Abstract
While different ways of presenting treatment effects can affect health care decisions, little is known about which presentations best help people make decisions consistent with their own values. We compared six summary statistics for communicating coronary heart disease (CHD) risk reduction with statins: relative risk reduction and five absolute summary measures-absolute risk reduction, number needed to treat, event rates, tablets needed to take, and natural frequencies. We conducted a randomized trial to determine which presentation resulted in choices most consistent with participants' values. We recruited adult volunteers who participated through an interactive Web site. Participants rated the relative importance of outcomes using visual analogue scales (VAS). We then randomized participants to one of the six summary statistics and asked them to choose whether to take statins based on this information. We calculated a relative importance score (RIS) by subtracting the VAS scores for the downsides of taking statins from the VAS score for CHD. We used logistic regression to determine the association between participants' RIS and their choice. 2,978 participants completed the study. Relative risk reduction resulted in a 21% higher probability of choosing to take statins over all values of RIS compared to the absolute summary statistics. This corresponds to a number needed to treat (NNT) of 5; i.e., for every five participants shown the relative risk reduction one additional participant chose to take statins, compared to the other summary statistics. There were no significant differences among the absolute summary statistics in the association between RIS and participants' decisions whether to take statins. Natural frequencies were best understood (86% reported they understood them well or very well), and participants were most satisfied with this information. Presenting the benefits of taking statins as a relative risk reduction increases the likelihood of people accepting treatment compared to presenting absolute summary statistics, independent of the relative importance they attach to the consequences. Natural frequencies may be the most suitable summary statistic for presenting treatment effects, based on self-reported preference, understanding of and satisfaction with the information, and confidence in the decision. ISRCTN85194921.
Highlights
Health care professionals, and policy makers to make informed choices about health care, they must have information about the effects of interventions that is valid and understandable
Presenting the benefits of taking statins as a relative risk reduction increases the likelihood of people accepting treatment compared to presenting absolute summary statistics, independent of the relative importance they attach to the consequences
Systematic reviews [1,2] have found that use of relative risk reduction (RRR) to represent the effect of treatment results in individuals perceiving a larger treatment effect and being more likely to decide in favor of treatment compared with the use of absolute risk reduction (ARR) or the number needed to treat (NNT) [1]
Summary
Health care professionals, and policy makers to make informed choices about health care, they must have information about the effects of interventions that is valid and understandable. The goal of the Health Information Project: Presentation Online (HIPPO) is to evaluate alternative ways of presenting research evidence in order to improve communication of information about the effects of health care and to facilitate clinical decisions that are consistent with patient values. While different ways of presenting treatment effects can affect health care decisions, little is known about which presentations best help people make decisions consistent with their own values. We compared six summary statistics for communicating coronary heart disease (CHD) risk reduction with statins: relative risk reduction and five absolute summary measures—absolute risk reduction, number needed to treat, event rates, tablets needed to take, and natural frequencies. The person needs to consider both the benefits and downsides of this course of action Can he or she afford to pay for statins, if their health care system requires him or her to? Can he or she afford to pay for statins, if their health care system requires him or her to? Does the person want to take a pill every day that might cause some side effects? That is, the person has to consider his or her ‘‘values’’—the relative desirability of all the possible outcomes of taking statins— before deciding whether to follow his or her doctor’s advice
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