Shared Decisions: A Qualitative Study on Clinician and Patient Perspectives on Statin Therapy and Statin-Associated Side Effects.
Shared Decisions: A Qualitative Study on Clinician and Patient Perspectives on Statin Therapy and Statin-Associated Side Effects.
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DOI：
10.1161/jaha.120.017915
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发表时间：
2020-11-17
影响因子：
5.4
通讯作者：
Virani SS
中科院分区：
文献类型：
--
作者：
Ahmed ST;Akeroyd JM;Mahtta D;Street R;Slagle J;Navar AM;Stone NJ;Ballantyne CM;Petersen LA;Virani SS
尽管指南推荐和临床试验数据表明获益，但他汀类药物治疗动脉粥样硬化性心血管疾病患者仍不理想。本研究的目的是了解临床医生和患者对他汀类药物治疗、他汀类药物相关副作用（SASE）、SASE管理以及围绕他汀类药物风险和获益的沟通的看法。我们对患有SASE的动脉粥样硬化性心血管疾病患者（n=17）和定期开他汀类药物的临床医生（n=20）进行了定性访谈。我们使用Atlas.ti软件辅助的定向内容分析，开发和修订临床医生和患者访谈的代码簿。最相关的代码被“堆排序”为5个主要主题领域：（1）SASE在严重程度、持续时间和发作时间方面各不相同;（2）临床医生围绕他汀类药物和SASE的沟通实践是可变的，并受到临床医生时间限制和患者对SASE的先入为主的观念的影响;（3）尽管“试错法”管理SASE可能有效地允许临床医生让患有动脉粥样硬化性心血管疾病的患者继续服用他汀类药物，但这可能会让患者感到沮丧;（4）外部来源，如媒体、互联网、社交网络和社交圈，影响患者的看法，并经常影响风险受益讨论;（5）决策辅助工具有助于促进临床医生围绕SASE做出决策，并与患者讨论SASE。由于各种患者和临床医生相关因素，他汀类药物在动脉粥样硬化性心血管疾病患者中的使用仍不理想。开发决策辅助工具以促进SASE的讨论、临床医生决策和SASE管理可能会改善他汀类药物在该高危人群中的使用。
Despite guideline recommendations and clinical trial data suggesting benefit, statin therapy use in patients with atherosclerotic cardiovascular disease remains suboptimal. The aim of this study was to understand clinician and patient views on statin therapy, statin‐associated side effects (SASEs), SASE management, and communication around statin risks and benefits. We conducted qualitative interviews of patients with atherosclerotic cardiovascular disease who had SASEs (n=17) and clinicians who regularly prescribe statins (n=20). We used directed content analysis, facilitated by Atlas.ti software, to develop and revise codebooks for clinician and patient interviews. The most relevant codes were “pile sorted” into 5 main topic domains: (1) SASEs vary in severity, duration, and time of onset; (2) communication practices by clinicians around statins and SASEs are variable and impacted by clinician time limitations and patient preconceived notions of SASEs; (3) although a “trial and error” approach to managing SASEs may be effective in allowing clinicians to keep patients with atherosclerotic cardiovascular disease on a statin, it can be frustrating for patients; (4) outside sources, such as the media, internet, social networks, and social circles, influence patients' perceptions and often impact the risk benefit discussion; and (5) a decision aid would be beneficial in facilitating clinician decision‐making around SASEs and discussion of SASEs with the patients. Statin use among patients with atherosclerotic cardiovascular disease remains suboptimal because of various patient‐ and clinician‐related factors. The development of a decision aid to facilitate discussion of SASEs, clinician decision‐making, and SASE management may improve statin use in this high‐risk population.