Article Text

Exploring patients’ perceptions and experiences of treatments for the prevention of variceal bleeding: a qualitative study
  1. Chris Poyner1,
  2. Dhiraj Tripathi2,3,
  3. Jonathan Mathers1
  1. 1Institute of Applied Health Research, University of Birmingham, Birmingham, Birmingham, UK
  2. 2University of Birmingham, Birmingham, UK
  3. 3Liver Unit, Queen Elizabeth Hospital, Birmingham, Birmingham, UK
  1. Correspondence to Dr Chris Poyner; c.poyner{at}


Background The most common fatal complication of liver cirrhosis is haemorrhaging caused by variceal rupture. The prevention of the first variceal bleed is, therefore, an important clinical goal. Little is known about patients’ experience of treatments geared towards this, or of their perceptions of treatments prior to being exposed to them.

Aims To explore the factors impacting patient preference for, and actual experience of carvedilol and variceal band ligation.

Methods Semistructured interviews were conducted with 30 patients from across the UK at baseline, prior to random allocation to either carvedilol or variceal band ligation. Twenty patients were interviewed a second time at 6-month follow-up. Five patients who declined the trial were also interviewed. Data were analysed using thematic analysis.

Results There was no clear preference for either treatment pathway at baseline. Key factors reported by patients to influence their treatment preference included: negative experiences with key treatment processes; how long-term or short-term treatment was perceived to be; treatment misconceptions; concerns around polypharmacy and worries around treatment adherence. Patient treatment experience was influenced by their perceptions of treatment effectiveness; clinical surveillance; clinician interaction and communication, or lack thereof. Carvedilol-specific experience was also influenced by the manifestation of side effects and patient dosage routine. Variceal band ligation-specific experience was positively influenced by the use of sedation, and negatively influenced by the procedure recovery period.

Conclusions These data do not support a view that the patient experience of beta-blockade for prevention of variceal bleeds is likely to be superior to variceal band ligation.

  • liver cirrhosis
  • portal hypertension
  • endoscopic procedures
  • oesophageal varices

Data availability statement

Data are available on reasonable request. The data are not in a repository at present. The data are securely held in an encrypted University of Birmingham server, accessible by Chris Poyner Orchid ID: 0000-0001-6271-2626.

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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Data availability statement

Data are available on reasonable request. The data are not in a repository at present. The data are securely held in an encrypted University of Birmingham server, accessible by Chris Poyner Orchid ID: 0000-0001-6271-2626.

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  • Contributors CP will act as the article guarantor. CP collected the data and recruited participants. JM and DT designed the study. CP and JM produced data collection materials and analysed the data. CP, DT and JM collaborated to write the manuscript.

  • Funding The CALIBRE study is funded by the National Institute for Health Research (NIHR) Health Technology Assessment (HTA), project number: 16/99/02.

  • Disclaimer The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.

    It is declared that this manuscript is original, has not been published before and is not currently being considered for publication elsewhere. We confirm that the manuscript has been read and approved by all named authors and that there are no other persons who satisfied the criteria for authorship but are not listed. We further confirm that the order of authors listed in the manuscript has been approved by all of us. We understand that the corresponding author is the sole contact for the editorial process, and is responsible for communicating with the other authors about progress, submissions of revisions and final approval of proofs.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.