TY - JOUR
T1 - Influence of Cardiovascular Risk Communication Tools and Presentation Formats on Patient Perceptions and Preferences
AU - Navar, Ann Marie
AU - Wang, Tracy Y.
AU - Mi, Xiaojuan
AU - Robinson, Jennifer G.
AU - Virani, Salim S.
AU - Roger, Veronique L.
AU - Wilson, Peter W.F.
AU - Goldberg, Anne C.
AU - Peterson, Eric D.
N1 - Funding Information:
receiving research support from Amgen, Sanofi, Amarin, Janssen, and Regeneron and consulting fees from NovoNordisk, Amarin, Amgen, and Sanofi. Dr Wang reports receiving research support from AstraZeneca, Boston Scientific, Bristol Myers Squibb, Daiichi Sankyo, Eli Lilly, Gilead, Pfizer, Regeneron and consultant/advisory/education fees from Merck, Gilead, and Sanofi. Dr Mi reports no relevant disclosures. Dr Robinson reports receiving research support from Amarin, Amgen, Astra-Zeneca, Eli Lilly, Esai, GlaxoSmithKline, Merck, Pfizer, Regeneron/Sanofi, and Takeda and consulting fees for Amgen, Eli Lilly, Merck, Pfizer, Regeneron, and Sanofi. Dr Virani reports receiving research support from the American Diabetes Association, American Heart Association, and the US Department of Veterans Affairs and honorarium from the American College of Cardiology and the National Lipid Association. Dr Goldberg reports receiving research support from Amarin, Amgen, Pfizer, and Regeneron/Sanofi; consulting fees from Regeneron/Sanofi and Esperion; and honorarium for editorial work for Merck Manual. Dr Peterson reports receiving research support from Amgen, AstraZeneca, Merck, and Sanofi and consulting fees for Amgen, AstraZeneca, Merck, and Sanofi Aventis.
Funding Information:
Funding/Support: This study was supported by
Publisher Copyright:
© 2018 American Medical Association. All rights reserved.
PY - 2018/12
Y1 - 2018/12
N2 - Importance: Practice guidelines recommend that clinicians engage patients in treatment decisions and explain atherosclerotic cardiovascular disease (ASCVD) risk but do not describe how to communicate this risk most effectively. Objective: To determine how the ASCVD risk time horizon, outcome, and presentation format influence risk perceptions and treatment preferences. Design, Setting, and Participants: From May 27, 2015, through November 12, 2015, participants from the Patient and Provider Assessment of Lipid Management Registry at 140 US cardiology, primary care, and endocrinology practices were presented 3 independent scenarios (representing the same hypothetical patient) and asked to rate their perceived risk and willingness to take medication to lower risk in light of (1) a 15% 10-year ASCVD event risk, (2) a 4% 10-year cardiovascular disease (CVD) death risk, and (3) a 50% lifetime ASCVD event risk. Exposures: Participants were randomized to receive risk estimates using numbers only, a bar graph, or a face pictogram. Results: Of 3566 eligible participants, 2708 (76.9%) responded (median age, 67 years [interquartile range, 61-76 years]; 280 [10.3%] African American; 1491 men [55.1%]). When shown the lifetime ASCVD risk, respondents were more likely to consider the risk "high to very high" than when presented the 10-year ASCVD risk or the CVD death risk (70.1% vs 31.4% vs 25.7%, respectively; both P <.001). Treatment willingness was also the 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 <.001). Compared with participants who were shown a bar graph or no graphic, those who were shown the 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. Conclusions and Relevance: The format, time horizon, and outcome used for risk estimation influence 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.
AB - Importance: Practice guidelines recommend that clinicians engage patients in treatment decisions and explain atherosclerotic cardiovascular disease (ASCVD) risk but do not describe how to communicate this risk most effectively. Objective: To determine how the ASCVD risk time horizon, outcome, and presentation format influence risk perceptions and treatment preferences. Design, Setting, and Participants: From May 27, 2015, through November 12, 2015, participants from the Patient and Provider Assessment of Lipid Management Registry at 140 US cardiology, primary care, and endocrinology practices were presented 3 independent scenarios (representing the same hypothetical patient) and asked to rate their perceived risk and willingness to take medication to lower risk in light of (1) a 15% 10-year ASCVD event risk, (2) a 4% 10-year cardiovascular disease (CVD) death risk, and (3) a 50% lifetime ASCVD event risk. Exposures: Participants were randomized to receive risk estimates using numbers only, a bar graph, or a face pictogram. Results: Of 3566 eligible participants, 2708 (76.9%) responded (median age, 67 years [interquartile range, 61-76 years]; 280 [10.3%] African American; 1491 men [55.1%]). When shown the lifetime ASCVD risk, respondents were more likely to consider the risk "high to very high" than when presented the 10-year ASCVD risk or the CVD death risk (70.1% vs 31.4% vs 25.7%, respectively; both P <.001). Treatment willingness was also the 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 <.001). Compared with participants who were shown a bar graph or no graphic, those who were shown the 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. Conclusions and Relevance: The format, time horizon, and outcome used for risk estimation influence 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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U2 - 10.1001/jamacardio.2018.3680
DO - 10.1001/jamacardio.2018.3680
M3 - Article
C2 - 30419113
AN - SCOPUS:85056419751
SN - 2380-6583
VL - 3
SP - 1192
EP - 1199
JO - JAMA Cardiology
JF - JAMA Cardiology
IS - 12
ER -