title: Patients' and physicians' experiences of atrial fibrillation consultations and anticoagulation decision-making: A multi-perspective IPA design.
abstract: OBJECTIVE
  To explore patients' and physicians' experiences of atrial fibrillation (AF) consultations and oral anticoagulation decision-making.
  
  
  METHODS
  Multi-perspective interpretative phenomenological analyses.
  
  
  METHODS
  Participants included small homogeneous subgroups: AF patients who accepted (n = 4), refused (n = 4) or discontinued (n = 3) warfarin, and four physician subgroups (n = 4 each group): consultant cardiologists, consultant general physicians, general practitioners and cardiology registrars. Semi-structured interviews were conducted. Transcripts were analysed using multi-perspective interpretative phenomenological analysis (IPA) analyses to attend to individuals within subgroups and making comparisons within and between groups.
  
  
  RESULTS
  Three themes represented patients' experiences: Positioning within the physician-patient dyad, Health-life balance, and Drug myths and fear of stroke. Physicians' accounts generated three themes: Mechanised metaphors and probabilities, Navigating toward the 'right' decision and Negotiating systemic factors.
  
  
  CONCLUSIONS
  This multi-perspective IPA design facilitated an understanding of the diagnostic consultation and treatment decision-making which foregrounded patients' and physicians' experiences. We drew on Habermas' theory of communicative action to recommend broadening the content within consultations and shifting the focus to patients' life contexts. Interventions including specialist multidisciplinary teams, flexible management in primary care and multifaceted interventions for information provision may enable the creation of an environment that supports genuine patient involvement and participatory decision-making.
authors.affiliation: a School of Health and Life Sciences , Aston University , Birmingham , UK.|b Faculty of Social Wellbeing, Department of Psychology , University of Malta , Msida , Malta.
authors.forename: Christian
authors.initials: C
authors.lastname: Borg Xuereb
authors.affiliation: a School of Health and Life Sciences , Aston University , Birmingham , UK.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Shaw
authors.affiliation: c University of Birmingham Institute for Cardiovascular Sciences, City Hospital , Birmingham , UK.
authors.forename: Deirdre A
authors.initials: DA
authors.lastname: Lane
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000628:therapy*; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D003142:Communication; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D010361:Patients / Q000523:psychology* / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology* / Q000706:statistics & numerical data; D036301:Qualitative Research; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: atrial fibrillation; decision-making; interpretative phenomenological analysis; medication adherence; oral anticoagulation; qualitative research