Suffering in deference: a focus group study of older cardiac patients' preferences for treatment and perceptions of risk

Objectives-To explore older people's experiences of health care in relation to their medical condition (ischaemic heart disease), their understanding of health risks, treatment preferences, and the impact of different treatme nts on their quality of life. Design-Qualitative study based on five focus groups. Setting-Five local heart support groups across London. Participants-38 patients aged 56 and over who were members of local heart s upport groups, diagnosed with ischaemic heart disease. Main outcome measure -Analysis of patients' narratives to identify key themes and issues using t he framework method of qualitative data analysis. Results-Cardiac patients would prefer to follow the cardiologist's recommen dation for treatment, based on their medical expertise. If offered a choice , many said they would prefer to take medication, at least initially, as th ey would rather not undergo surgery. However, they accepted that, depending on their medical condition, they might not have a choice. Other factors th at participants said affected their choice of treatments included their sta te of health, treatment outcomes, families' feelings, their age, and the pr evious number of operations they had undergone. They found it difficult to discuss risk in terms of numbers; most felt that a 3% risk of death from su rgery was low. Instead, they discussed risk in terms of likelihood of treat ment restoring quality of life. Patients expressed the fear that medication was not a cure and that surgical revascularisation is a traumatic experien ce that does not necessarily last forever. Participants felt that they need ed further information on the impact of surgery and medication to make a mo re informed choice. Other barriers they felt they had faced in being treate d were problems in accessing cardiologists and age discrimination. Conclusion-It was apparent from these focus groups that few patients were i nvolved in medical decision making about their treatment. Most preferred th e doctor to make the decision and did want to be involved. Despite their ex periences as cardiac patients, they required much more information about tr eatment options for their condition before being able to make informed choi ces, where appropriate. Improved access to specialist care (cardiologists) and equal treatment by age are also required before patients' preferences c an be elicited in practice.