Theme | Treatment | Subtheme | Summary findings |
Treatment preferences at baseline interview | Carvedilol | Aversion to gastroscopic procedures | All patients had experienced at least one gastroscopy previously and preference for carvedilol was often influenced by this experience. |
Carvedilol | Misconceptions around the nature of the VBL procedure | Some patients described VBL inaccurately, that is, as surgery, or not requiring sedation to justify their preference for carvedilol. | |
Carvedilol | The causal mechanism of carvedilol | A small number of patients mentioned the causal mechanism of carvedilol as the key reason for their stated preference. | |
VBL | Concern about polypharmacy | Some patients described already taking several medications as a concern, or a more general dislike of taking tablets | |
VBL | Carvedilol adherence | Some participants went on to report a concern about their capacity to remember to take carvedilol on a daily basis | |
VBL | History of mental health challenges | In a small number of cases, patients with a history of mental health issues were concerned that taking medication could cause such issues to resurface | |
VBL | VBL as the quicker solution | Some participants perceived VBL as a quicker solution due to the long-term nature of carvedilol prescription, and a perception that the issue of variceal bleeding is dealt with once varices have been banded | |
VBL | Lower blood pressure as problematic | A small number of patients felt that having their blood pressure lowered would negatively impact their health or quality of life due to a fear of blacking out or fainting. | |
Reasons given for a stated lack of treatment preference | Neither | Lack of knowledge on which to base a preference | Slightly fewer than half of the trial participants interviewed reported no clear treatment preference at the baseline interview. Most commonly, patients who did not have a clear preference were most concerned by overall health outcomes. |
Patients’ actual experience of treatment | Carvedilol | Side effects | A lack of side effects contributed to satisfaction with treatment as did a perception of improved health outcomes. A slight majority of participants did report at least one negative side effect. Reported side effects included: dizziness, fainting, nausea, diarrhoea, palpitations, fatigue and low mood. The most commonly discussed side effect was fatigue. |
Carvedilol | Importance of dosage routine to positive experience of carvedilol | For some patients, side effects lessened or were alleviated after the first month or so of taking the medication. Dosage routine alterations were often key to this. | |
VBL | Sedation as key to a better patient experience than anticipated | Patients who described anxiety around VBL due to previous negative experiences of endoscopy, reported a better than anticipated experience due to the positive impact of sedation. | |
VBL | Trust in clinician conducting procedure | Treatment acceptability was reported as low by patients where they were not confident in the clinician performing the procedure. In many cases patients suggested that trusting relationships with their consultants were key to a positive VBL procedure experience | |
VBL | Pain during VBL recovery period | The recovery from VBL was reported as the most challenging aspect. Pain and nausea were reported. Patients described the need to eat, soft and cold foods. Some felt underprepared for their recovery. | |
Both | Peace of mind related to perceptions of treatment effectiveness | In most cases, carvedilol patients expressed concern regarding a lack of continued monitoring and desired reassurance that the treatment was working. For VBL patients, a key positive of the experience was what was perceived as knowledge that their varices had been, or were in the process of being eradicated. |
VBL, variceal band ligation.