title: Balancing risk versus benefit: the elderly patient's perspective on warfarin therapy.
abstract: Warfarin therapy is underused in the target at-risk elderly population. Clinicians perceive that older patients are reluctant to use this therapy, however the perspective of patients or their carers has yet to be explored.
  
  
  OBJECTIVE
  To explore in-depth the perspectives of elderly patients and/or their carers regarding the use of warfarin therapy.
  
  
  METHODS
  A qualitative study, using semi-structured group interviews was undertaken. The audio-taped discussions were transcribed verbatim, then thematically analysed to identify emergent themes. Group discussions were conducted at a major Sydney teaching hospital, over a 2-month period. Individuals aged 65 years or older (and/or their carers) who were using long-term (6 months) warfarin therapy were recruited by voluntary response to study flyers.
  
  
  RESULTS
  17 patients and carers (mean age 77.2 SD=7.5 years) participated in one of two focus groups. Five core themes emerged regarding warfarin therapy: inadequate knowledge and understanding about it, patients/carers variable experience of information provision, cycle of reactions to being on it, issues in its practical management, and the spectrum of experiences with it. Overall, participants were very accepting of the therapy, describing a high level of compliance, despite initial fears and anxieties, and a relative lack of knowledge. Patients felt somewhat abandoned in their management of warfarin due to the lack of ongoing support services in the community, and inadequate information provision.
  
  
  CONCLUSIONS
  Elderly patients and their carers appear to be quite accepting of warfarin therapy, in contrast to the perceptions of health care professionals. More effort is needed, however, in terms of information provision, particularly in the form of community-based services, to assist patients in the long-term management of warfarin.
authors.affiliation: BPharm , DipHPharm, PhD. Lecturer in Pharmacy. Research Associate, Clinical Pharmacology and Aged Care & Rehabilitation, Royal North Shore Hospital. Faculty of Pharmacy, University of Sydney ( Australia ).
authors.forename: Beata V
authors.initials: BV
authors.lastname: Bajorek
authors.affiliation: Clinical Senior Lecturer in Medicine. Head Aged Care … Rehabilitation Medicine. Department of Aged Care and Rehabilitation, Royal North Shore Hospital. St Leonards ( Australia ).
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Ogle
authors.affiliation: Former Head Department of Pharmacy, Royal North Shore Hospital. St Leonards ( Australia ).
authors.forename: Margaret J
authors.initials: MJ
authors.lastname: Duguid
authors.affiliation: Former Head Department of Clinical Pharmacology. Royal North Shore Hospital. St Leonards ( Australia ).
authors.forename: Gillian M
authors.initials: GM
authors.lastname: Shenfield
authors.affiliation: Head of Department, Pharmacy Practice, Faculty of Pharmacy, University of Sydney ( Australia ).
authors.forename: Ines
authors.initials: I
authors.lastname: Krass
keywords: Aged; Attitude to Health; Australia; Qualitative Research; Warfarin