What to say and how to say it

Návar, Ann Marie; Stone, Neil J.; Martin, Seth S.

doi:10.1097/hco.0000000000000322

Cited by 29 publications

(13 citation statements)

References 34 publications

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“…This evidence gap is surprising, especially in light of the emerging literature on risk–benefit communication in other areas of preventive medicine ( e.g. vaccinations [ 26 ], cancer screening [ 27 ] and cardiovascular prevention [ 28 ]). There might be a perception of LTBI treatment as a public health intervention administered using a programmatic management approach rather than individualised decision making.…”

Section: Discussionmentioning

confidence: 99%

Physicians' perspectives on communication and decision making in clinical encounters for treatment of latent tuberculosis infection

2018

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The aim of the study was to explore the views of tuberculosis (TB) physicians on treatment of latent TB infection (LTBI), focusing on decision making and communication in clinical practice.20 Australian TB physicians participated in a semistructured interview in person or over the telephone. Interviews were recorded, transcribed and analysed thematically.The study identified challenges that physicians face when discussing treatment for LTBI with patients. These included difficulties explaining the concept of latency (in particular to patients from culturally and linguistically diverse backgrounds) and providing guidance to patients while still framing treatment decisions as a choice. Tailored estimates of the risk of developing TB and the risk of developing an adverse effect from LTBI treatment were considered the most important information for decision making and discussion with patients. Physicians acknowledged that there is a significant amount of unwarranted treatment variation, which they attributed to the lack of evidence about the risk–benefit balance of LTBI treatment in certain scenarios and guidelines that refer to the need for case-by-case decision making in many instances.In order to successfully implement LTBI treatment at a clinical level, consideration should be given to research on how to best address communication challenges arising in clinical encounters.

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Section: Discussionmentioning

confidence: 99%

Physicians' perspectives on communication and decision making in clinical encounters for treatment of latent tuberculosis infection

2018

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“…Communicating 10-year cardiovascular risk to motivate patients to improve statin adherence and lower LDL-C remains challenging. 30 …”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Effectiveness of a Patient Centered Educational Mailer Designed to Improve Statin Adherence: A Pragmatic Trial

Nord

Berry

Stults

et al. 2017

eGEMs

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Background:Patients with high total cholesterol have increased risk of cardiovascular disease. National Cholesterol Education Program (NCEP) and American Heart Association (AHA) guidelines recommend cholesterol lowering with statin medications; however, statin adherence remains poor. We hypothesized that patient-centered education on the 10-year risk for each of the major constituents of cardiovascular disease would increase statin adherence and achievement of the low-density lipoprotein cholesterol (LDL-C) goal.Methods:Veterans within the Salt Lake City Veterans Affairs (VA) Medical Center initiating statin therapy from October 2008 to December 2011 were randomized in a pragmatic design to receive either an educational mailer or usual care. The mailer outlined their 10-year global cardiovascular risk, separated into coronary heart disease, stroke, and congestive heart failure. The study was unblinded and followed an intention-to-treat analysis where outcome measures were obtained during normal care process. The primary outcome measure was the achievement of the LDL-C goal during the 12-month follow-up.Results:Two hundred and seven patients were randomly assigned to either the intervention arm (95) or the control arm (112). No differences in the proportion of patients meeting the LDL-C goal were detected during 12-months [Relative Risk (RR): 0.95 (95 percent confidence interval (CI): 0.77–1.17)] or 18-months [RR: 1.03 (95 percent CI: 0.84, 1.25)]. Patients in the intervention arm had higher adherence on average, e.g., intervention patients were more likely to have 70 percent or more days of statin therapy compared to patients who received standard care—though this did not reach statistical significance—RR: 1.33 (95 percent CI: 1.00, 1.78). There were no statistical differences in cardiovascular outcomes or mortality.Conclusion:Patient education mailers sent to patients starting statin treatment did not have a clear impact on LDL-C goal achievement or adherence to statin therapy.

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“…The way in which information is conveyed plays an important role for understanding the level of CVD risk, which in turn determines health seeking behavior for risk prevention [9][10]. Graphic formats or bar charts and thermometer formats (with percentages) have, for example, been evaluated in previous qualitative studies conducted in Australia and their results are inconclusive to some degree [4,11].…”

Section: Introductionmentioning

confidence: 99%

Perceived cardiovascular disease risk and tailored communication strategies among rural and urban community dwellers in Rwanda: A qualitative study

Niyibizi

Okop

Nganabashaka

et al. 2021

Preprint

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Background In Rwanda, cardiovascular diseases (CVDs) are the third leading cause of death, and hence constitute an important public health issue. Like worldwide, most CVDs are due to lifestyle and preventable risk factors. Prevention interventions are based on risk factors for CVD risk, yet the outcome of such interventions might be limited by the lack of awareness or misconception of CVD risk. This study aimed to explore how rural and urban population groups in Rwanda perceive CVD risk and tailor communication strategies for estimated total cardiovascular risk. Methods An exploratory qualitative study design was applied using focus group discussions to collect data from rural and urban community dwellers. Thematic analysis with Atlas ti 7.5.18 was used and main findings for each theme reported as a narrative summary. Results Participants thought that CVD risk is due to either financial stress, psychosocial stress, substance abuse, noise pollution, unhealthy diets, diabetes or overworking. Participants did not understand CVD risk presented in quantitative format, but preferred qualitative formats or colors to represent low, moderate and high CVD risk through in-person communication. Participants preferred to be screened for CVD risk by community health workers using mobile health technology. Conclusion Rural and urban community members in Rwanda are aware of their CVD risk. Community health workers are preferred by local communities for CVD risk screening. Quantitative formats to present the total CVD risk appear inappropriate to the Rwandan population and qualitative formats are therefore advisable. Thus, operational research on the use of qualitative formats to communicate CVD risk is recommended to improve decision-making on CVD risk communication in the context of Rwanda.

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What to say and how to say it

Cited by 29 publications

References 34 publications

Physicians' perspectives on communication and decision making in clinical encounters for treatment of latent tuberculosis infection

Physicians' perspectives on communication and decision making in clinical encounters for treatment of latent tuberculosis infection

Evaluation of the Effectiveness of a Patient Centered Educational Mailer Designed to Improve Statin Adherence: A Pragmatic Trial

Perceived cardiovascular disease risk and tailored communication strategies among rural and urban community dwellers in Rwanda: A qualitative study

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