Alignment of Doctors' Understanding of Treatment Burden Priorities and Chronic Heart Failure Patients' Experiences: A Nominal Group Technique Consultation

Magnolia Cardona; Adem Sav; Zoe A Michaleff; Sarah T Thomas; Claudia C Dobler

doi:10.2147/PPA.S385911

Alignment of Doctors' Understanding of Treatment Burden Priorities and Chronic Heart Failure Patients' Experiences: A Nominal Group Technique Consultation

Patient Prefer Adherence. 2023 Jan 20:17:153-165. doi: 10.2147/PPA.S385911. eCollection 2023.

Authors

Magnolia Cardona^{1

2}, Adem Sav³, Zoe A Michaleff¹, Sarah T Thomas², Claudia C Dobler^{1

4}

Affiliations

¹ Institute for Evidence Based Healthcare, Bond University, Robina, Queensland, Australia.
² Gold Coast Hospital and Health Service, Southport, Queensland, Australia.
³ School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.
⁴ The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.

Abstract

Purpose: To identify and rank areas of treatment burden in chronic heart failure (CHF), including solutions, that should be discussed during the clinical encounter from a patient, and doctors' perspective.

Patients and methods: Patients with CHF and clinicians managing heart failure were invited. Nominal group technique sessions held either face to face or online in 2021-2022, with individual identification of priorities and voting on ranking.

Results: Four patient groups (N=22) and one doctor group (N=5) were held. For patients with heart failure, in descending order of priority Doctor-patient communication, Inefficiencies of the healthcare system, Healthcare access issues, Cost implications of treatment, Psychosocial impacts on patients and their families, and Impact of treatment work were the most important treatment burdens. Priorities independently identified by the doctors aligned with the patients' but ranking differed. Patient solutions ranged from involvement of nurses or pharmacists to enhance understanding of discharge planning, through to linkage between health information systems, and maintaining strong family or social support networks. Doctors' solutions covered timing medicines with activities of daily living, patient education on the importance of compliance, medication reviews to overcome clinical inertia, and routine clinical audits.

Conclusion: The top treatment burden priorities for CHF patients were related to interaction with clinicians and health system inefficiencies, whereas doctors were generally aware of patients' treatment burden but tended to focus on the complexity of the direct treatment work. Addressing the priority issues identified here can commence with clinicians becoming aware of the issues that matter to patients and proactively discussing feasible immediate and longer-term solutions during clinical encounters.

Keywords: barriers; older adults; patient priorities; qualitative studies.

Grants and funding

This study was funded by a grant from the Gold Coast Health Collaborative Research Grant Scheme (application ID RGS20190034). The funding body did not have any role in the design, planning or implementation of the study. CCD had salary support (independent of the study) from the Australian National Health and Medical Research Council (NHMRC) (application ID APP1123733).