Practical steps for shared decision-making include outlining the range of options, providing information in their FDA approved Drug Library manufacturer preferred format, checking understanding and exploring
ideas to arrive at an agreed decision . Such parameters have been incorporated into standardized measures of concordance . Multiple benefits of a concordance-based approach have been demonstrated in various settings, including improved adherence, increased patient satisfaction with care, and reductions in the number of medications prescribed and in medication-related problems [12,13]. Doctor–patient concordance has been associated with improved mental health, social function and vitality [14,15]. Patient-centred communicative behaviours that stress a collaborative selleck chemicals approach between doctor and patient have been shown to be associated with stronger coping mechanisms, improved quality of life, quicker recovery, and enhanced functional status [13,16,17]. Despite these benefits, the extent to which concordance is routinely incorporated in clinical consultations is unclear [7,12]. Third-party observers of general practice (GP) consultations have shown low levels of concordance activity . Identified barriers include patient reticence and doctors’ lack of skills to facilitate the process . HIV treatment involves complex decisions about starting, switching and stopping treatment, yet no published
studies exist on concordance in this area. Decisions about whether, when, and how to change antiretroviral regimens can be particularly complicated, involving consideration of factors such as virological and immunological parameters, drug resistance, Thiamet G drug-related toxicity and tolerability
and regimen complexity [18–22]. This study aimed to retrospectively assess patients’ perceptions of concordance during the making of decisions on HAART switching and stopping. In particular, the aims were (1) to explore levels of concordance and (2) to examine the relationship between concordance and physical and psychological symptoms, quality of life, adherence, satisfaction, HIV sexual risk behaviour, and laboratory markers [CD4 cell count and viral load (VL)] at baseline and 6–12 months after patients completed the questionnaire. This quantitative, self-completion questionnaire study was conducted during a 3-month period in 2005/2006 in five NHS out-patient HIV clinics, of which four were in London and one in Brighton. Clinics were selected to reflect the demographics of the HIV epidemic in this part of the United Kingdom and had large HIV-infected patient cohorts. All consecutive patients aged 18 years or over with sufficient English to complete a questionnaire who attended the clinics during the study period were invited to participate by a researcher or research nurse. The questionnaire collected the following information. Demographics.