M-6 RISK COMMUNICATION USING ABSOLUTE RISK REDUCTION OR PROLONGATION OF LIFE: DOES IT INFLUENCE REAL LIFE DECISIONS ABOUT CHOLESTEROL LOWERING MEDICATION?

Wednesday, October 23, 2013: 11:15 AM
Key Ballroom 8,11,12 (Hilton Baltimore)
Decision Psychology and Shared Decision Making (DEC)

Charlotte Gry Harmsen1, Jesper Bo Nielsen, PhD2, Ivar Sønbø Kristiansen, MD, PhD, MPH3, Adrian Edwards, MB, PhD4, Jorgen Nexoe, MD, PhD2, Dorte Eig Jarbol, MD, PhD2 and Henrik Støvring, MSc, PhD5, (1)Institute of Public Health, University of Southern Denmark, 5000 Odense C, Denmark, (2)University of Southern Denmark, Odense, Denmark, (3)University of Oslo, Oslo, Norway, (4)Cardiff University, Cardiff, United Kingdom, (5)Aarhus University, Aarhus, Denmark
Purpose: Shared decision making requires that patients are informed about treatment options. However, it remains unclear how different risk reduction formats affect decisions made by real-life patients. The objective of this study was to assess the effect of using prolongation of life (POL) versusabsolute risk reduction (ARR) to express effectiveness of cholesterol-lowering treatment on patients’ redemptions of statin prescriptions, and on patients’ confidence in their decision and satisfaction with the risk communication.

Methods: Fifty-six general practitioners (GPs) from 30 practices in Southern Denmark were cluster-randomized (using practices as clusters) to use either POL or ARR as effectiveness measures when informing patients about effectiveness of statin treatment for primary prevention cardiovascular disease (CVD). The prognosis without treatment was presented as life expectancy or 10-year mortality risk, respectively. Patients’ redemption of statin prescriptions was recorded in regional prescription database three months after the consultation. The COMRADE questionnaire was used to measure patients’ confidence in their decision and satisfaction with the communication.

Results: Of 240 patients included in the study, 112 were allocated to POL-information and 128 to ARR. The groups were balanced with respect to patient as well as GP characteristics. Patients redeeming a statin prescription totaled 6 (5.4%) in the POL-group and 32 (25%) in the ARR-group (p<0.001). The mean scores of patients’ confidence in decision on a scale from 1 to 5 were 4.17 (95% CI 4.00-4.34) for POL-patients and 4.05 (95% CI 3.89-4.22) for ARR-patients. The mean scores for satisfaction with communication in the consultation were 4.41 (95% CI 4.27-4.55) and 4.23 (95% CI 4.09-4.39) respectively.  

Conclusion: The proportion of patients redeeming a statin prescription may be substantially lower when patients are informed about its effectiveness in terms of POL than ARR, but the level of confidence in decision and satisfaction with communication may not be influenced.