|
Sign In to gain access to subscriptions and/or personal tools.
|
Communicating the Benefits of Chronic Preventive Therapy
Does the Format of Efficacy Data Determine Patients' Acceptance of Treatment?
Janet E. Hux, MSc, MD
C. David Naylor, MD, DPhil
Patients' informed acceptance of chronic medical therapy hinges on communicating the potential benefits of drugs in quantitative terms. In a hypothetical scenario of treatment initiation, the authors assessed how three different formats of the same data affected the willingness of 100 outpatients to take what were implied to be three different lipid-lowering drugs. Side-effects were declared negligible and costs insured. Subjects make a "yes-no" decision about taking such a medication, and graded the decision on a certainty scale. Advised of a relative risk reduction-"34% reduction in heart attacks"-88% of the patients assented to therapy. All other formats elicited significantly more refusals (p < 0.0001): for absolute risk difference—"1.4% fewer patients had heart attacks"—42% assented; for in verted absolute risk—"treat 71 persons for 5 years to prevent one heart attack"—only 31% accepted treatment. When the data were extrapolated to disease-free survival—"average gain of 15 weeks"—40% consented. Similar responses were obtained for descriptions of an antihypertensive drug: 89% assented to therapy when given relative risk reduction but only 46% when given absolute risk reduction. The subjects were confident in both acceptance and refusal: 93% of the decisions were rated "somewhat certain" to "completely certain." The authors conclude that patients' views of medical therapy are shaped by the formats in which potential benefits are presented. Multiple complementary formats may be most ap propriate. The results imply that many patients may decline treatment if briefed on the likelihood or extent of benefit. Key words: patient compliance; framing effects; informed consent; physician-patient communication. (Med Decis Making 1995;15:152-157)
Medical Decision Making, Vol. 15, No. 2,
152-157 (1995)
DOI: 10.1177/0272989X9501500208
 CiteULike  Complore  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter What's this?
This article has been cited by other articles:
|
|
|
|
 
S. Woloshin, L. M. Schwartz, and B. S. Kramer
Promoting Healthy Skepticism in the News: Helping Journalists Get It Right
J Natl Cancer Inst,
November 20, 2009;
(2009)
djp409v1.
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Visvanathan, R. T. Chlebowski, P. Hurley, N. F. Col, M. Ropka, D. Collyar, M. Morrow, C. Runowicz, K. I. Pritchard, K. Hagerty, et al.
American Society of Clinical Oncology Clinical Practice Guideline Update on the Use of Pharmacologic Interventions Including Tamoxifen, Raloxifene, and Aromatase Inhibition for Breast Cancer Risk Reduction
J. Clin. Oncol.,
July 1, 2009;
27(19):
3235 - 3258.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J.-L. Tang, W.-Z. Wang, J.-G. An, Y.-H. Hu, S.-H. Cheng, and S. Griffiths
How willing are the public to pay for anti-hypertensive drugs for primary prevention of cardiovascular disease: a survey in a Chinese city
Int. J. Epidemiol.,
June 2, 2009;
(2009)
dyp213v1.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. M. Griffith, C. L. Lewis, S. Hawley, S. L. Sheridan, and M. P. Pignone
Randomized Trial of Presenting Absolute v. Relative Risk Reduction in the Elicitation of Patient Values for Heart Disease Prevention With Conjoint Analysis
Med Decis Making,
March 1, 2009;
29(2):
167 - 174.
[Abstract]
[PDF]
|
|
|
|
|
|
|
F. A. McAlister MD MSc
The "number needed to treat" turns 20 -- and continues to be used and misused
Can. Med. Assoc. J.,
September 9, 2008;
179(6):
549 - 553.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. L. Cuite, N. D. Weinstein, K. Emmons, and G. Colditz
A Test of Numeric Formats for Communicating Risk Probabilities
Med Decis Making,
June 1, 2008;
28(3):
377 - 384.
[Abstract]
[PDF]
|
|
|
|
|
|
|
F. Goodyear-Smith, B. Arroll, L. Chan, R. Jackson, S. Wells, and T. Kenealy
Patients Prefer Pictures to Numbers to Express Cardiovascular Benefit From Treatment
Ann. Fam. Med,
May 1, 2008;
6(3):
213 - 217.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. C. Politi, P. K. J. Han, and N. F. Col
Communicating the Uncertainty of Harms and Benefits of Medical Interventions
Med Decis Making,
October 1, 2007;
27(5):
681 - 695.
[Abstract]
[PDF]
|
|
|
|
|
|
|
D. Feldman-Stewart, M. D. Brundage, and V. Zotov
Further Insight into the Perception of Quantitative Information: Judgments of Gist in Treatment Decisions
Med Decis Making,
January 1, 2007;
27(1):
34 - 43.
[Abstract]
[PDF]
|
|
|
|
|
|
|
L. M Schwartz, S. Woloshin, E. L Dvorin, and H G. Welch
Ratio measures in leading medical journals: structured review of accessibility of underlying absolute risks
BMJ,
December 16, 2006;
333(7581):
1248 - 1248.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. A. McNutt
Shared Medical Decision Making: Problems, Process, Progress
JAMA,
November 24, 2004;
292(20):
2516 - 2518.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A Slowther, S Ford, and T Schofield
Ethics of evidence based medicine in the primary care setting
J. Med. Ethics,
April 1, 2004;
30(2):
151 - 155.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
G. Domenighetti, B. D'Avanzo, M. Egger, F. Berrino, T. Perneger, P. Mosconi, and M. Zwahlen
Women's perception of the benefits of mammography screening: population-based survey in four countries
Int. J. Epidemiol.,
October 1, 2003;
32(5):
816 - 821.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. van Walraven, R. G. Hart, G. A. Wells, P. Petersen, P. J. Koudstaal, A. L. Gullov, B. S. P. Hellemons, B. G. Koefed, and A. Laupacis
A Clinical Prediction Rule to Identify Patients With Atrial Fibrillation and a Low Risk for Stroke While Taking Aspirin
Arch Intern Med,
April 28, 2003;
163(8):
936 - 943.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. H Makela and R. K Griffith
Enhancing Treatment of Bipolar Disorder Using the Patient's Belief System
Ann. Pharmacother.,
April 1, 2003;
37(4):
543 - 545.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. S. Kristiansen, J. Nexoe, D. Gyrd-Hansen, and J. B. Nielsen
NNT is not easily understood
Fam. Pract.,
October 1, 2002;
19(5):
566 - 566.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. T. Chlebowski, N. Col, E. P. Winer, D. E. Collyar, S. R. Cummings, V. G. Vogel III, H. J. Burstein, A. Eisen, I. Lipkus, and D. G. Pfister
American Society of Clinical Oncology Technology Assessment of Pharmacologic Interventions for Breast Cancer Risk Reduction Including Tamoxifen, Raloxifene, and Aromatase Inhibition
J. Clin. Oncol.,
August 1, 2002;
20(15):
3328 - 3343.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. E Straus
Individualizing Treatment Decisions: The Likelihood of Being Helped or Harmed
Eval Health Prof,
June 1, 2002;
25(2):
210 - 224.
[Abstract]
[PDF]
|
|
|
|
|
|
|
J. Nexoe, D. Gyrd-Hansen, J. Kragstrup, I. S. Kristiansen, and J. B. Nielsen
Danish GPs' perception of disease risk and benefit of prevention
Fam. Pract.,
February 1, 2002;
19(1):
3 - 6.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Wells, P. Marshall, B. Crawley, and K. Dickersin
Newspaper Reporting of Screening Mammography
Ann Intern Med,
December 18, 2001;
135(12):
1029 - 1037.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. M. Schapira, A. B. Nattinger, and C. A. McHorney
Frequency or Probability? A Qualitative Study of Risk Communication Formats Used in Health Care
Med Decis Making,
December 1, 2001;
21(6):
459 - 467.
[Abstract]
[PDF]
|
|
|
|
|
|
|
A Edwards and G Elwyn
Understanding risk and lessons for clinical risk communication about treatment preferences
Qual. Saf. Health Care,
September 1, 2001;
10(90001):
i9 - 13.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Ebrahim
The Use of Numbers Needed to Treat Derived from Systematic Reviews and Meta-Analysis: Caveats and Pitfalls
Eval Health Prof,
June 1, 2001;
24(2):
152 - 164.
[Abstract]
[PDF]
|
|
|
|
|
|
|
A. Edwards, K. Hood, E. Matthews, D. Russell, I. Russell, J. Barker, M. Bloor, P. Burnard, J. Covey, R. Pill, et al.
The Effectiveness of One-to-one Risk-communication Interventions in Health Care: A Systematic Review
Med Decis Making,
July 1, 2000;
20(3):
290 - 297.
[Abstract]
[PDF]
|
|
|
|
|
|
|
R. Moynihan, L. Bero, D. Ross-Degnan, D. Henry, K. Lee, J. Watkins, C. Mah, and S. B. Soumerai
Coverage by the News Media of the Benefits and Risks of Medications
N. Engl. J. Med.,
June 1, 2000;
342(22):
1645 - 1650.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Kee
Confidence limits and the limits of confidence
QJM,
February 1, 2000;
93(2):
121 - 124.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. F. Steiner
Talking about Treatment
Ann Intern Med,
January 4, 2000;
132(1):
94 - 94.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Edwards and G. Elwyn
How Should Effectiveness of Risk Communication to Aid Patients' Decisions Be Judged?: A Review of the Literature
Med Decis Making,
October 1, 1999;
19(4):
428 - 434.
[Abstract]
[PDF]
|
|
|
|
|
|
|
A. Edwards, G. Elwyn, and R. Gwyn
General practice registrar responses to the use of different risk communication tools in simulated consultations: a focus group study
BMJ,
September 18, 1999;
319(7212):
749 - 752.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
L. Smeeth, A. Haines, and S. Ebrahim
Numbers needed to treat derived from meta-analyses---sometimes informative, usually misleading
BMJ,
June 5, 1999;
318(7197):
1548 - 1551.
[Full Text]
|
|
|
|
|
|
|
C. K. Daugherty
Impact of Therapeutic Research on Informed Consent and the Ethics of Clinical Trials: A Medical Oncology Perspective
J. Clin. Oncol.,
May 1, 1999;
17(5):
1601 - 1601.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. F. Steiner
Talking about Treatment: The Language of Populations and the Language of Individuals
Ann Intern Med,
April 6, 1999;
130(7):
618 - 622.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. M. Schwartz, S. Woloshin, and H. G. Welch
Risk Communication in Clinical Practice: Putting Cancer in Context
J Natl Cancer Inst Monographs,
January 1, 1999;
1999(25):
124 - 133.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
J. E. Hux and C. D. Naylor
In the Eye of the Beholder
Arch Intern Med,
November 27, 1995;
155(21):
2277 - 2280.
[Abstract]
[PDF]
|
|
|
|
|
