Communicating cardiovascular disease risk: an interview study of General Practitioners' use of absolute risk within tailored communication strategies
Communicating cardiovascular disease risk: an interview study of General Practitioners' use of absolute risk within tailored communication strategies
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DOI：
10.1186/1471-2296-15-106
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发表时间：
2014-05-29
影响因子：
2.9
通讯作者：
McCaffery, Kirsten
中科院分区：
文献类型：
--
作者：
Bonner, Carissa;Jansen, Jesse;McCaffery, Kirsten
背景资料：心血管疾病（CVD）预防指南鼓励评估绝对CVD风险-基于最具预测性的风险因素，在固定时间段内发生CVD事件的概率。然而，很少有全科医生（全科医生）使用绝对心血管疾病的风险一致，沟通困难已被确定为一个障碍，改变做法。本研究旨在探讨全科医生的描述，他们的心血管疾病风险的沟通策略，包括绝对risk. Methods的作用：半结构化访谈进行了有目的的样本25全科医生在澳大利亚新南威尔士州。转录的录音进行了主题编码，使用框架分析方法，以确保严谨性。结果：全科医生使用的绝对心血管疾病的风险在三个不同的沟通策略：“积极的”，“恐吓战术”，和“间接的”。一个“积极的”策略，旨在安抚和激励，用于低风险，决心改变生活方式，并对心血管疾病的风险有所关注的患者。绝对风险被用来说明他们如何降低风险。一个“恐吓战术”的策略被用于高风险，缺乏动力，和不屑一顾的态度的患者。绝对风险是用来“吓唬”他们采取行动的。一种“间接”策略，即CVD风险不是主要关注点，用于低风险但有一些生活方式风险因素、高度焦虑、对改变高度抗拒或难以理解概率的患者。非定量的绝对风险格式被发现是有帮助的，在这些situation.Conclusions：本研究表明，全科医生如何使用三种不同的沟通策略，以解决心血管疾病的风险问题，这取决于他们对病人的风险，动机和焦虑的看法。绝对风险在每种策略中扮演着不同的角色。为全科医生提供解释绝对风险的替代方法，以实现不同的沟通目标，可能会提高他们在实践中使用绝对CVD风险评估。
Background: Cardiovascular disease (CVD) prevention guidelines encourage assessment of absolute CVD risk - the probability of a CVD event within a fixed time period, based on the most predictive risk factors. However, few General Practitioners (GPs) use absolute CVD risk consistently, and communication difficulties have been identified as a barrier to changing practice. This study aimed to explore GPs' descriptions of their CVD risk communication strategies, including the role of absolute risk.Methods: Semi-structured interviews were conducted with a purposive sample of 25 GPs in New South Wales, Australia. Transcribed audio-recordings were thematically coded, using the Framework Analysis method to ensure rigour.Results: GPs used absolute CVD risk within three different communication strategies: 'positive', 'scare tactic', and 'indirect'. A 'positive' strategy, which aimed to reassure and motivate, was used for patients with low risk, determination to change lifestyle, and some concern about CVD risk. Absolute risk was used to show how they could reduce risk. A 'scare tactic' strategy was used for patients with high risk, lack of motivation, and a dismissive attitude. Absolute risk was used to 'scare' them into taking action. An 'indirect' strategy, where CVD risk was not the main focus, was used for patients with low risk but some lifestyle risk factors, high anxiety, high resistance to change, or difficulty understanding probabilities. Non-quantitative absolute risk formats were found to be helpful in these situations.Conclusions: This study demonstrated how GPs use three different communication strategies to address the issue of CVD risk, depending on their perception of patient risk, motivation and anxiety. Absolute risk played a different role within each strategy. Providing GPs with alternative ways of explaining absolute risk, in order to achieve different communication aims, may improve their use of absolute CVD risk assessment in practice.