title: How do general practitioners and patients make decisions about cardiovascular disease risk?
abstract: OBJECTIVE
  Although current guidelines around the world recommend using absolute risk (AR) thresholds to decide whether cardiovascular disease (CVD) risk should be managed with lifestyle or medication, the use of AR in clinical practice is limited. The aim of this study was to explore the factors that influence general practitioner (GP) and patient decision making about CVD risk management, including the role of risk perception.
  
  
  METHODS
  Qualitative descriptive study involving semi-structured interviews with 25 GPs and 38 patients in Australia in 2011-2012. Transcribed audio-recordings were thematically coded and a Framework Analysis method was used.
  
  
  RESULTS
  GPs rarely mentioned AR thresholds but were influenced by their subjective perception of the patient's risk and motivation, and their own attitudes toward prevention, including concerns about medication side effects and the efficacy of lifestyle change. Patients were influenced by individual risk factors, their own motivation to change lifestyle, and attitudes toward medication: initially negative, but this improved if medication was more effective than lifestyle. High perceived risk led to medication being recommended by GPs and accepted by patients, but this was not necessarily based on AR. Patient perceptions of high risk also increased motivation to change lifestyle, particularly if they were resistant to the idea of taking medication.
  
  
  CONCLUSIONS
  Perceived risk, motivation, and attitudes appeared to be more important than AR thresholds in this study. CVD risk management guidelines could be more useful if they include strategies to help GPs consider patients' risk perception, motivation, and attitudes as well as evidence-based recommendations.
authors.affiliation: Screening and Test Evaluation Program (STEP), Sydney School of Public Health.
authors.forename: Carissa
authors.initials: C
authors.lastname: Bonner
authors.affiliation: Screening and Test Evaluation Program (STEP), Sydney School of Public Health.
authors.forename: Jesse
authors.initials: J
authors.lastname: Jansen
authors.affiliation: Screening and Test Evaluation Program (STEP), Sydney School of Public Health.
authors.forename: Shannon
authors.initials: S
authors.lastname: McKinn
authors.affiliation: Screening and Test Evaluation Program (STEP), Sydney School of Public Health.
authors.forename: Les
authors.initials: L
authors.lastname: Irwig
authors.affiliation: Faculty of Health Sciences and Medicine, Bond University.
authors.forename: Jenny
authors.initials: J
authors.lastname: Doust
authors.affiliation: Faculty of Health Sciences and Medicine, Bond University.
authors.forename: Paul
authors.initials: P
authors.lastname: Glasziou
authors.affiliation: Screening and Test Evaluation Program (STEP), Sydney School of Public Health.
authors.forename: Kirsten
authors.initials: K
authors.lastname: McCaffery
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001315:Australia; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control* / Q000523:psychology*; D003657:Decision Making; D005260:Female; D058005:General Practitioners / Q000523:psychology*; D015438:Health Behavior; D006801:Humans; D007407:Interviews as Topic; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010465:Perception; D010817:Physician-Patient Relations; D036301:Qualitative Research; D012307:Risk Factors; D012308:Risk Management / Q000379:methods*