping and Senior Lecturer, The Research School of Health and Welfare, School of Health Sciences, Jönköping University, Jönköping, Sweden
Karl Hedman Karl Hedman
PhD Candidate. Department of Sociology, Lund University and Director of International Relations, School of Health Sciences, Jönköping University, Jönköping, Sweden
Anders Brostrom
Associate Professor. Department of Nursing Science, School of Health Sciences, Jönköping University, Jönköping and Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden

Abstract

Rationale: Atrial fibrillation (AF) increases the risk of stroke and it can be reduced by treatment with warfarin. Some patients consider that warfarin is a stressful treatment with undesired effects and the perceived barriers include unwillingness to take it. Knowledge of patients resisting warfarin treatment may be useful for the potential threat to maintaining shared decision-making in the consultation as a central tenet of person-centered medicine.Aims and objectives: To identify how patients resist treatment with warfarin and how cardiologists respond to patients’ resistance. The co-constructive perspective of this work analyses the consultations by emphasizing the clinical communication strategies of both patients and cardiologists.Method: Eleven videotaped consultations, in 4 different hospitals, were selected for analysis. Treatment interactions regarding warfarin between patients with AF and cardiologists were analysed, according to the methodology of conversation analysis.Results: There were 4 types of resistance from patients for accepting treatment with warfarin. These included “Giving reasons for their resistance”, “Suggestion of another treatment option by the patient”, “Stating a treatment preference” and “Questioning or challenging the cardiologist’s treatment recommendation”. The cardiologists’ responses to the patients’ resistance included “Repeating the treatment recommendation”, “Negotiation with the patient”, “Providing additional information on the recommended treatment” and “Extending the explanation for the purpose of taking the treatment”.Conclusions: By showing resistance, patients are thought to want to participate in their treatment decisions and an awareness of patients’ resistance to treatment enables cardiologists to address the patients’ experience-based views on their treatment and individual concerns as part of clinical strategies to increase the person-centeredness of medical intervention.

Article Details

Issue
Vol. 2 No. 3 (2012): September
Section
Shared Decision Making

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