Cardiovascular Risk Assessment in Younger Patients

DOI: 10.3238/zfa.2017.0353–0359

Einflüsse der Darstellungsform auf die subjektive Risikowahrnehmung und den Entscheidungskonflikt

german translation / full article

Keywords: decision-aid event-free survival cardiovascular disease risk perception decisional conflict

Implications of Different Risk Representation on Risk Perception and Decisional Conflict

Background: Shared decision making (SDM) is a well-accepted concept to increase patients’ participation regarding diagnostic or therapeutic issues. Increasingly, lifetime risk or time-to-event (TTE) formats have been suggested as they might have advantages, e.g. in younger patients to better show consequences of unhealthy behaviour compared to a 10-year risk prognosis. We conducted a study, in which the 10-year risk illustration in the decision-aid-software arriba (the so called emoticons), is compared within a randomized trial to a newly developed TTE illustration. In a subanalysis the impact on younger patients is investigated.

Methods: Within this cluster-randomized controlled trial, thirty-two family physicians (FPs) recruited 304 patients and counseled them with arriba , randomized to either the emoticons or the TTE illustration, followed by a patient questionnaire to figure out the decisional conflict (DCS) and the perceived risk. The substudy focuses on a younger patient population (n = 39, aged 30–45).

Results: Younger patients counseled with the TTE-representation feel a significantly higher subjective risk (p = 0.001). In addition, they have higher scores in the DCS, representing a higher decisional conflict.

Conclusions: Lifetime representations seem to have advantages in younger patients, as they seem to visualize their risk better than a 10-year representation. Additionally, they cause a stronger decisional conflict. It needs to be shown in further studies if these results are generalizable including a higher number of young patients. Additionally, the relevance of an increased DCS needs to be reconsidered in transactional decision aids.

(State: 15.09.2017)

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