Hux J E, Naylor C D
Clinical Epidemiology Unit, Sunnybrook Health Science Centre, North York, Ontario, Canada.
Med Decis Making. 1995 Apr-Jun;15(2):152-7. doi: 10.1177/0272989X9501500208.
Patients' informed acceptance of chronic medical therapy hinges on communicating the potential benefits of drugs in quantitative terms. In a hypothetical scenario of treatment initiation, the authors assessed how three different formats of the same data affected the willingness of 100 outpatients to take what were implied to be three different lipid-lowering drugs. Side-effects were declared negligible and costs insured. Subjects make a "yes-no" decision about taking such a medication, and graded the decision on a certainty scale. Advised of a relative risk reduction--"34% reduction in heart attacks"--88% of the patients assented to therapy. All other formats elicited significantly more refusals (p < 0.0001): for absolute risk difference--"1.4% fewer patients had heart attacks"--42% assented; for inverted absolute risk--"treat 71 persons for 5 years to prevent one heart attack"--only 31% accepted treatment. When the data were extrapolated to disease-free survival--"average gain of 15 weeks"--40% consented. Similar responses were obtained for descriptions of an antihypertensive drug: 89% assented to therapy when given relative risk reduction but only 46% when given absolute risk reduction. The subjects were confident in both acceptance and refusal: 93% of the decisions were rated "somewhat certain" to "completely certain." The authors conclude that patients' views of medical therapy are shaped by the formats in which potential benefits are presented. Multiple complementary formats may be most appropriate. The results imply that many patients may decline treatment if briefed on the likelihood or extent of benefit.
患者对慢性药物治疗的知情接受程度取决于能否以量化方式传达药物的潜在益处。在一个假设的治疗起始场景中，作者评估了相同数据的三种不同呈现形式如何影响100名门诊患者服用三种不同降脂药物（暗示）的意愿。声明副作用可忽略不计且费用已承保。受试者对是否服用此类药物做出“是/否”决定，并在确定程度量表上对该决定进行评分。被告知相对风险降低——“心脏病发作风险降低34%”——88%的患者同意接受治疗。所有其他形式引发的拒绝明显更多（p<0.0001）：对于绝对风险差异——“心脏病发作患者减少1.4%”——42%的患者同意；对于倒置绝对风险——“治疗71人5年可预防一次心脏病发作”——只有31%的患者接受治疗。当数据外推至无病生存期——“平均增加15周”——40%的患者同意。对于一种降压药物的描述也得到了类似的反应：给予相对风险降低时89%的患者同意接受治疗，但给予绝对风险降低时只有46%的患者同意。受试者对接受和拒绝都很有信心：93%的决定被评为“有点确定”到“完全确定”。作者得出结论，患者对药物治疗的看法受潜在益处呈现形式的影响。多种互补形式可能最合适。结果表明，如果向许多患者介绍获益的可能性或程度，他们可能会拒绝治疗。
