How do patients with hypertension or chronic heart failure contribute to healthcare choices in consultations? A qualitative evidence synthesis.

Problem

Shared decision making (SDM) is a process by which healthcare professionals and patients work together to make choices about the patient’s healthcare. Although widely advocated, SDM has not been embedded in routine healthcare. To achieve SDM, both patient and clinician must contribute to the decision making process. Accounts of the patient contribution to healthcare encounters are limited, and we found no systematic reviews addressing this.

This review focuses on two conditions, chosen to explore the range of experiences of patients. Hypertension is a typically asymptomatic risk factor for cardiovascular disease, in which treatment seeks to lower the risk of future events. By contrast, chronic heart failure is typically symptomatic, life-limiting and affects more elderly and multimorbid patients; treatment seeks to ameliorate symptoms and lower the risk of future healthcare events. We sought to develop conceptual understanding of how patients contribute to consultations about these two common healthcare conditions, in order to understand how patient participation can be better supported.

Approach

A comprehensive search strategy to identify both published and unpublished studies, including grey literature sources. Reports will be included if they use qualitative methods of data collection and analysis, provide qualitative data, are written in English and meet the inclusion criteria. Title and abstracts and subsequently full texts will be screened against inclusion criteria:

Setting: Any healthcare setting;

Perspective: People with high blood pressure or heart failure (or both) and / or their healthcare professionals;

Phenomena of interest: i. Contribution of patients to healthcare encounters in which healthcare choices are being considered, in studies based either on direct observation or on the accounts of either healthcare professionals or patients.

ii. Ways in which patient contribution to consultations is facilitated by healthcare professionals.

ii. The amount and type of contributions made my patients in this context.

Comparison: Healthcare professional report, patient report, direct observation.

Evaluation: i. Nature of patient contribution ii. Impact of patient contribution to healthcare encounters on how healthcare choices are explored and, where applicable, on decision making within the healthcare encounter.

If the data is sufficiently rich and will sustain interpretive approaches, a meta-ethnography is planned. Should the data be insufficiently rich to sustain interpretive approaches, methods of thematic synthesis will be used

Findings

We will report the following data from included studies: condition (heart failure or high blood pressure), population, healthcare setting, study methods, theoretical framework, model of SDM, and results of the qualitative synthesis.

Consequences

This review aims to develop conceptual understanding of how patients contribute to consultations about two common healthcare conditions, in order to understand how patient participation in healthcare choices can be supported. The findings will inform a qualitative study investigating patient and healthcare professional experiences of SDM.