The Effectiveness of One-to-one Risk-communication Interventions in Health Care

Edwards, Adrian; Hood, Kerenza; Matthews, Elaine; Russell, Daphne; Russell, Ian; Barker, Jacqueline; Bloor, Michael; Burnard, Philip; Covey, Judith; Pill, Roisin; Wilkinson, Clare; Stott, N. C. H.

doi:10.1177/0272989x0002000305

Cited by 152 publications

(126 citation statements)

References 29 publications

Supporting

Mentioning

120

Contrasting

Unclassified

Order By: Relevance

“…Research indicates that patients are more motivated to seek medical treatment if they are given personally relevant information rather than information about average risks. 26 Doctors should therefore assess each patient's risk of coronary heart disease individually, on the basis of clinical data and information from the family history. Research indicates that doctors and patients may assess the patient's family history differently.…”

Section: Implications For Clinical Practicementioning

confidence: 99%

Perceived Vulnerability to Heart Disease in Patients with Familial Hypercholesterolemia: A Qualitative Interview Study

Frich

Ose²,

Malterud³

et al. 2006

The Annals of Family Medicine

View full text Add to dashboard Cite

PURPOSE Knowledge about the ways patients perceive their vulnerability to disease is important for communication with patients about risk and preventive health measures. This interview study aimed to explore how patients with a diagnosis of heterozygous familial hypercholesterolemia understand and perceive their vulnerability to coronary heart disease. METHODSWe did a qualitative study of 40 patients with familial hypercholesterolemia who were recruited through a lipid clinic in Norway. We elicited participants' perceptions about their vulnerability to heart disease in semistructured interviews. Data were analyzed by systematic text condensation inspired by Giorgi's phenomenological method. RESULTSWe found that participants negotiated a personal and dynamic sense of vulnerability to coronary heart disease that was grounded in notions of their genetic and inherited risk. Participants developed a sense of their vulnerability in a 2-step process. First, they consulted their family history to assess their genetic and inherited risk, and for many a certain age determined when they could expect to develop symptoms of coronary heart disease. Second, they negotiated a personal sense of vulnerability by comparing themselves with their family members. In these comparisons, they accounted for individual factors, such as sex, cholesterol levels, use of lipid-lowering medications, and lifestyle. Participants' personal sense of vulnerability to heart disease could shift dynamically as a result of changes in situational factors, such as cardiac events in the family, illness experiences, or becoming a parent. CONCLUSIONSPatients with a diagnosis of familial hypercholesterolemia negotiate a personal and dynamic sense of vulnerability to coronary heart disease that is grounded in their understanding of their genetic and inherited risk. Doctors should elicit patients' understanding of their family history and their personal vulnerability to individualize clinical management. 2006;4:198-204. DOI: 10.1370/afm.529. Ann Fam Med INTRODUCTION Communicating with patients about their risk of future disease and preventive health measures is challenging for the doctor.1 A strong predictor of patients' readiness for medical treatment and preventive behavior is their perceived vulnerability to disease. [2][3][4][5][6] The family history forms a basis upon which a person assesses his or her own vulnerability to common chronic diseases, 7,8 and the family history is becoming increasingly important as a medical devise to predict risk of future disease.9 How do patients with a well-defi ned genetic disorder relate to their family history? How do patients with a diagnosed familial risk understand and perceive their vulnerability to future disease?Heterozygous familial hypercholesterolemia is an autosomal dominant genetic condition, characterized by elevated low-density lipoprotein Jan C. Frich, MD, MSc 1,2 Leiv Ose, MD, PhD 3 Kirsti Malterud, MD, PhD 4,5 Per Fugelli, MD 199 PAT IEN T S' PERC EIV ED V UL NER A BIL I T Y(LDL) chol...

show abstract

Section: Implications For Clinical Practicementioning

confidence: 99%

Perceived Vulnerability to Heart Disease in Patients with Familial Hypercholesterolemia: A Qualitative Interview Study

Frich

Ose²,

Malterud³

et al. 2006

The Annals of Family Medicine

View full text Add to dashboard Cite

show abstract

“…Studies of the effects of risk communication on a range of outcomes have a greater effect if they concern personalised rather than generalised risk. 31 Furthermore, it seems self-evident that clinicians should try to present information that reflects as far as possible the impact of the risks and benefits upon the individual patient sitting in front of them. Thus, it is not appropriate to say to a patient with AF that she has a five-fold increase in the risk of stroke, not only because this breaks one of the cardinal rules on using relative risk, but also because this is an average figure for all people with AF regardless of their individual risk factors.…”

Section: Individualised Risk Presentation: Tailored Probabilitiesmentioning

confidence: 99%

Risk communication in the clinical consultation

2005

Self Cite

View full text Add to dashboard Cite

-Modern healthcare and modern societies are facing up to the need for greater engagement of patients in treatment decisions. Shared and informed decision-making is replacing traditional paternalistic approaches to decisions; health policy both reflects and drives these changes. A critical contribution to better informed decisions by patients is the effective communication of risk in the clinical consultation. This is not straightforward, but there is a growing evidence base to improve performance in this area to the benefit of both patients and clinicians. The purpose of this review is to provide an accessible and practical guide to better communication of risk by clinicians. KEY WORDS: communication skills, decisionmaking, risk communication, uncertaintyRisk communication is the open two-way exchange of information and opinion about risk, leading in the context of healthcare to better understanding and more informed decisions about clinical management. 1 However, this straightforward definition belies the difficulty of doing this effectively. 2 There are many reasons why discussing risk with patients in the clinical consultation is increasingly important. The policy agenda in healthcare in the NHS is rapidly changing. There is a major emphasis on choice; 3 together with that comes the need to give information that helps patients make more informed decisions. Hitherto, choice has been rather narrowly restricted to issues such as where to be treated. Arguably, choice is more important in making decisions on treatment options where there may be more than one treatment to consider, often with different risk and benefit profiles and long-lasting consequences for the patient.Thus, there has recently been considerable emphasis on shared and informed decision-making, in contrast to doctor-led paternalistic approaches that have dominated in the past. 4 In part, this reflects a wider societal change towards a more consumerist society, aligned with increasing expectations of healthcare. However, it also reflects a moral and ethical imperative better to engage patients in decisions that materially affect their health, especially when it is increasingly acknowledged that patients' values and preferences vary widely and that doctors are poor at predicting these in individual patients. 5 Furthermore, there is increasing evidence that patients who are better informed and more engaged in decisions about their own care are more likely to be knowledgeable, more likely to adhere to their chosen treatment and may have better outcomes. 6,7 There has been an explosion of decision aids to help patients participate in decision making and to make informed choices consistent with their values by presenting the clinical evidence and the likely effects of alternative treatments. A key element of such decision aids is the presentation of risks and benefits; it is within this field of endeavour that much of what we now know about good communication of risk arises. Whether or not they use decision aids, though, clinicians have a majo...

show abstract

“…Typically, these are priority groups for the prevention of overweight and cardiovascular disease, but also the groups that are not easily reached by preventive efforts. An awareness of a potentially increased risk for their children of diseases later in life that is associated with their own family disease history may increase families' motivation to follow healthy lifestyle guidelines [38]. Children of immigrants were under-represented in the PIAMA study, and we cannot exclude the possibility that different associations of family history of diabetes/CVD with offspring cardiometabolic markers would be observed for other ethnicities.…”

Section: Discussionmentioning

confidence: 97%

Family history of myocardial infarction, stroke and diabetes and cardiometabolic markers in children

et al. 2016

View full text Add to dashboard Cite

Aims/hypothesis Despite the overlap in occurrence of cardiovascular disease (CVD) and type 2 diabetes and their risk factors, family history of these diseases has not yet been investigated simultaneously in relation to cardiometabolic markers in offspring. We examined how a family history of CVD and/or diabetes relates to cardiometabolic markers in offspring, and to what extent these diseases independently contribute to cardiometabolic markers. Methods We used data from 1,374 12-year-old children and their parents participating in a birth cohort study in the Netherlands. Family history of CVD (myocardial infarction [MI] and stroke) and diabetes were reported by the parents. Children were classified as 'no', 'moderate' or 'strong' family history, based on early/late onset of disease in parents and grandparents. Cardiometabolic markers were measured at 12 years of age: waist circumference, cholesterol, blood pressure and HbA 1c .Results Compared with those with no family history, children with a strong family history of MI and/or stroke and/or diabetes (29% of the study population) had 0.13 mmol/l higher total cholesterol (TC) (95% CI 0.03, 0.23) and 0.18 higher TC/ HDL-cholesterol (HDLC) ratio (95% CI 0.04, 0.32). A strong family history of MI or diabetes was independently associated with unfavourable cardiometabolic markers specific to those diseases. These associations remained after adjusting for BMI. Children with a moderate family history had no unfavourable cardiometabolic markers. Conclusions/interpretation One-third of the children had a strong family history of CVD and/or diabetes. These children had higher TC levels and TC/HDLC ratios than children with no family history. A strong family history of MI or diabetes was independently associated with unfavourable cardiometabolic markers specific to those diseases.

show abstract

The Effectiveness of One-to-one Risk-communication Interventions in Health Care

Cited by 152 publications

References 29 publications

Perceived Vulnerability to Heart Disease in Patients with Familial Hypercholesterolemia: A Qualitative Interview Study

Perceived Vulnerability to Heart Disease in Patients with Familial Hypercholesterolemia: A Qualitative Interview Study

Risk communication in the clinical consultation

Family history of myocardial infarction, stroke and diabetes and cardiometabolic markers in children

Contact Info

Product

Resources

About