title: Decision to take osteoporosis medication in patients who have had a fracture and are 'high' risk for future fracture: a qualitative study.
abstract: BACKGROUND
  Patients' values and preferences are fundamental tenets of evidence-based practice, yet current osteoporosis (OP) clinical guidelines pay little attention to these issues in therapeutic decision making. This may be in part due to the fact that few studies have examined the factors that influence the initial decision to take OP medication. The purpose of our study was to examine patients' experiences with the decision to take OP medication after they sustained a fracture.
  
  
  METHODS
  A phenomenological qualitative study was conducted with outpatients identified in a university teaching hospital fracture clinic OP program. Individuals aged 65+ who had sustained a fragility fracture within 5 years, were 'high risk' for future fracture, and were prescribed OP medication were eligible. Analysis of interview data was guided by Giorgi's methodology.
  
  
  RESULTS
  21 patients (6 males, 15 females) aged 65-88 years participated. All participants had low bone mass; 9 had OP. Fourteen patients were taking a bisphosphonate while 7 patients were taking no OP medications. For 12 participants, the decision to take OP medication occurred at the time of prescription and involved minimal contemplation (10/12 were on medication). These patients made their decision because they liked/trusted their health care provider. However, 4/10 participants in this group indicated their OP medication-taking status might change. For the remaining 9 patients, the decision was more difficult (4/9 were on medication). These patients were unconvinced by their health care provider, engaged in risk-benefit analyses using other information sources, and were concerned about side effects; 7/9 patients indicated that their OP medication-taking status might change at a later date.
  
  
  CONCLUSIONS
  Almost half of our older patients who had sustained a fracture found the decision to take OP medication a difficult one. In general, the decision was not considered permanent. Health care providers should be aware of their potential role in patients' decisions and monitor patients' decisions over time.
authors.affiliation: Mobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute, St, Michael's, Toronto, Ontario, Canada. salej@smh.ca
authors.forename: Joanna E M
authors.initials: JE
authors.lastname: Sale
authors.forename: Monique A
authors.initials: MA
authors.lastname: Gignac
authors.forename: Gillian
authors.initials: G
authors.lastname: Hawker
authors.forename: Lucy
authors.initials: L
authors.lastname: Frankel
authors.forename: Dorcas
authors.initials: D
authors.lastname: Beaton
authors.forename: Earl
authors.initials: E
authors.lastname: Bogoch
authors.forename: Victoria
authors.initials: V
authors.lastname: Elliot-Gibson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002755:Choice Behavior; D004164:Diphosphonates / Q000009:adverse effects / Q000627:therapeutic use*; D011307:Drug Prescriptions; D019317:Evidence-Based Medicine; D005260:Female; D050723:Fractures, Bone / Q000209:etiology / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D006785:Hospitals, University; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence; D009864:Ontario; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy*; D010044:Outpatient Clinics, Hospital; D010353:Patient Education as Topic; D057240:Patient Preference; D036301:Qualitative Research; D018570:Risk Assessment; D012307:Risk Factors; D055502:Secondary Prevention
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates