Treatment decision-making in heart failure management
File(s)
Author(s)
Welch, Sophie
Type
Thesis
Abstract
Background:
Demands for increased patient and public involvement in healthcare has led to changes in policy on decision-making. The shared decision-making (SDM) model is advocated in current health policy and encourages partnership between patients and professionals. Yet limited evidence exists of its effects on clinical outcomes and cost. As a result, a policy-practice divide has emerged. Heart failure management has adopted a more personalised approach to treatment. Yet knowing the treatment that is likely to have the best therapeutic effect does not mean it is right for that individual patient. Patients’ health decisions are influenced by a variety of factors, including their experience of illness and disease beliefs. Professionals need increased understanding of how patients make decisions to support the integration of SDM in to practice.
Purpose:
This thesis aims to explore different stakeholder perspectives of decision-making in heart failure management and to identify the barriers and facilitators to SDM.
Method:
A mixed-methods study design involving: Pan-London analyses of multidisciplinary team (MDT) meetings; a qualitative interview study analysed by thematic analysis (Glaser and Strauss, 1967); a Delphi consensus survey. Together these data inform key recommendations to improve communication about treatments and the design of future research.
Results:
The structures, functions and processes of MDT meetings varied within and across NHS Trusts. Professionals’ assumptions about patient preferences, information needs and approach to decision-making were key barriers to a SDM approach. There was agreement that patients should be involved in treatment decisions, yet there was limited consensus on the priority areas for improvements to practice.
Conclusion:
Considerable variation exists in the process of treatment decision-making and there is limited concordance between the views of patients, their families and health professionals. Professionals need to tailor their approach to treatment discussions and assess patients health information-sourcing behaviour to better support patient involvement in decision-making.
Demands for increased patient and public involvement in healthcare has led to changes in policy on decision-making. The shared decision-making (SDM) model is advocated in current health policy and encourages partnership between patients and professionals. Yet limited evidence exists of its effects on clinical outcomes and cost. As a result, a policy-practice divide has emerged. Heart failure management has adopted a more personalised approach to treatment. Yet knowing the treatment that is likely to have the best therapeutic effect does not mean it is right for that individual patient. Patients’ health decisions are influenced by a variety of factors, including their experience of illness and disease beliefs. Professionals need increased understanding of how patients make decisions to support the integration of SDM in to practice.
Purpose:
This thesis aims to explore different stakeholder perspectives of decision-making in heart failure management and to identify the barriers and facilitators to SDM.
Method:
A mixed-methods study design involving: Pan-London analyses of multidisciplinary team (MDT) meetings; a qualitative interview study analysed by thematic analysis (Glaser and Strauss, 1967); a Delphi consensus survey. Together these data inform key recommendations to improve communication about treatments and the design of future research.
Results:
The structures, functions and processes of MDT meetings varied within and across NHS Trusts. Professionals’ assumptions about patient preferences, information needs and approach to decision-making were key barriers to a SDM approach. There was agreement that patients should be involved in treatment decisions, yet there was limited consensus on the priority areas for improvements to practice.
Conclusion:
Considerable variation exists in the process of treatment decision-making and there is limited concordance between the views of patients, their families and health professionals. Professionals need to tailor their approach to treatment discussions and assess patients health information-sourcing behaviour to better support patient involvement in decision-making.
Version
Open Access
Date Issued
2019-05
Date Awarded
2019-12
Copyright Statement
Creative Commons Attribution NonCommercial NoDerivatives Licence
Advisor
Riley, Jillian
Lyon, Alexander
Publisher Department
National Heart & Lung Institute
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)