Influence of Cardiovascular Risk Communication Tools and Presentation Formats on Patient Perceptions and Preferences.
Influence of Cardiovascular Risk Communication Tools and Presentation Formats on Patient Perceptions and Preferences.
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DOI：
10.1001/jamacardio.2018.3680
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发表时间：
2018-12-01
期刊：
影响因子：
24
通讯作者：
Peterson ED
中科院分区：
文献类型：
--
作者：
Navar AM;Wang TY;Mi X;Robinson JG;Virani SS;Roger VL;Wilson PWF;Goldberg AC;Peterson ED
实践指南建议临床医生让患者参与治疗决策并解释动脉粥样硬化性心血管疾病（ASCVD）的风险，但没有描述如何最有效地传达风险。确定ASCVD风险时间范围、结局和报告格式如何影响风险认知和治疗偏好。参与者被呈现3个独立的场景（代表相同的假设患者），并被要求对感知风险和服用药物以降低风险的意愿进行评级：1）15%的10年ASCVD事件风险，2）4%的10年心血管疾病（CVD）死亡风险，3）50%的终身ASCVD事件风险。2015年5月27日至2015年11月12日，140名美国心脏病学，初级保健和内分泌学实践。3566名参与者来自血脂管理登记的患者和提供者评估。参与者被随机分配接受仅使用数字，条形图或面部象形图的风险评估。在3566名合格的参与者中，2708人做出了回答（76.9%，中位年龄67岁，10.3%为非洲裔美国人，55.1%为男性）。当显示终生ASCVD风险时，受访者比10年ASCVD风险或CVD死亡风险更可能认为风险“高至非常高”（分别为70.1% vs 31.4% vs 25.7%;均P<.0001）。终生ASCVD风险的治疗意愿也最高（77.9%非常愿意），其次是10年ASCVD风险（68.1%）和10年CVD死亡风险（63.1%，均P<.0001）。与显示条形图或没有图形的参与者相比，那些显示象形图风险信息的参与者对疾病严重程度的感知最低，考虑治疗的意愿最低。这些发现在人口统计和社会经济亚组中都是可靠的。用于风险评估的格式、时间范围和结果都可能影响患者的感知，在设计风险沟通工具时应予以考虑。当显示终生风险估计值时，患者的风险感知和治疗意愿高于10年估计值。象形图风险显示可能会降低风险感知和治疗考虑。
Practice guidelines recommend that clinicians engage patients in treatment decisions and explain atherosclerotic cardiovascular disease (ASCVD) risk, but do not describe how to communicate risk most effectively. To determine how the ASCVD risk time horizon, outcome, and presentation format affect risk perceptions and treatment preferences. Participants were presented 3 independent scenarios (representing the same hypothetical patient) and asked to rate perceived risk and willingness to take medication to lower risk: 1) 15% 10-year ASCVD event risk, 2) 4% 10-year cardiovascular disease (CVD) death risk, and 3) 50% lifetime ASCVD event risk. 140 U.S. cardiology, primary care, and endocrinology practices from May 27, 2015, through November 12, 2015. 3566 participants from the Patient and Provider Assessment of Lipid Management Registry. Participants were randomized to receive risk estimates using numbers only, a bar graph, or a face pictogram. Of 3566 eligible participants, 2708 responded (76.9%, median age 67 years, 10.3% African American, 55.1% male). When shown lifetime ASCVD risk, respondents were more likely to consider risk “high to very high” than when presented 10-year ASCVD risk or CVD death risk (70.1% vs 31.4% vs 25.7%, respectively; both P<.0001). Treatment willingness was also highest for lifetime ASCVD risk (77.9% very willing) followed by 10-year ASCVD risk (68.1%) and 10-year CVD death risk (63.1%, both P<.0001). Compared with participants shown a bar graph or no graphic, those shown risk information with a pictogram had the lowest perception of disease severity and the lowest willingness to consider therapy. These findings were robust across demographic and socioeconomic subgroups. The format, time horizon, and outcome used for risk estimation can all affect patient perceptions and should be considered when designing risk communication tools. When shown lifetime risk estimates, patients had higher risk perception and willingness for therapy than when shown 10-year estimates. Pictogram risk displays may decrease risk perception and consideration for treatment.
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影响因子：
5.1
作者：
Koelewijn-van Loon, Marije S.;van der Weijden, Trudy;Grol, Richard
通讯作者：
Grol, Richard
影响因子：
4.8
作者：
Navar, Ann Marie;Wang, Tracy Y.;Peterson, Eric
通讯作者：
Peterson, Eric
影响因子：
4.8
作者：
Navar, Ann Marie;Wang, Tracy Y.;Peterson, Eric D.
通讯作者：
Peterson, Eric D.
影响因子：
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作者：
Catapano, Alberico L;Graham, Ian;Zamorano, Jose Luis
通讯作者：
Zamorano, Jose Luis
影响因子：
39.2
作者：
Zipkin, Daniella A.;Umscheid, Craig A.;Feldstein, David A.
通讯作者：
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