title: Complexities of patient choice in cardiac rehabilitation: qualitative findings.
abstract: OBJECTIVE
  This paper is a report of a study of the choices patients make when offered home-based or hospital-based cardiac rehabilitation.
  
  
  BACKGROUND
  In some countries, patients may be offered a choice of home-based or hospital-based cardiac rehabilitation. While evaluating a home-based programme, Road to Recovery, developed by the British Heart Foundation, we examined patients' experiences of being offered this choice.
  
  
  METHODS
  Interviews were conducted with 35 patients and 12 staff members delivering the pilot programme in five rehabilitation services during 2006-2008.
  
  
  RESULTS
  While the staff members interviewed reported that all patients were given a clear choice between a home-based and hospital-based or community-based programme, this choice was less clear-cut in the patient interviews. When choice was offered, the choice of a home-based programme was often based on constraints rather than on being a positive choice. Obstacles patients faced in making the choice included lack of information on which to base a choice; inadequate systems of referral; insufficient appropriately trained staff; restricted choice of times to attend the hospital programmes; the geographical location of services and restrictive socio-economic factors (inflexible working hours, access to transport).
  
  
  CONCLUSIONS
  The possibility of informed choice relies in the first instance on the availability and accessibility of appropriate services. Nurses need awareness and commitment to finding out about and overcoming obstacles that impede patient participation in cardiac rehabilitation. Only in this manner will it be possible to fulfil the calls in national and some international clinical guidelines for 'individualized' or 'menu-based' programmes tailored to specific patient needs.
authors.affiliation: Wounds Group, Department of Health Sciences, University of York, UK. mm538@york.ac.uk
authors.forename: Mary
authors.initials: M
authors.lastname: Madden
authors.forename: Gill
authors.initials: G
authors.lastname: Furze
authors.forename: Robert J P
authors.initials: RJ
authors.lastname: Lewin
mesh_terms: D000328:Adult; D000368:Aged; D002755:Choice Behavior; D003327:Coronary Disease / Q000517:prevention & control / Q000534:rehabilitation*; D005260:Female; D006297:Health Services Accessibility; D006699:Home Care Services; D006801:Humans; D008297:Male; D008875:Middle Aged; D015403:Nursing Evaluation Research; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D057240:Patient Preference; D036301:Qualitative Research; D012047:Rehabilitation Centers; D013222:State Medicine / Q000458:organization & administration; D006113:United Kingdom