A qualitative study of clinical decision-making in a multidisciplinary outpatient clinic for patients with atrial fibrillation - from the patient’s perspective

Abstract

Background: International studies show that patient involvement in clinical decision-making has a positive effect on patients’ experiences of quality and on their adherence to the initiated treatment. Studies also demonstrate that patients are becoming more interested in engaging in decision-making processes. While patient involvement in decision-making plays an important role in the newest European guidelines for treatment of patients with atrial fibrillation, recent research points to the challenges associated with this ideal. The aim of the present study was to determine how patients with newly diagnosed atrial fibrillation experienced the clinical decision-making process in outpatient treatment courses.Methods: The study had a qualitative research design. Data were generated by means of fieldwork in which the researcher participated in outpatient consultations with participating patients. Field notes were supplemented with semi-structured individual interviews. Fourteen patients (7 women and 7 men) between the ages of 40 to 82 were included. The empirical data were analyzed and interpreted according to Ricoeur’s interpretation theory.Results: Three main themes were identified: (1) Lack of prerequisites for patient involvement in decision-making at the first consultation; (2) Limited patient involvement in the anticoagulant choice and (3) Lack of follow-up on the patient’s understanding of illness and treatment. Conclusion: The data showed that the medical aspects of the patients’ illness were most often the focus of attention, whereas the patients’ own experiences, needs and preferences were not systematically included in the decision-making process.