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SHP 08-193 – HSR&D Study

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SHP 08-193
Patients' View of Hepatitis C Treatment Completion or Withdrawal
Jack A Clark PhD
Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA
Bedford, MA
Funding Period: April 2008 - September 2008

BACKGROUND/RATIONALE:
Hepatitis C (HCV) infection constitutes a major health threat to veterans. Screening for HCV risk has been broadly implemented, and effective treatments are available. Although potentially curative, medication treatment is prolonged, costly, and burdensome on patients. Side effects are often severe and diminish quality of life. Consequently early withdrawal from treatment is common. Reasons for continuing or withdrawing from treatment, and thus opportunities for supporting successful completion, are poorly understood.

OBJECTIVE(S):
Appropriate theoretical models to guide research and inform the development of interventions exist, but need specification in the setting of HCV. Hence, we conducted a pilot study to explore how patients experience the challenging treatment regimens prescribed for HCV.

METHODS:
In depth, qualitative interviews were conducted with 18 patients selected from the hepatitis C clinic at our VAMC. Analyses of verbatim transcripts of patients' accounts focused on identifying significant topics and themes relating to treatment experiences, side effects, motivations for completing treatment, and the role of health care providers.

FINDINGS/RESULTS:
Patients described how they contracted hepatitis C, with accounts varying with respect to the role of drug use. Patients described how they came to be diagnosed, including the events leading to diagnosis, process of diagnosis, and their emotional responses. The diagnosis was a surprise in most cases. The patients in this study described the full range of side effects identified in previous studies, including flu-like symptoms. However, these side effects were formulated in ways that signified complex, psychosocial effects on the quality of patients' lives, emphasizing behavioral changes, impacts on others, effects on how they viewed themselves. The patients reported complex motivations to pursue treatment and persevere in the face of debilitating side effects. Chief among these was a sense that they had no alternative to completing treatment: one must "do this or die years earlier." Doctors and nurses played major roles in patients' accounts of treatment. The doctor was the primary source of clinical, biomedical information. He was the one who presented the starkly framed choice of treatment. The nurse, in contrast, was a major source of information and practical support in managing the multiple, debilitating side effects of treatment. The nurse was a constant, critical source of support, she provided information and explained side effects; she inquired about potential problems, e.g., depression; and she engaged in open, honest discussion related to challenge of completing treatment.

IMPACT:
By examining the patterns, barriers, and influences on antiviral medication completion by veterans, the VA may better understand the health care needs of veterans in ways that will contribute toward identifying potential health care system gaps and approaches for enhancing VA's ability to meet these needs.

PUBLICATIONS:

Conference Presentations

  1. Clark JA, Drainoni M, Koppelman E, Gifford A. Factors Related to Hepatitis C Treatment Completion in the VHA. Paper presented at: VA QUERI National Meeting; 2008 Dec 10; Phoenix, AZ.
  2. Drainoni M, Gifford AL, Koppelman E, Clark JA. Factors Associated with Hepatitis C Treatment Completion or Withdrawal among Veterans. Poster session presented at: VA QUERI National Meeting; 2008 Dec 10; Phoenix, AZ.


DRA: none
DRE: Diagnosis, Treatment - Observational
Keywords: Adherence, Hepatitis C, Patient preferences
MeSH Terms: none

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