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Nigel Lambert

Publications and source records attributed to Nigel Lambert.

5 recordsLinked to original sources
PubMed2004

Assessing patients' preferences for treatments for angina using a modified repertory grid method.

A current popular theme in medicine concerns whether and how patients should be involved in treatment choice. Assuming patient involvement is desirable, how should one go about eliciting preferences? A variety of quantitative and qualitative methods exist that may be used for this purpose, one of which is the repertory grid method. This method involves eliciting constructs (reasons) for preferences through comparing sets of three options. This method allows the structured elicitation of the reasons behind individual preferences, but also, when used with generalised procrustes analysis (GPA), allows aggregation of individual data to reveal general preference patterns. In this study the repertory grid method was used to examine patient preferences for angina treatments with the goal of, first, gaining some understanding of general patterns of patient preference, and second, examining the likely utility of the technique in this setting. A sample of 21 patients with mild and stable angina from two general practices in Norfolk, UK was interviewed using the repertory grid method to elicit the constructs underlying their preferences amongst seven angina treatments (including 'no treatment'). Individualised questionnaires were then produced and sent to the patients for self-completion, which required rating the extent to which each construct was relevant for each treatment (scored on visual analogue rating scales). Analysis of the ratings, using GPA, showed that the constructs clustered around two dimensions: 'some treatment' versus 'no treatment', and drug treatment versus surgical treatment. While some treatment was generally preferred to no treatment, individuals varied in preference for drug treatments or surgical treatments. Although the latter were generally perceived as 'effective' they were also perceived, for example, as 'invasive', 'frightening', related to 'negative experiences', and being more appropriate for when symptoms are severe ('proportionate'). We consider the implications of these results for involving patients in choosing amongst treatments.

Adult↗
PubMed2004

Reasons underpinning patients' preferences for various angina treatments.

OBJECTIVE: To elicit patients' preferences for the treatment of angina. DESIGN: Angina patients were interviewed in order to elicit their personal reasons underlying preferences for various treatment options. Interviews followed a general repertory grid technique, in which seven treatment options were presented to patients in triads. Treatments considered ranged from medication to invasive revascularization therapies, with a 'no treatment' option. SETTING: Two general practices in Norwich, Norfolk. SUBJECTS: Twenty-one patients with diagnosed angina, which was both mild and stable. MAIN OUTCOME MEASURES: Treatment preferences verbalized by patients during interview, and the underlying reasons for these. RESULTS: Attitudes voiced towards the range of treatments for angina were diverse; 27 different reasons underlying patients' preferences were identified. Patients' preferences were largely justified by reasons associated with the conditional effectiveness or otherwise of treatments. When presented with treatment triads, medication (drug) treatments were over 2.5 times more likely to be chosen as a most preferred option than invasive or surgical treatments. Although surgical treatments were generally considered to be 'effective', it was perceived that they were more appropriate for situations when the condition became life-threatening. There were occasions, however, when preferences were driven by other reasons, such as a desire to avoid surgery because it was perceived negatively as 'invasive' and 'frightening'. Drug treatments were viewed as 'quick', 'easy' and reversible. Personal experiences of the effectiveness or otherwise of treatments were frequently cited as reasons for stated preferences. However, patients often commented that they would prefer the doctor to make the decision about their treatment. CONCLUSIONS: Patients choices among treatments was largely driven by perceptions of their effectiveness or otherwise. Although surgery was perceived as 'effective' it was also seen as conditionally so, dependent upon severity of the condition - which is not necessarily the case, as the risks of adverse events and surgical complications increase for emergency cases. As such, access to better information about the effectiveness and timeliness of interventions is needed. Although respondents held anxieties about treatment, particularly invasive or surgical treatments, fewer choices were driven by emotional and lifestyle factors unrelated to 'effectiveness', such as fear or ease of treatment.

Adult↗
PubMedDate not supplied

Using interpretative phenomenology to understand the food-related experiences and beliefs of a select group of low-income UK women.

OBJECTIVE: The purpose of this study was to provide an in-depth account of the beliefs and experiences pertaining to food and health from a specific group of low-income women in the United Kingdom. DESIGN: Data for this in-depth, qualitative study were collected using audiotaped semistructured interviews. PARTICIPANTS: Fourteen white, European women (aged 40 to 60 years) from a defined low-income group were recruited using systematic, nonprobabilistic sampling. Participants lived in a small city in a largely rural region of the United Kingdom. ANALYSIS: Interview transcripts were analyzed using an interpretative phenomenological approach. They were evaluated independently by several investigators, and, following discussions, a series of "shared themes" were agreed upon. RESULTS: All of the shared themes identified could be grouped into three superthemes or "drivers," which seemed to govern the women's attitudes and behaviors toward food choice and health. "Egocentric systems" related to the uniqueness of the participants and the social worlds they inhabit. "Information characteristics" described what information the participants were exposed to and how it was processed. Finally, "control issues" described how perceptions of control influenced attitudes toward food and health. CONCLUSIONS AND IMPLICATIONS: The study highlights the need for health professionals to consider the different value systems of target groups in health promotion policies. The impact of "New Age" beliefs and the Human Genome Project on public health nutrition are two areas that particularly merit further research.

Adult↗