Can postponement of an adverse outcome be used to present risk reductions to a lay audience? A population survey.
BACKGROUND
For shared decision making doctors need to communicate the effectiveness of therapies such that patients can understand it and discriminate between small and large effects. Previous research indicates that patients have difficulties in understanding risk measures. This study aimed to test the hypothesis that lay people may be able to discriminate between therapies when their effectiveness is expressed in terms of postponement of an adverse disease event.


METHODS
In 2004 a random sample of 1,367 non-institutionalized Danes aged 40+ was interviewed in person. The participants were asked for demographic information and asked to consider a hypothetical preventive drug treatment. The respondents were randomized to the magnitude of treatment effectiveness (heart attack postponement of 1 month, 6 months, 12 months, 2 years, 4 years and 8 years) and subsequently asked whether they would take such a therapy. They were also asked whether they had hypercholesterolemia or had experienced a heart attack.


RESULTS
In total 58% of the respondents consented to the hypothetical treatment. The proportions accepting treatment were 39%, 52%, 56%, 64%, 67% and 73% when postponement was 1 month, 6 months, 12 months, 2 years, 4 years and 8 years respectively. Participants who thought that the effectiveness information was difficult to understand, were less likely to consent to therapy (p = 0.004).


CONCLUSIONS
Lay people can discriminate between levels of treatment effectiveness when they are presented in terms of postponement of an adverse event. The results indicate that such postponement is a comprehensible measure of effectiveness.
Dahl
Rasmus
R
Research Unit of General Practice, University of Southern Denmark Odense, Denmark. r.dahl@dadlnet.dk
Gyrd-Hansen
Dorte
D
Kristiansen
Ivar Sønbø
IS
Nexøe
Jørgen
J
Bo Nielsen
Jesper
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003625:Data Collection; D003657:Decision Making; D004192:Discrimination, Psychological; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control; D010817:Physician-Patient Relations; D011322:Primary Prevention / Q000379:methods*; D040242:Risk Reduction Behavior; D013997:Time Factors; D016896:Treatment Outcome