Decisional Needs and Patient Treatment Preferences for Heart Failure Medications: A Scoping Review
CJC Open, ISSN: 2589-790X, Vol: 5, Issue: 2, Page: 136-147
2023
- 6Citations
- 29Captures
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Metrics Details
- Citations6
- Citation Indexes6
- CrossRef2
- Captures29
- Readers29
- 29
Review Description
Pharmacologic management of heart failure with reduced ejection fraction (HFrEF) involves several medications. Decision aids informed by patient decisional needs and treatment preferences could assist in making HFrEF medication choices; however, these are largely unknown. We searched MEDLINE, Embase, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), without language restriction, for qualitative, quantitative, and mixed-method studies that included patients with HFrEF or clinicians providing HFrEF care, and reported data on decisional needs or treatment preferences applicable to HFrEF medications. We classified decisional needs using a modified version of the Ottawa Decision Support Framework (ODSF). From 3996 records, we included 16 reports describing 13 studies (n = 854). No study explicitly assessed ODSF decisional needs; however, 11 studies reported ODSF-classifiable data. Patients commonly reported having inadequate knowledge or information, and difficult decisional roles. No study systematically assessed treatment preferences, but 6 studies reported on attribute preferences. Reducing mortality and improving symptoms frequently were ranked as being important, whereas cost importance rankings varied, and adverse events generally were ranked as being less important. This scoping review identified key decisional needs regarding HFrEF medications, notably inadequate knowledge or information, and difficult decisional roles, which can readily be addressed by decision aids. Future studies should systematically explore the full scope of ODSF-based decisional needs in patients with HFrEF, along with relative preferences among treatment attributes to further inform development of individualized decision aids. La prise en charge pharmacologique de l’insuffisance cardiaque avec fraction d’éjection réduite (ICFER) peut être réalisée à l’aide de plusieurs médicaments. Des outils d’aide à la décision reposant sur les besoins décisionnels et les préférences thérapeutiques des patients pourraient faciliter le choix des médicaments dans les cas d’ICFER. Malheureusement, ce type d’outils demeure largement inconnu. Nous avons interrogé les bases de données MEDLINE, Embase et Cumulative Index to Nursing and Allied Health Literature (CINAHL), sans restriction quant à la langue, pour trouver des études qualitatives, quantitatives et mixtes incluant des patients atteints d’ICFER ou des cliniciens prodiguant des soins aux personnes atteintes d’ICFER. Nous avons recueilli les données sur les besoins décisionnels ou les préférences thérapeutiques qui s’appliquaient aux médicaments contre l’ICFER, puis avons classé les besoins décisionnels à l’aide d’une version modifiée du Modèle d’aide à la décision d’Ottawa (MADO). Sur un total de 3996 résultats, nous avons retenu 16 rapports décrivant 13 études (n = 854). Aucune étude n’évaluait explicitement les besoins décisionnels selon le MADO, mais 11 études faisaient état de données qu’il était possible de classer selon ce modèle. Les patients ont fréquemment mentionné avoir des connaissances ou des informations inadéquates et un rôle décisionnel difficile. Aucune étude n’évaluait systématiquement les préférences de traitement, mais six études ont rapporté des préférences quant aux attributs du traitement. La réduction de la mortalité et l’atténuation des symptômes étaient souvent classées comme importantes, les coûts faisaient l’objet d’un classement variable et les événements indésirables étaient généralement classés comme étant peu importants. Cette revue exploratoire a permis de relever des besoins décisionnels clés concernant les médicaments contre l’ICFER, notamment des connaissances et des informations inadéquates, et un rôle décisionnel difficile, besoins qui peuvent facilement être comblés par des outils d’aide à la décision. De futures études devraient explorer de manière systématique la portée complète des besoins décisionnels des patients atteints d’ICFER selon le MADO, ainsi que les préférences relatives quant aux attributs du traitement pour orienter l’élaboration d’outils personnalisés d’aide à la décision.
Bibliographic Details
http://www.sciencedirect.com/science/article/pii/S2589790X22002505; http://dx.doi.org/10.1016/j.cjco.2022.11.013; http://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=85147117017&origin=inward; http://www.ncbi.nlm.nih.gov/pubmed/36880079; https://linkinghub.elsevier.com/retrieve/pii/S2589790X22002505; https://dx.doi.org/10.1016/j.cjco.2022.11.013
Elsevier BV
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