A pilot project examining the predicted preferences of patients and physicians in the primary prophylaxis of variceal hemorrhage
Open Access
- 12 October 2007
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Hepatology
- Vol. 47 (1), 169-176
- https://doi.org/10.1002/hep.21945
Abstract
Endoscopic variceal ligation (EVL) and nonselective beta‐blockers (hereafter just called beta‐blockers) are both effective for primary prophylaxis for variceal hemorrhage; however, the route of administration and side effects of these treatments are distinct. The objective of this study was to examine predicted preferences of patients and physicians for the primary prevention of variceal hemorrhage. Untreated patients with newly diagnosed esophageal varices and practicing gastroenterologists were enrolled in this study. Patients with contraindications to either EVL or beta‐blockers were excluded. Predicted preferences for treatment were evaluated with an interactive computer task designed to elicit subjects' trade‐offs related to the route of administration, risk of fatigue, sexual dysfunction, dysphagia, shortness of breath and/or hypotension, procedure‐related bleeding, and perforation. Fifty‐three patients and 61 physicians were enrolled. Thirty‐four (64%) patients and 35 (57%) physicians preferred EVL over beta‐blockers. Patients' predicted preferences were most strongly influenced by the risks of shortness of breath or hypotension, fatigue, and procedure‐related bleeding, whereas physicians placed greater importance on procedure‐related bleeding, sexual dysfunction, and perforation. Forty‐eight patients were prescribed beta‐blockers, two were not given prophylaxis, and three were lost to follow‐up. Conclusion: Predicted treatment preferences among both patients and physicians for primary prophylaxis of variceal hemorrhage vary significantly. Physicians in this study preferring EVL stated that they prescribe beta‐blockers as first‐line therapy in order to remain compliant with guidelines. Physicians should discuss both EVL and beta‐blockers with patients requiring primary prophylaxis for variceal hemorrhage. Future guidelines should incorporate individual patient preferences. (HEPATOLOGY 2007.)This publication has 27 references indexed in Scilit:
- A randomized study comparing ligation with propranolol for primary prophylaxis of variceal bleeding in candidates for liver transplantationLiver Transplantation, 2007
- Evolving Consensus in Portal Hypertension Report of the Baveno IV Consensus Workshop on methodology of diagnosis and therapy in portal hypertensionJournal of Hepatology, 2005
- Measuring disease activity in ankylosing spondylitis: patient and physician have different perspectivesRheumatology, 2005
- 208 Beta-blockers reduce mortality in cirrhotic patients with oesophageal varices who have never bled (cochrane review)Journal of Hepatology, 2004
- Differences between perspectives of physicians and patients on anticoagulation in patients with atrial fibrillation: observational study Commentary: Varied preferences reflect the reality of clinical practiceBMJ, 2001
- How do patients' treatment preferences compare with those of clinicians?Quality and Safety in Health Care, 2001
- A meta-analysis of endoscopic variceal ligation for primary prophylaxis of esophageal variceal bleedingHepatology, 2001
- Measuring Patients' Medical Care Preferences: Care Seeking versus Self-TreatingMedical Decision Making, 2001
- Lack of Congruence in the Ratings of Patients' Health Status by Patients and Their PhysiciansMedical Decision Making, 2001
- Pharmacological Treatment of Portal Hypertension: An Evidence-Based ApproachSeminars in Liver Disease, 1999