title: The effectiveness of personalized coronary heart disease and stroke risk communication.
abstract: BACKGROUND
  Current guidelines recommend global risk assessment to guide vascular risk factor management; however, most provider-patient communication focuses on individual risk factors in isolation. We sought to evaluate the impact of personalized coronary heart disease and stroke risk communication on patients' knowledge, beliefs, and health behavior.
  
  
  METHODS
  We conducted a randomized controlled trial testing personalized risk communication based on Framingham stroke and coronary heart disease risk scores compared with a standard risk factor education. A total of 89 patients were recruited from primary care clinics and followed up for 3 months. Outcomes included the following: risk perception and worry, risk factor knowledge, risk reduction preferences and decision conflict, medication adherence, health behaviors, and blood pressure.
  
  
  RESULTS
  Participants had a very low understanding of numeric information, high perceived risk for stroke or myocardial infarction, and high proportion of medication nonadherence. Patients' ability to identify vascular risk factors increased with personalized risk communication (mean 1.8 additional risk factors, 95% CI 1.3-2.2) and standard risk factor education (mean 1.6 additional risk factors, 95% CI 1.1-2.1) immediately after the intervention but was not sustained at 3 months. Patients in the personalized group had less decision conflict than the standard risk factor education group over intended risk reduction strategies (5.9 vs 10.1, P = .003). There was no appreciable impact of either communication strategy on medication adherence, exercise, smoking cessation, or blood pressure.
  
  
  CONCLUSIONS
  Personalized risk communication was preferred by patients and had a small impact on risk reduction preferences and decision conflict but had no impact on patient beliefs or behavior compared with standard risk factor education.
authors.affiliation: Center for Health Services Research in Primary Care, Durham VA Medical Center, NC 27705, USA.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Powers
authors.forename: Susanne
authors.initials: S
authors.lastname: Danus
authors.forename: Janet M
authors.initials: JM
authors.lastname: Grubber
authors.forename: Maren K
authors.initials: MK
authors.lastname: Olsen
authors.forename: Eugene Z
authors.initials: EZ
authors.lastname: Oddone
authors.forename: Hayden B
authors.initials: HB
authors.lastname: Bosworth
mesh_terms: D000368:Aged; D003142:Communication; D003327:Coronary Disease / Q000523:psychology*; D003657:Decision Making; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D020521:Stroke