COMMUNICATING RISKS AND BENEFITS OF PREVENTIVE TUBERCULOSIS TREATMENT: AUSTRALIAN PHYSICIANS' PERSPECTIVES

Purpose: The aim of this study was to explore the views of physicians on how to communicate and make decisions about preventive tuberculosis (TB) treatment during clinical encounters.

Method(s): Twenty TB physicians from five different Australian states and territories participated in a semi-structured interviews in person or over the phone. We utilised an inductive-deductive approach working back and forth between data and themes to develop a coding framework until a comprehensive set of themes was established.

Result(s): Physicians indicated that they would try to influence patients’ decisions when the estimated individual benefit of the intervention clearly outweighed the risk. Some stated that they always provide a recommendation for or against preventive TB treatment, while others emphasised that they try to provide a balanced view about the risks and benefits. Physicians stated that they were more likely to use shared decision making in discussions about preventive TB treatment than in discussions about treatment of actual diseases.

   The estimated risk of developing TB was considered the most important information to inform the decision about preventive TB treatment and to communicate to patients, followed by the estimated risk of developing a significant adverse event from treatment. While some physicians would welcome an individually tailored treatment recommendation obtained from a decision analysis, others said they would prefer to only use plain estimates of risks and benefits in their discussion with patients. Most physicians thought that line graphs and pictograms are very helpful to communicate risks and benefits to patients.

Conclusion(s): Participants varied in their views on how much physicians should guide patients’ decision to take preventive TB treatment. Physicians supported shared decision making in situations with unclear overall treatment benefit, but would try to convince patients to take preventive TB treatment when the perceived risk of developing TB is high. Most physicians were open to the idea of using a decision aid for preventive TB treatment, at least in certain cases. Visual aids, especially to communicate the risk of developing active TB, were considered to be very helpful for the clinical encounter.