Abstract
BackgroundDespite increasing recognition of the importance of involving patients in decisions on preventive healthcare interventions, little is known about how well patients understand and utilise information provided on the relative benefits from these interventions. The aim of this study was to explore whether lay people can discriminate between preventive interventions when effectiveness is presented in terms of relative risk reduction (RRR), and whether such discrimination is influenced by presentation of baseline risk.MethodsThe study was a randomised cross-sectional interview survey of a representative sample (n = 1,519) of lay people with mean age 59 (range 40–98) years in Denmark. In addition to demographic information, respondents were asked to consider a hypothetical drug treatment to prevent heart attack. Its effectiveness was randomly presented as RRR of 10, 20, 30, 40, 50 or 60 percent, and half of the respondents were presented with quantitative information on the baseline risk of heart attack. The respondents had also been asked whether they were diagnosed with hypercholesterolemia or had experienced a heart attack.ResultsIn total, 873 (58%) of the respondents consented to the hypothetical treatment. While 49% accepted the treatment when RRR = 10%, the acceptance rate was 58–60% for RRR>10. There was no significant difference in acceptance rates across respondents irrespective of whether they had been presented with quantitative information on baseline risk or not.ConclusionIn this study, lay people's decisions about therapy were only slightly influenced by the magnitude of the effect when it was presented in terms of RRR. The results may indicate that lay people have difficulties in discriminating between levels of effectiveness when they are presented in terms of RRR.
Highlights
Despite increasing recognition of the importance of involving patients in decisions on preventive healthcare interventions, little is known about how well patients understand and utilise information provided on the relative benefits from these interventions
In a hypothetical situation, respondents are only slightly influenced by a difference between 10% versus 60% relative risk reduction (RRR) of the given drug treatment, and RRR-effect was not influenced by presentation of baseline risk
A specific problem associated with our design is that one could argue that base-line risk was – in some form – presented to all respondents, and it is conceivable that 1% baseline risk is perceived as about the same risk as "slightly increased risk of heart attack"
Summary
Despite increasing recognition of the importance of involving patients in decisions on preventive healthcare interventions, little is known about how well patients understand and utilise information provided on the relative benefits from these interventions. Patient autonomy is a core element of medical ethics. Patient autonomy implies that patients and doctors share responsibility for medical decision to the extent patients wish to be included. For shared decision making to be meaningful, patients need to have an under-. BMC Medical Informatics and Decision Making 2008, 8:31 http://www.biomedcentral.com/1472-6947/8/31 standing of the effectiveness of medical interventions. This usually requires the use of the risk concept. Communicating risk information is a fundamental and increasingly prominent part of medical practice. Effective risk communication can enhance knowledge, involvement in decisions about testing or treatment, autonomy and empowerment of patients [1]. It is vital that we identify the available evidence about how risk communication should best be done
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