Avoidance hierarchies and preferences for anticoagulation--semi-qualitative analysis of older patients' views about stroke prevention and the use of warfarin.
OBJECTIVE
To examine older patients' preferences regarding the use of warfarin to prevent atrial fibrillation related strokes when faced with cumulative probabilities of treatment risk and benefit.


METHODS
A semi-qualitative researcher administered questionnaire and interview.


METHODS
81 patients attending a general elderly medicine outpatient clinic.


RESULTS
Up to 50% of participants would decline warfarin treatment when shown both cumulative benefits of stroke risk reduction and risk of intracerebral haemorrhage. Principal themes highlighted concepts of gambling and trade offs relating to risk and benefit. Attitudes about stroke and negative perceptions of intracerebral haemorrhage were major contributory themes in the decision to refuse warfarin treatment.


CONCLUSIONS
Older people use very individualistic health beliefs in judging how to trade risks to preserve quality of life. Carefully explaining risk information and listening to elders' views and reasoning is likely to result in a more informed choice regarding the use of anticoagulation in stroke prevention.
Fuller
Richard
R
Medical Department for the Elderly, The General Infirmary, Leeds LS1 3EX, UK. Ftworf@aol.com
Dudley
Nigel
N
Blacktop
Jon
J
D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D001294:Attitude to Health; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000523:psychology; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D020521:Stroke / Q000517:prevention & control* / Q000523:psychology*; D011795:Surveys and Questionnaires; D014859:Warfarin / Q000009:adverse effects* / Q000627:therapeutic use
D000925:Anticoagulants; D014859:Warfarin