title: Absolute cardiovascular disease risk and shared decision making in primary care: a randomized controlled trial.
abstract: OBJECTIVE
  We wanted to determine the effect of promoting the effective communication of absolute cardiovascular disease (CVD) risk and shared decision making through disseminating a simple decision aid for use in family practice consultations.
  
  
  METHODS
  The study was based on a pragmatic, cluster randomized controlled trial (phase III) with continuing medical education (CME) groups of family physicians as the unit of randomization. In the intervention arm, 44 physicians (7 CME groups) consecutively recruited 550 patients in whom cholesterol levels were measured. Forty-seven physicians in the control arm (7 CME groups) similarly included 582 patients. Four hundred sixty patients (83.6%) of the intervention arm and 466 patients (80.1%) of the control arm were seen at follow-up. Physicians attended 2 interactive CME sessions and received a booklet, a paper-based risk calculator, and individual summary sheets for each patient. Control physicians attended 1 CME-session on an alternative topic. Main outcome measures were patient satisfaction and participation after the index consultation, change in CVD risk status, and decisional regret at 6 months' follow-up.
  
  
  RESULTS
  Intervention patients were significantly more satisfied with process and result (Patient Participation Scale, difference 0.80, P<.001). Decisional regret was significantly lower at follow-up (difference 3.39, P = .02). CVD risk decreased in both groups without a significant difference between study arms.
  
  
  CONCLUSIONS
  A simple transactional decision aid based on calculating absolute individual CVD risk and promoting shared decision making in CVD prevention can be disseminated through CME groups and may lead to higher patient satisfaction and involvement and less decisional regret, without negatively affecting global CVD risk.
authors.affiliation: Department of General Practice/Family Medicine, Phillips-University Marburg, Marburg, Germany. krones@med.uni-marburg.de
authors.forename: Tanja
authors.initials: T
authors.lastname: Krones
authors.forename: Heidemarie
authors.initials: H
authors.lastname: Keller
authors.forename: Andreas
authors.initials: A
authors.lastname: Sönnichsen
authors.forename: Eva-Maria
authors.initials: EM
authors.lastname: Sadowski
authors.forename: Erika
authors.initials: E
authors.lastname: Baum
authors.forename: Karl
authors.initials: K
authors.lastname: Wegscheider
authors.forename: Justine
authors.initials: J
authors.lastname: Rochon
authors.forename: Norbert
authors.initials: N
authors.lastname: Donner-Banzhoff
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods; D010358:Patient Participation; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010821:Physicians, Family; D011320:Primary Health Care / Q000379:methods*; D018570:Risk Assessment