Back to Journals » Patient Preference and Adherence » Volume 13

The Optimizing-Risk-Communication (OptRisk) randomized trial – impact of decision-aid-based consultation on adherence and perception of cardiovascular risk

Authors Adarkwah CC, Jegan N, Heinzel-Gutenbrunner M, Kühne F, Siebert U, Popert U, Donner-Banzhoff N, Kürwitz S

Received 9 December 2018

Accepted for publication 26 January 2019

Published 27 March 2019 Volume 2019:13 Pages 441—452

DOI https://doi.org/10.2147/PPA.S197545

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 2

Editor who approved publication: Dr Johnny Chen


Charles Christian Adarkwah,1–3 Nikita Jegan,1 Monika Heinzel-Gutenbrunner,4 Felicitas Kühne,5,6 Uwe Siebert,5–7 Uwe Popert,8 Norbert Donner-Banzhoff,1 Sarah Kürwitz1,9

1Department of General Practice and Family Medicine, University of Marburg, Marburg, Germany; 2Department of Health Services Research and General Practice, Faculty of Life Sciences, University of Siegen, Siegen, Germany; 3Department of Health Services Research, Maastricht University, Maastricht, The Netherlands; 4MH Statistik Beratung, Marburg, Germany; 5Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology, Innsbruck, Austria; 6Division of Public Health Decision Modelling, Health Technology Assessment and Health Economics, ONCOTYROL – Center for Personalized Cancer Medicine, Innsbruck, Austria; 7Center for Health Decision Science, Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA; 8Department of General Practice, University of Göttingen, Göttingen, Germany; 9Department of Public Health, University of Bielefeld, Germany

Background: Shared decision-making is a well-established approach to increasing patient participation in medical decisions. Increasingly, using lifetime-risk or time-to-event (TTE) formats has been suggested, as these might have advantages in comparison with a 10-year risk prognosis, particularly for younger patients, whose lifetime risk for some events may be considerably greater than their 10-year risk. In this study, a randomized trial, the most popular 10-year risk illustration in the decision-aid software Arriba (emoticons), is compared with a newly developed TTE illustration, which is based on a Markov model. The study compares the effect of these two methods of presenting cardiovascular risk to patients on their subsequent adherence to intervention.
Methods: A total of 294 patients were interviewed 3 months after they had had a consultation with their GP on cardiovascular risk prevention. Adherence to behavioral change or medication intervention was measured as the primary outcome. The latter was expressed as a generated score. Furthermore, different secondary outcomes were measured, ie, patient perception of risk and self-rated importance of avoiding a cardiovascular event, as well as patient numeracy, which was used as a proxy for patient health literacy.
Results: Overall, no significant difference in patient adherence was found depending on risk representation. In the emoticon group, the number of interventions had a significant impact on the adherence score (P=0.025). Perception of risk was significantly higher in patients counseled with the TTE risk display, whereas the importance of avoiding a cardiovascular event was rated equally highly in both groups and actually increased over time.
Conclusion: The TTE format is an appropriate means for counseling patients. Adherence is a very complex construct, which cannot be fully explained by our findings. The study results support our call for considering TTE illustrations as a valuable alternative to current decision-support tools covering cardiovascular prevention. Nevertheless, further research is needed to shed light on patient motivation and adherence with regard to cardiovascular risk prevention.
Trial registration: The study was registered at the German Clinical Trials Register and at the WHO International Clinical Trials Register Platform (ICTRP, ID DRKS00004933); registered February 2, 2016 (retrospectively registered).

Keywords: randomized trial, Arriba, decision aid, adherence, risk perception, shared decision-making 10-year prognosis, risk assessment, lifetime risk, time to event, cardiovascular disease

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]