Researchers from the College of Health and the Department of Primary Care at the Royal Free and University College Medical School, London, assessed older people's experience of heart disease treatment.
Included in the study were 38 people aged 56 and older, who belonged to five different local heart support groups from differing areas of affluence across London. All of them had been diagnosed with coronary artery disease. They discussed understanding of risk, treatment preferences, and the impact of different treatments on their quality of life. Their comments were analysed and distilled to identify key themes.
The results showed that there was little evidence of shared decision making among doctors and patients. Older patients preferred the doctor to make the decisions for them. But many of the patients were simply not involved, just told how they would be treated. A lack of information about their medical condition and treatment options, and a poor understanding of risk meant that they were unable to make fully informed choices about their care, the comments showed.
Many patients felt that a cardiologist would have been the only person to tell them what they needed to know about surgery and drugs. But difficulties obtaining a referral and lengthy waiting times put this out of their reach for many. Several patients felt discriminated against because of their age.
The authors comment: "Where quality of life and life expectancy issues are an important consideration, patients' informed preferences should be as important in health care decisions as the body of evidence on the clinical effectiveness and costs of a procedure." Because older patients tend to defer to the doctor, does not mean that they are happy with their treatment, say the authors.
[Suffering in deference: a focus groups study of older cardiac patients' preferences for treatment and perceptions of risk 2001; 10 (supplement) ; i23-8]
Journal
Quality in Health Care