Communicating cardiovascular disease risk: an interview study of General Practitioners’ use of absolute risk within tailored communication strategies

BMC Family Practice

Research Article

Les Irwig¹  Shannon McKinn²  Carissa Bonner²  Jesse Jansen²  Kirsten McCaffery²  Paul Glasziou³  Jenny Doust³ 

[1] Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, 2006, Sydney, NSW, Australia;Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, 2006, Sydney, NSW, Australia;Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, Edward Ford Building A27, 2006, Sydney, NSW, Australia;Screening and Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Edward Ford Building A27, 2006, Sydney, NSW, Australia;Faculty of Health Sciences and Medicine, Bond University, QLD 4226, Robina, Australia;

关键词: Cardiovascular disease risk;    Prevention;    General practice;    Primary care;    Doctor-patient communication;    Risk communication;    Risk perception;   

DOI  :  10.1186/1471-2296-15-106

 received in 2014-03-06, accepted in 2014-05-21,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundCardiovascular disease (CVD) prevention guidelines encourage assessment of absolute CVD risk - the probability of a CVD event within a fixed time period, based on the most predictive risk factors. However, few General Practitioners (GPs) use absolute CVD risk consistently, and communication difficulties have been identified as a barrier to changing practice. This study aimed to explore GPs’ descriptions of their CVD risk communication strategies, including the role of absolute risk.MethodsSemi-structured interviews were conducted with a purposive sample of 25 GPs in New South Wales, Australia. Transcribed audio-recordings were thematically coded, using the Framework Analysis method to ensure rigour.ResultsGPs used absolute CVD risk within three different communication strategies: ‘positive’, ‘scare tactic’, and ‘indirect’. A ‘positive’ strategy, which aimed to reassure and motivate, was used for patients with low risk, determination to change lifestyle, and some concern about CVD risk. Absolute risk was used to show how they could reduce risk. A ‘scare tactic’ strategy was used for patients with high risk, lack of motivation, and a dismissive attitude. Absolute risk was used to ‘scare’ them into taking action. An ‘indirect’ strategy, where CVD risk was not the main focus, was used for patients with low risk but some lifestyle risk factors, high anxiety, high resistance to change, or difficulty understanding probabilities. Non-quantitative absolute risk formats were found to be helpful in these situations.ConclusionsThis study demonstrated how GPs use three different communication strategies to address the issue of CVD risk, depending on their perception of patient risk, motivation and anxiety. Absolute risk played a different role within each strategy. Providing GPs with alternative ways of explaining absolute risk, in order to achieve different communication aims, may improve their use of absolute CVD risk assessment in practice.

【 授权许可】

Unknown   
© Bonner et al.; licensee BioMed Central Ltd. 2014. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.