https://doi.org/10.4081/qrmh.2017.7006

If my cholesterol is…then I foresee…: patient accounts of uncertainty

Vol. 1 No. 3 (2017)
Submitted: 21 August 2017
Accepted: 3 October 2017
Published: 31 December 2017
Abstract Views: 647
PDF: 489
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Authors

Darlene K. Drummond
Darlene.K.Drummond@Dartmouth.edu
Institute for Writing and Rhetoric, Dartmouth College, Hanover, NH, United States.
The author examines the talk of patients with high cholesterol as they discuss their experiences of adding a statin to their treatment regimen. The primary objective was to understand patients’ expectations of statins, and their beliefs and feelings as they continued or discontinued use, and to better understand why adherence to a statin regimen is particularly low. While numerous studies report reasons for nonadherence, few apply theory to provide plausible explanations. Analysis of the focus group data revealed three major themes. First, patients do not view high cholesterol as serious in light of other major health problems like diabetes and cancer within the household. Second, patients believe statins are effective in lowering cholesterol but risky. Third, many patients do not understand how high levels of cholesterol are produced in the body and how statins interrupt that process. Problematic integration theory is used to explain the uncertainty patients experience when given a diagnosis of high cholesterol, the use of statins to control it, and the quality of information received about both cholesterol and statins.

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Citations

Crossref
Scopus
Google Scholar
Europe PMC
CDC Centers for Disease Control and Prevention. Deaths and mortality. Retrieved 9-28-
Available from https://www.cdc.gov/nchs/fastats/deaths.htm
Birtcher K. When compliance is an issue—how to enhance statin adherence and address adverse effects. Curr Atheroscler Rep 2015; 17: 471-478. DOI: https://doi.org/10.1007/s11883-014-0471-8
CDC Centers for Disease Control and Prevention. Cholesterol. c2015 [cited 2017 Aug 9]. Available from http://www.cdc.gov./cholesterol/facts.htm
Aggarwal B, Mosca L. Lifestyle and psychosocial risk factors predict non-adherence to medication. Ann Behav Med 2010; 40: 228-233. DOI: https://doi.org/10.1007/s12160-010-9212-6
American Heart Association. Heart disease and stroke statistics: Our guide to current statistics and the supplement to our Heart and Stroke Facts. Dallas, TX: AHA; 2008.
Ho CKM, Walker SW. Statins and their interactions with other lipid-modifying medications: Safety issues in the elderly. Ther Adv Drug Safety 2012; 3: 35-46. DOI: https://doi.org/10.1177/2042098611428486
Christensen AJ. Patient adherence to medical treatment regimens: Bridging the gap between behavioral science and biomedicine. New Haven, CT: Yale University Press; 2004.
Cook PF. Adherence to medications. In: W. T. O’Donohue WT, Levensky ER, eds. Promoting treatment adherence: A practical handbook for health care providers. Thousand Oaks, CA: Sage; 2006. pp. 183-202. DOI: https://doi.org/10.4135/9781452225975.n12
Mann DM, Allegrante JP, Natarajan S, Halm EA, Charlson M. Predictors of adherence to statins for primary prevention. Cardiovasc Drugs Ther 2007; 21: 311-316. DOI: https://doi.org/10.1007/s10557-007-6040-4
Mann DM, Ponieman D, Montori VM, Arciniega J, McGinn T. The statin choice decision aid in primary care: A randomized trial. Patient Educ Couns 2010; 80:138-140. DOI: https://doi.org/10.1016/j.pec.2009.10.008
Abbass I, Revere L, Mitchell J, Appari A. Medication nonadherence: the role of cost, community, and individual factors. Health Services Res 2017; 52: 1511-1533. DOI: https://doi.org/10.1111/1475-6773.12547
Wei MY, Ito MK, Cohen JD, Brinton EA, Jacobson TA. Predictors of statin adherence, switching, and discontinuation in the USAGE survey: Understanding the use of statins in America and gaps in patient education. J Clin Lipidol 2013; 7: 472-483. DOI: https://doi.org/10.1016/j.jacl.2013.03.001
Sirtori CR. The pharmacology of statins. Pharmacol Res 2014; 88: 3-11. DOI: https://doi.org/10.1016/j.phrs.2014.03.002
Macedo AF, Taylor FC, Casas, JP, Adler A, Prieto-Merino D, Ebrahim S. Unintended effects of statins from observational studies in the general population: systematic review and meta-analysis. BMC Med 2014; 12: 1-13. DOI: https://doi.org/10.1186/1741-7015-12-51
Sattar N, Preiss D, Murray HM, et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomized statin trials. Lancet 2010; 375: 735-742. DOI: https://doi.org/10.1016/S0140-6736(09)61965-6
Jukema JW, Cannon CP, de Craen AJM, Westendorp RGJ, Trompet S. The controversies of statin therapy: weighing the evidence. J Am Coll Cardiol 2012; 60:875-881. DOI: https://doi.org/10.1016/j.jacc.2012.07.007
Cholesterol Treatment Trialists’ (CTT) Collaboration. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet 2012; 380: 581-590. DOI: https://doi.org/10.1016/S0140-6736(12)60367-5
Simpson RJ, Mendys P. The effects of adherence and persistence on clinical outcomes in patients treated with statins: a systematic review. J Clin Lipidol 2010; 4: 462-471. DOI: https://doi.org/10.1016/j.jacl.2010.08.026
O’Neil A, Sanna L, Redlich C, et al. The impact of statins on psychological wellbeing: a systematic review and meta-analysis. BMC Med 2012; 10: 1-9. DOI: https://doi.org/10.1186/1741-7015-10-154
Swiger KJ, Manalac RJ, Blaha, MJ, Blumenthal RS, Martin SS. Statins, mood, sleep, and physical function: a systematic review. Eur J Clin Pharmacol 2014; 70: 1413-1422. DOI: https://doi.org/10.1007/s00228-014-1758-y
Chakraborty S. Part I: The role of trust in patient noncompliance: A qualitative case study of users of statins for the chronic treatment of high-cholesterol in New York City. J Risk Res 2013; 16: 97-112. DOI: https://doi.org/10.1080/13669877.2012.727097
Babrow AS. Problematic integration theory. In: Whaley B, Samter W, eds. Explaining communication: Contemporary theories and exemplars. Mahwah, NJ: Lawrence Erlbaum Associates; 2007. pp. 181-200.
Babrow AS. Communication and problematic integration: Understanding diverging probability and value, ambiguity, ambivalence, and impossibility. Commun Theory 1992; 2: 95-130. DOI: https://doi.org/10.1111/j.1468-2885.1992.tb00031.x
Babrow AS. Uncertainty, value, communication, and problem integration. J Commun 2001; 51: 553-573. DOI: https://doi.org/10.1111/j.1460-2466.2001.tb02896.x
Babrow AS, Hines SC, Kasch CR. Managing uncertainty in illness explanation: An application of problematic integration theory. In: Whaley B, ed. Explaining illness: Research, theory, and strategies. Mahwah, NJ: Lawrence Erlbaum Associates; 2000. pp. 41-67.
Keller V F, Drummond DK, Bueno Y, Spadola J, Schy E. Final report: Understanding statin non-adherence: A qualitative study. Prepared for the Innovation Center, AstraZeneca. UM-Humana Health Services Research Center; May, 2007.
McCracken G. The long interview. Newbury Park, CA: Sage; 1988. DOI: https://doi.org/10.4135/9781412986229
Owen WF. Interpretive themes in relational communication. Q J Speech 1984; 70: 274-287. DOI: https://doi.org/10.1080/00335638409383697
Doherty WJ, Campbell TL. Families and health. Thousand Oaks, CA: Sage; 1988.
Sells D, Sledge WH, Wieland M, et al. Cascading crises, resilience and social support within the onset and development of multiple chronic conditions. Chronic Illn 2009; 5: 92-102. DOI: https://doi.org/10.1177/1742395309104166
Kirkegaard P, Edwards A, Risor MB, Thomsen JL. Risk of cardiovascular disease? A qualitative study of risk interpretation among patients with high cholesterol. BMC Fam Pract 2013; 14: 137-142. DOI: https://doi.org/10.1186/1471-2296-14-137
Russell LD, Babrow AS. Risk in the making: Narrative, problematic integration, and the social construction of risk. Commun Theory 2011; 21: 239-260. DOI: https://doi.org/10.1111/j.1468-2885.2011.01386.x
Niederdeppe J, Byrne S, Avery RJ, Cantor J. Direct-to-consumer television advertising exposure, diagnosis with high-cholesterol, and statin use. J Gen Intern Med 2013; 28: 886-893. DOI: https://doi.org/10.1007/s11606-013-2379-3
Byrne S, Niederdeppe J, Avery RJ, Cantor J. “When diet and exercise are not enough”: An examination of lifestyle change inefficacy claims in direct-to-consumer advertising. Health Commun 2013; 28: 800-813. DOI: https://doi.org/10.1080/10410236.2012.725125

How to Cite

Drummond, Darlene K. 2017. “If My Cholesterol is…then I foresee…: Patient Accounts of Uncertainty”. Qualitative Research in Medicine and Healthcare 1 (3). https://doi.org/10.4081/qrmh.2017.7006.

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