Patients' perspectives on taking warfarin: qualitative study in family practice.
BACKGROUND
Despite the well-documented benefits of using warfarin to prevent stroke, physicians remain reluctant to initiate therapy, and especially so with the elderly owing to the higher risk of hemorrhage. Prior research suggests that patients are more accepting of the risk of bleeding than are physicians, although there have been few qualitative studies. The aim of this study was to employ qualitative methods to investigate the experience and perspective of individuals taking warfarin.


METHODS
We conducted face-to-face interviews with 21 older patients (12 male, 9 female) who had been taking warfarin for a minimum of six months. Participants were patients at a family practice clinic situated in a large, tertiary care teaching hospital. We used a semistructured interview guide with four main thematic areas: decision-making, knowledge/education, impact, and satisfaction. Data were analysed according to the principles of content analysis.


CONCLUSIONS
Participants tended to have minimal input into the decision to initiate warfarin therapy, instead relying in great part on physicians' expertise. There appeared to be low retention of information received regarding the therapy; half the patients in our sample possessed only a superficial level of understanding of the risks and benefits. This notwithstanding, participants reported a high level of satisfaction with the care provided and a low level of impact on their day-to-day lives.


CONCLUSIONS
Minimal patient involvement in the initial decision and modest knowledge did not appear to diminish satisfaction with warfarin management. At the same time, care providers exert a tremendous influence on the initiation of warfarin therapy and should strive to incorporate patient preferences and expectations into the decision-making process.
Sunnybrook and Women's College Health Sciences Centre, Toronto, ON M4N 3M5 Canada. gui.dantas@utoronto.ca
Guilherme Coelho
GC
Dantas
Barbara V
BV
Thompson
Judith A
JA
Manson
C Shawn
CS
Tracy
Ross E G
RE
Upshur
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D005194:Family Practice; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010358:Patient Participation; D017060:Patient Satisfaction; D036301:Qualitative Research; D011788:Quality of Life; D014859:Warfarin / Q000627:therapeutic use*
D000925:Anticoagulants; D014859:Warfarin