Sydney School of Public Health, The University of Sydney, Sydney, Australia.
Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
Patient Educ Couns. 2018 May;101(5):843-853. doi: 10.1016/j.pec.2017.12.003. Epub 2017 Dec 11.
Cardiovascular disease (CVD) prevention guidelines recommend medication based on the probability of a heart attack/stroke in the next 5-10 years. However, heuristics and biases make risk communication challenging for doctors. This study explored how patients interpret personalised CVD risk results presented in varying formats and timeframes.
GPs recruited 25 patients with CVD risk factors and varying medication history. Participants were asked to 'think aloud' while using two CVD risk calculators that present probabilistic risk in different ways, within a semi-structured interview. Transcribed audio-recordings were coded using Framework Analysis.
Key themes were: 1) numbers lack meaning without a reference point; 2) risk results need to be both credible and novel; 3) selective attention to intervention effects. Risk categories (low/moderate/high) provided meaningful context, but short-term risk results were not credible if they didn't match expectations. Colour-coded icon arrays showing the effect of age and interventions were seen as novel and motivating. Those on medication focused on benefits, while others focused on harms.
CVD risk formats need to be tailored to patient expectations and experiences in order to counteract heuristics and biases.
Doctors need access to multiple CVD risk formats to communicate effectively about CVD prevention.
心血管疾病（CVD）预防指南建议根据未来 5-10 年内心脏病发作/中风的概率来使用药物。然而，启发式和偏差使得医生进行风险沟通具有挑战性。本研究探讨了患者如何解释以不同格式和时间框架呈现的个性化 CVD 风险结果。
全科医生招募了 25 名有 CVD 危险因素和不同用药史的患者。参与者被要求在半结构化访谈中使用两种以不同方式呈现概率风险的 CVD 风险计算器“边想边做”。使用框架分析对转录的音频记录进行编码。
主要主题是：1）没有参考点，数字就没有意义；2）风险结果需要既可信又新颖；3）选择性关注干预效果。风险类别（低/中/高）提供了有意义的背景，但如果短期风险结果与预期不符，则不可信。显示年龄和干预措施影响的彩色图标数组被认为新颖且有激励作用。正在服用药物的人关注的是益处，而其他人则关注的是危害。
为了对抗启发式和偏差，CVD 风险格式需要根据患者的期望和经验进行调整。
医生需要获得多种 CVD 风险格式，以便有效地进行 CVD 预防沟通。
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