title: The effect of ethnicity on different ways of expressing cardiovascular treatment benefits and patient decision-making.
abstract: BACKGROUND
  The way information is presented to communicate risk and treatment benefit affects patients' understanding and perception of their risk and can influence their decisions.
  
  
  OBJECTIVE
  To assess the effect of ethnicity on patient preferences for different ways of expressing risk and treatment benefits.
  
  
  METHODS
  Using tailored questionnaires, we surveyed Ma¯ori , Pacific and Indian peoples of known CVD risk to assess format preferences encouraging them to take medication or assist their understanding of possible treatment benefits. Statistical analysis determined any association of ethnicity with patient preferences.
  
  
  RESULTS
  Of the 376 participants, 50% identified as New Zealand (NZ) European; 15% Maori ; 25% Pacific and 10% Indian ethnicity. Patients preferred positive framing of risk (66%). Relative risk was the format reported as most encouraging to take medication and to understand risk, with natural frequencies least preferable, although Pacific people significantly preferred natural frequencies (p<0.0001) compared with other ethnic groups. The majority (55%) preferred pictures to numbers for explaining risk. Ma¯ori , Pacific and Indian participants significantly preferred 100-people chart formats over bar graphs compared with NZ Europeans/Others (p=0.002). Most (68%) preferred doctors to give their opinion on taking medication instead of explaining risks using numbers and/or pictures. Pacific and Indian peoples significantly preferred doctors to make decisions on treatment compared to NZ European/Other and Ma¯ori participants (p<0.0001).
  
  
  CONCLUSIONS
  Ethnic differences in patient preferences for communication formats and decision-making should be considered when tailoring effective communication in primary care. However, individual preferences cannot be presumed and a combination of methods should routinely be used.
authors.affiliation: Department of General Practice and Primary Health Care, The University of Auckland, Auckland, New Zealand. manjri.raval@my.jcu.edu.au.
authors.forename: Manjri
authors.initials: M
authors.lastname: Raval
authors.affiliation: Department of General Practice and Primary Health Care, The University of Auckland, Auckland, New Zealand.
authors.forename: Felicity
authors.initials: F
authors.lastname: Goodyear-Smith
authors.affiliation: Section of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
authors.forename: Susan
authors.initials: S
authors.lastname: Wells
mesh_terms: D044466:Asian People / Q000523:psychology; D002318:Cardiovascular Diseases / Q000208:ethnology*; D003142:Communication; D003657:Decision Making; D005006:Ethnicity / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D010358:Patient Participation; D057240:Patient Preference; D011320:Primary Health Care / Q000379:methods*; D018570:Risk Assessment; D044465:White People / Q000523:psychology