title: Determinants for acceptance of preventive treatment against heart disease - a web-based population survey.
abstract: BACKGROUND
  Patients' perception of risk and their lifestyle choices are of major importance in the treatment of common chronic diseases. This study reveals determinants for and knowledge about why people accept or reject preventive medical interventions against heart disease.
  
  
  METHODS
  A representative sample of 40-60-year-old Danish inhabitants was invited to participate in a web-based survey. The respondents were presented with a hypothetical scenario and asked to imagine that they were at an increased risk of heart disease, and subsequently presented with an offer of a preventive medical intervention. The aim was to elicit preference structures when potential patients are presented with different treatment conditions.
  
  
  RESULTS
  About one third of the respondents were willing to accept preventive medical treatment. Respondents with personal experience with heart disease were more likely to accept treatment than respondents with family members with heart disease or no prior experience with heart disease. The willingness to accept treatment was similar for both genders, and when adjusting for experience with heart disease, age was not associated with willingness to accept treatment. Socioeconomic status in terms of lower education was positively associated with acceptance. The price of treatment reduced willingness to accept for the lower income groups, whereas it had no effect in the highest income group. Some 57% of respondents who were willing to accept treatment changed their decision following information on potential side effects.
  
  
  CONCLUSIONS
  In accordance with our pre-study hypothesis, individuals with low income were more sensitive to price than individuals with high income. Thus, if the price of preventive medication increases above certain limits, a substantial proportion of the population may refrain from treatment. More than half of the respondents who were initially willing to accept treatment changed their decision when informed about the presence of potential side effects. This is an important observation in relation to risk communication, since most side effects occur very seldom, and a skewed assessment of treatment efficacy compared to risk of side effects may refrain some patients from treatment. Thus, more research is needed to better allow patients to compare treatment efficacy with risk of side effects in quantitative terms.
authors.affiliation: Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, J,B,Winsløws Vej 9, DK-5000 Odense C, Denmark. jbnielsen@health.sdu.dk.
authors.forename: Nielsen Jesper
authors.initials: NJ
authors.lastname: Bo
authors.forename: Jarbøl Dorte
authors.initials: JD
authors.lastname: Ejg
authors.forename: Gyrd-Hansen
authors.initials: GH
authors.lastname: Dorte
authors.forename: Barfoed Benedicte Marie
authors.initials: BB
authors.lastname: Lind
authors.forename: Larsen Pia
authors.initials: LP
authors.lastname: Veldt
mesh_terms: D000328:Adult; D000368:Aged; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D002755:Choice Behavior; D002908:Chronic Disease; D003132:Commerce; D003142:Communication; D003625:Data Collection / Q000379:methods; D003718:Denmark; D005190:Family; D005260:Female; D015438:Health Behavior; D006331:Heart Diseases / Q000517:prevention & control*; D006801:Humans; D020407:Internet; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012306:Risk; D012959:Socioeconomic Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents
references.citation: Fam Pract. 2004 Dec;21(6):623-9
references.pmid: 15520034
references.citation: Health Econ. 2011 Aug;20(8):917-29
references.pmid: 20730781
references.citation: JAMA. 2002 Jul 24-31;288(4):455-61
references.pmid: 12132975
references.citation: BMC Med Inform Decis Mak. 2012 Aug 09;12:89
references.pmid: 22873796
references.citation: Patient. 2012;5(4):239-49
references.pmid: 23116323
references.citation: Cochrane Database Syst Rev. 2005 Oct 19;(4):CD000011
references.pmid: 16235271
references.citation: Health Educ Q. 1988 Summer;15(2):175-83
references.pmid: 3378902
references.citation: Public Health Nutr. 2004 Feb;7(1A):187-200
references.pmid: 14972060
references.citation: Clin Ther. 2008 Nov;30(11):2167-79
references.pmid: 19108805
references.citation: MedGenMed. 2007 Sep 19;9(3):58
references.pmid: 18092064
references.citation: Fam Pract. 2002 Feb;19(1):3-6
references.pmid: 11818342
references.citation: CMAJ. 2014 Jan 7;186(1):23-30
references.pmid: 24246588
references.citation: Nutrition. 1999 Jun;15(6):523-6
references.pmid: 10378216
references.citation: J Clin Pharm Ther. 2001 Oct;26(5):331-42
references.pmid: 11679023
references.citation: Circulation. 2010 Mar 30;121(12):1455-8
references.pmid: 20351303
references.citation: Patient Educ Couns. 2013 Apr;91(1):105-12
references.pmid: 23218590
references.citation: Expert Rev Pharmacoecon Outcomes Res. 2006 Dec;6(6):673-9
references.pmid: 20528493
references.citation: J Rheumatol. 2007 Jul;34(7):1569-75
references.pmid: 17552039
references.citation: N Engl J Med. 2005 Aug 4;353(5):487-97
references.pmid: 16079372
references.citation: BMC Med Inform Decis Mak. 2008 Jun 19;8:25
references.pmid: 18565218
references.citation: J Pain. 2010 Nov;11(11):1095-108
references.pmid: 20452835