title: Qualitative analysis of patient-centered decision attributes associated with initiating hepatitis C treatment.
abstract: BACKGROUND
  In this era of a constantly changing landscape of antiviral treatment options for chronic viral hepatitis C (CHC), shared clinical decision-making addresses the need to engage patients in complex treatment decisions. However, little is known about the decision attributes that CHC patients consider when making treatment decisions. We identify key patient-centered decision attributes, and explore relationships among these attributes, to help inform the development of a future CHC shared decision-making aid.
  
  
  METHODS
  Semi-structured qualitative interviews with CHC patients at four Veterans Health Administration (VHA) hospitals, in three comparison groups: contemplating CHC treatment at the time of data collection (Group 1), recently declined CHC treatment (Group 2), or recently started CHC treatment (Group 3). Participant descriptions of decision attributes were analyzed for the entire sample as well as by patient group and by gender.
  
  
  RESULTS
  Twenty-nine Veteran patients participated (21 males, eight females): 12 were contemplating treatment, nine had recently declined treatment, and eight had recently started treatment. Patients on average described eight (range 5-13) decision attributes. The attributes most frequently reported overall were: physical side effects (83%); treatment efficacy (79%), new treatment drugs in development (55%); psychological side effects (55%); and condition of the liver (52%), with some variation based on group and gender. Personal life circumstance attributes (such as availability of family support and the burden of financial responsibilities) influencing treatment decisions were also noted by all participants. Multiple decision attributes were interrelated in highly complex ways.
  
  
  CONCLUSIONS
  Participants considered numerous attributes in their CHC treatment decisions. A better understanding of these attributes that influence patient decision-making is crucial in order to inform patient-centered clinical approaches to care (such as shared decision-making augmented with relevant decision-making aids) that respond to patients' needs, preferences, and circumstances.
authors.affiliation: VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, 16111 Plummer St. Bldg. 25, North Hills, CA, 91343, USA. Jessica.Zuchowski@va.gov.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Zuchowski
authors.affiliation: VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, 16111 Plummer St. Bldg. 25, North Hills, CA, 91343, USA. alisonh@ucla.edu.|Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA. alisonh@ucla.edu.
authors.forename: Alison B
authors.initials: AB
authors.lastname: Hamilton
authors.affiliation: Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR, 72114, USA. Jeffrey.Pyne@va.gov.|Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4300 West 7th Street, Little Rock, AR, 72205, USA. Jeffrey.Pyne@va.gov.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Pyne
authors.affiliation: Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Rd, Bedford, MA, 01730, USA. jaclark@bu.edu.|Department of Health Policy and Management, Boston University School of Public Health, 715 Albany St. #358w, Boston, MA, 02118, USA. jaclark@bu.edu.
authors.forename: Jack A
authors.initials: JA
authors.lastname: Clark
authors.affiliation: VA HSR&D Center for Innovations in Quality, Effectiveness & Safety, Michael E DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX, 77030, USA. anail@bcm.edu.|Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA. anail@bcm.edu.
authors.forename: Aanand D
authors.initials: AD
authors.lastname: Naik
authors.affiliation: VA HSR&D Center for Innovations in Quality, Effectiveness & Safety, Michael E DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX, 77030, USA. Donna.Smithd19d7@va.gov.
authors.forename: Donna L
authors.initials: DL
authors.lastname: Smith
authors.affiliation: VA HSR&D Center for Innovations in Quality, Effectiveness & Safety, Michael E DeBakey VA Medical Center, 2002 Holcombe Boulevard, Houston, TX, 77030, USA. Fasiha.Kanwal@va.gov.|Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA. Fasiha.Kanwal@va.gov.
authors.forename: Fasiha
authors.initials: F
authors.lastname: Kanwal
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D003657:Decision Making; D005260:Female; D006304:Health Status; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D018802:Patient-Centered Care; D018907:Privacy; D036301:Qualitative Research; D012720:Severity of Illness Index; D057545:Social Stigma; D012944:Social Support; D016312:Treatment Refusal
chemical_list: D000998:Antiviral Agents