Patients' perception about risks and benefits of antithrombotic treatment for the prevention of venous thromboembolism (VTE) after orthopedic surgery: a qualitative study.
Patients' perception about risks and benefits of antithrombotic treatment for the prevention of venous thromboembolism (VTE) after orthopedic surgery: a qualitative study.
复制标题
DOI：
10.1186/s12891-015-0777-x
复制
发表时间：
2015-10-26
影响因子：
2.3
通讯作者：
Patorno E
中科院分区：
文献类型：
--
作者：
Najafzadeh M;Kim SC;Patterson C;Schneeweiss S;Katz JN;Brick GW;Ready JE;Polinski JM;Patorno E
第9版美国胸科医师学会抗血栓治疗和血栓预防指南强调了考虑“患者重要”结局的风险-获益比的重要性。然而，关于患者对骨科手术后抗血栓治疗的不同结局的感知和理解，以及影响他们决定使用这些治疗的因素，我们知之甚少。采用一系列半结构化访谈，我们探讨了患者对关节置换术后抗血栓治疗预防静脉血栓栓塞（VTE）的获益和风险的理解和看法。对2014年在三级护理医院（Brigham and Women's Hospital，Boston，MA）接受膝关节或髋关节置换手术的患者进行了一系列半结构化访谈。对讨论进行了记录和转录。两名研究人员独立编码和分析数据，以确定重要的主题和概念，使用不断的比较方法。在64名被邀请的患者中，12名患者（19%）完成了访谈。大多数患者（92%）知道抗血栓治疗对降低血栓风险的益处，而只有不到一半的患者对深静脉血栓形成和肺栓塞有明确的认识。虽然所有患者都知道轻微出血的风险，但只有6例患者（50%）认为大出血的风险是抗血栓治疗的可能副作用。总体而言，患者认为出血是不如血栓形成事件重要的结局。缺乏对大出血风险的认识，短期暴露不会有意义地影响出血风险的假设，以及出血是可控事件的假设影响了他们的感知。大多数患者（83%）表示，他们使用抗血栓药物的决定主要是基于对医生专业知识的信任。患者认为血栓形成事件是比出血事件更重要的结局。患者对血栓形成和出血事件的理解各不相同，可能在其偏好中起关键作用。大多数患者表示，对医生专业知识的信任对他们使用抗血栓药物的决定有很大影响。
The 9th edition of the American College of Chest Physicians’ Antithrombotic Therapy and Prevention of Thrombosis guidelines emphasize the importance of considering the risk–benefit ratio of “patient-important” outcomes. However, little is known about patients’ perception and understanding regarding the different outcomes of antithrombotic treatment after orthopedic surgery, and the factors that influence their decision to use these treatments. Using a series of semi-structured interviews, we explored patients’ understanding and perception concerning the benefits and risks of antithrombotic treatment for the prevention of venous thromboembolism (VTE) after joint replacement surgery. A series of semi-structured interviews were conducted with patients who had undergone knee or hip replacement surgery at a tertiary care hospital (Brigham and Women’s Hospital, Boston, MA) in 2014. Discussions were recorded and transcribed. Two investigators independently coded and analyzed the data to identify important themes and concepts using the constant comparative method. Of 64 patients who were invited, 12 patients (19 %) completed the interviews. The majority of patients (92 %) were aware of the benefits of antithrombotic therapy for reducing the risk of blood clots, while less than half of them had a clear understanding of deep vein thrombosis and pulmonary embolism. While all patients were aware of risk of minor bleeding, only 6 patients (50 %) considered the risk of major bleeding as a possible side effect of antithrombotic treatment. Overall, patients perceived bleeding as a less important outcome than a thrombotic event. The lack of awareness about the risk of major bleeding, the assumption that a short-term exposure would not meaningfully affect bleeding risk, and the assumption that bleeding is a controllable event influenced their perception. Most patients (83 %) stated that their decision to use antithrombotic medications was mainly based on the trust in their physician’s expertise. Patients perceived thrombotic events as more important outcomes than bleeding events. Patients’ understanding of thrombotic and bleeding events varies and may play a key role in their preferences. The majority of patients stated that trust in their physician’s expertise had a large influence on their decision to use antithrombotic medications.