‘They need to tell you and not just do it’: Veteran and physician perspectives on point-of-care research in VA

Abstract

Point-of-care research (POCr) is part of a larger effort to advance the Veterans Health Administration (VHA) as a learning health system. It has the potential to improve health care outcomes and drive down costs of research by evaluating “in-use” medications and therapies. However, patients and physicians must be inclined to participate in this type of research. There is a need to assess patient and physician willingness, decision making, and methods of informed consent with respect to patient and physician participation in POCr. An exploratory study was conducted involving three focus groups, two with VA patients (n=8) and one with physicians (n=6) affiliated with a Midwestern VA Health Care System, to explore attitudes and preferences towards issues in POCr. Emerging themes were captured through qualitative content analysis. Four primary themes emerged from the focus group data: (1) a qualified willingness to participate in POCr; (2) the doctor-patient relationship as a context for POCr; (3) transparency and choice in POCr participation; and (4) protecting patient confidentiality and privacy. Our exploratory study among VA physicians and patients suggests that POCr may be perceived as intervening or undermining the physician-patient relationship in cases where randomization supplants doctor-patient decision making, or where a waiver of informed consent may diminish the need for physician-patient interaction. Informed consent is important in POCr because it offers a way for patients and physicians to establish rapport and trust, particularly in cases where randomization removes the need for clinical decision making.

Keywords

• point-of-care, clinical decision support systems, doctor-patient relationship, informed consent