Real-world factors aid HCV patient treatment decisions

In the face of rapidly changing treatment options for hepatitis C virus (HCV) infections, understanding what factors patients consider in making treatment decisions becomes crucial. A new study provides insights into what HCV patients consider and how those decisions interact with their real-life situations.

Researchers led by Jessica Zuchowski, PhD, MPH, health science specialist at VA Greater Los Angeles at Sepulveda, conducted interviews with 29 chronic hepatitis C patients at four VA hospitals. Twelve of the patients were contemplating treatment, nine had recently declined treatment, and eight had recently started treatment within the past 15 weeks. 

On average, the patients described eight decision attributes. The attributes most frequently reported overall were: physical side effects (83%), treatment efficacy (79%), new treatment drugs in development (55%), psychological side effects (55%), and condition of the liver (52%).

Personal life circumstance attributes, such as availability of family support and the burden of financial responsibilities, also influenced treatment decisions.

The researchers reported their results in the October 1, 2015 issue of BMC Gastroenterology. They noted that this is the first qualitative study of patients’ rationales and thought processes regarding the initiation of HCV treatment.

“Patients’ understanding of outcomes expectancies, potential risks and benefits, and values-informed preferences should guide treatment decisions, in addition to the clinician’s expert opinion and evidence,” Zuchowski told Medical Economics. “Data suggest that health outcomes are comparatively better for patients who are informed about their treatment options, have realistic expectations of outcomes, participate in setting goals for potential treatments, and are able to link personal values to their goals. Shared decision-making is a model of patient-centered care that enables and encourages patients to play an active role in the management of their own health.”

The number of attributes considered and the most frequently reported attributes varied somewhat based on the patient group. “Decision attributes were interrelated in patients’ decision-making narratives and this was consistent across groups,” she said.

“Patterns in the co-occurrence of decision attributes highlight the ways in which ‘medical’ attributes and ‘life circumstance’ attributes were closely woven together in patient experiences,” Zuchowski added. “While patients’ treatment decisions were influenced by their personalized medical risks associated with their illness status, they were also influenced by the ways in which these risks interfaced with their unique life circumstances.”

For example, physical side effects and their unpredictable severity were frequently considered in conjunction with support networks and financial obligations, and the promise of new treatment drugs was considered in conjunction with a number of other attributes.

These results shed light on decision attributes that influence patient HCV treatment decisions and reveal complex relationships between medical attributes and life circumstance attributes in these decisions.

“The study illuminates common perceptions patients bring to the table in a shared decision-making context. Clinicians can help patients make treatment decisions by elucidating personalized medical risk in conjunction with personal life circumstances and preferences while encouraging mutual engagement in care that is likely conducive to subsequent adherence and completion of complex treatment regimens,” Zuchowski said.