The impact of a decision aid about heart disease prevention on patients' discussions with their doctor and their plans for prevention: a pilot randomized trial

Stacey L Sheridan, John Shadle, Ross J Simpson Jr, Michael P Pignone, Stacey L Sheridan, John Shadle, Ross J Simpson Jr, Michael P Pignone

Abstract

Background: Low utilization of effective coronary heart disease (CHD) prevention strategies may be due to many factors, but chief among them is the lack of patient involvement in prevention decisions. We undertook this study to test the effectiveness of an individually-tailored, computerized decision aid about CHD on patients' discussions with their doctor and their plans for CHD prevention.

Methods: We conducted a pilot randomized trial in a convenience sample of adults with no previous history of cardiovascular disease to test the effectiveness of an individually-tailored, computerized decision aid about CHD prevention against a risk factor list that patients could present to their doctor.

Results: We enrolled 75 adults. Mean age was 53. 59% were female, 73% white, and 23% African-American. 66% had some college education. 43% had a 10-year CHD risk of 0-5%, 25% a risk of 6-10%, 24% a risk of 11-20%, and 5% a risk of > 20%. 78% had at least one option to reduce their CHD risk, but only 45% accurately identified the strategies best supported by evidence. 41 patients received the decision aid, 34 received usual care. In unadjusted analysis, the decision aid increased the proportion of patients who discussed CHD risk reduction with their doctor from 24% to 40% (absolute difference 16%; 95% CI -4% to +37%) and increased the proportion who had a specific plan to reduce their risk from 24% to 37% (absolute difference 13%; 95% CI -7% to +34%). In pre-post testing, the decision aid also appeared to increase the proportion of patients with plans to intervene on their CHD risk (absolute increase ranging from 21% to 47% for planned medication use and 5% to 16% for planned behavioral interventions).

Conclusion: Our study confirms patients' limited knowledge about their CHD risk and effective risk reduction options and provides preliminary evidence that an individually-tailored decision aid about CHD prevention might be expected to increase patients' discussions about CHD prevention with their doctor and their plans for CHD risk reduction. These findings should be replicated in studies with a larger sample size and patients at overall higher risk of CHD.

Trial registration: ClinicalTrials.gov NCT00315978.

Figures

Figure 1
Figure 1
Study design. The dotted line margin denotes interventions and measurement occurring at a single clinical visit.
Figure 2
Figure 2
Recruitment and enrollment.

References

    1. Hyman DJ, Pavlik VN. Characteristics of patients with uncontrolled hypertension in the United States. N Engl J Med. 2001;345:479–86. doi: 10.1056/NEJMoa010273.
    1. Thorndike AN, Rigotti NA, Stafford RS, Singer DE. National patterns in the treatment of smokers by physicians. JAMA. 1998;279:604–8. doi: 10.1001/jama.279.8.604.
    1. Pearson TA, Laurora I, Chu H, Kafonek S. The lipid treatment assessment project (L-TAP): a multicenter survey to evaluate the percentages of dyslipidemic patients receiving lipid- lowering therapy and achieving low-density lipoprotein cholesterol goals. Arch Intern Med. 2000;160:459–67. doi: 10.1001/archinte.160.4.459.
    1. Ford ES, Jones DH. Cardiovascular health knowledge in the United States: findings from the National Health Interview Survey, 1985. Prev Med. 1991;20:725–36. doi: 10.1016/0091-7435(91)90067-E.
    1. Folsom AR, Sprafka JM, Luepker RV, Jacobs DR., Jr Beliefs among black and white adults about causes and prevention of cardiovascular disease: the Minnesota Heart Survey. Am J Prev Med. 1988;4:121–7.
    1. Avis NE, Smith KW, McKinlay JB. Accuracy of perceptions of heart attack risk: what influences perceptions and can they be changed? Am J Public Health. 1989;79:1608–12.
    1. Kreuter MW, Strecher VJ. Changing inaccurate perceptions of health risk: results from a randomized trial. Health Psychol. 1995;14:56–63. doi: 10.1037/0278-6133.14.1.56.
    1. Marteau TM, Kinmonth AL, Thompson S, Pyke S. The psychological impact of cardiovascular screening and intervention in primary care: a problem of false reassurance? British Family Heart Study Group. Br J Gen Pract. 1996;46:577–82.
    1. Woloshin S, Schwartz LM, Byram SJ, Sox HC, Fischhoff B, Welch HG. Women's understanding of the mammography screening debate. Arch Intern Med. 2000;160:1434–40. doi: 10.1001/archinte.160.10.1434.
    1. Levenkron JC, Greenland P. Patient priorities for behavioral change: selecting from multiple coronary disease risk factors. J Gen Intern Med. 1988;3:224–9.
    1. Lalonde L, O'Connor AM, Drake E, Duguay P, Lowensteyn I, Grover SA. Development and preliminary testing of a patient decision aid to assist pharmaceutical care in the prevention of cardiovascular disease. Pharmacotherapy. 2004;24:909–22. doi: 10.1592/phco.24.9.909.36104.
    1. Pearson TA. New tools for coronary risk assessment: what are their advantages and limitations? Circulation. 2002;105:886–92. doi: 10.1161/hc0702.103727.
    1. O'Connor AM, Stacey D, Rovner D, Holmes-Rovner M, Tetroe J, Llewellyn-Thomas H, Entwistle V, Rostom A, Fiset V, Barry M, Jones J. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2001:CD001431.
    1. Sheridan SL, Harris RP, Woolf SH. Shared decision making about screening and chemoprevention. a suggested approach from the U.S. Preventive Services Task Force. Am J Prev Med. 2004;26:56–66. doi: 10.1016/j.amepre.2003.09.011.
    1. Heart to Heart
    1. Pignone M, Sheridan SL, Lee YZ, Kuo J, Phillips C, Mulrow C, Zeiger R. Heart to Heart: a computerized decision aid for assessment of coronary heart disease risk and the impact of risk-reduction interventions for primary prevention. Prev Cardiol. 2004;7:26–33.
    1. Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. Prediction of coronary heart disease using risk factor categories. Circulation. 1998;97:1837–47.
    1. Degner LF, Sloan JA. Decision making during serious illness: what role do patients really want to play? J Clin Epidemiol. 1992;45:941–50. doi: 10.1016/0895-4356(92)90110-9.
    1. Kim J, Whitney A, Hayter S, Lewis C, Campbell M, Sutherland L, Fowler B, Googe S, McCoy R, Pignone M. Development and initial testing of a computer-based patient decision aid to promote colorectal cancer screening for primary care practice. BMC Med Inform Decis Mak. 2005;5:36. doi: 10.1186/1472-6947-5-36.
    1. Dolan JG, Frisina S. Randomized controlled trial of a patient decision aid for colorectal cancer screening. Med Decis Making. 2002;22:125–39. doi: 10.1177/02729890222063017.
    1. Wolf AM, Schorling JB. Does informed consent alter elderly patients' preferences for colorectal cancer screening? Results of a randomized trial. J Gen Intern Med. 2000;15:24–30. doi: 10.1046/j.1525-1497.2000.01079.x.
    1. Pignone M, Harris R, Kinsinger L. Videotape-based decision aid for colon cancer screening. A randomized, controlled trial. Ann Intern Med. 2000;133:761–9.
    1. Lovibond SH, Birrell PC, Langeluddecke P. Changing coronary heart disease risk-factor status: the effects of three behavioral programs. J Behav Med. 1986;9:415–37. doi: 10.1007/BF00845131.
    1. Oliver JW, Kravitz RL, Kaplan SH, Meyers FJ. Individualized patient education and coaching to improve pain control among cancer outpatients. J Clin Oncol. 2001;19:2206–12.
    1. Greenfield S, Kaplan S, Ware JE., Jr Expanding patient involvement in care. Effects on patient outcomes. Ann Intern Med. 1985;102:520–8.
    1. Greenfield S, Kaplan SH, Ware JE, Jr, Yano EM, Frank HJ. Patients' participation in medical care: effects on blood sugar control and quality of life in diabetes. Gen Intern Med. 1988;3:448–57.
    1. Kaplan SH, Greenfield S, Ware JE., Jr Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care. 1989;27:S110–27. doi: 10.1097/00005650-198903001-00010.
    1. Adherence to long-term therapies: Evidence for action
    1. Kreuter MW, Strecher VJ. Do tailored behavior change messages enhance the effectiveness of health risk appraisal? Results from a randomized trial. Health Educ Res. 1996;11:97–105.
    1. Skinner CS, Campbell MK, Rimer BK, Curry S, Prochaska JO. How effective is tailored print communication? Ann Behav Med. 1999;21:290–8.
    1. Montgomery AA, Fahey T, Peters TJ, MacIntosh C, Sharp DJ. Evaluation of computer based clinical decision support system and risk chart for management of hypertension in primary care: randomised controlled trial. BMJ. 2000;320:686–90. doi: 10.1136/bmj.320.7236.686.
    1. Hall LM, Jung RT, Leese GP. Controlled trial of effect of documented cardiovascular risk scores on prescribing. BMJ. 2003;326:251–2. doi: 10.1136/bmj.326.7383.251.

Source: PubMed

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