Communicating the benefits of chronic preventive therapy: does the format of efficacy data determine patients' acceptance of treatment?
Female; Humans; Male; Adult; Questionnaires; Aged; Middle Aged; Treatment Outcome; Patient Acceptance of Health Care; Informed Consent; Non-U.S. Gov't; Research Support; decision making; Statistical; Data Interpretation; Primary Prevention; Patient Education; Antilipemic Agents/therapeutic use; Hyperlipidemia/complications/drug therapy/psychology
Patients' informed acceptance of chronic medical therapy hinges on communicating the potential benefits of drugs in quantitative terms. In a hypothetical scenario of treatment initiation, the authors assessed how three different formats of the same data affected the willingness of 100 outpatients to take what were implied to be three different lipid-lowering drugs. Side-effects were declared negligible and costs insured. Subjects make a "yes-no" decision about taking such a medication, and graded the decision on a certainty scale. Advised of a relative risk reduction--"34% reduction in heart attacks"--88% of the patients assented to therapy. All other formats elicited significantly more refusals (p < 0.0001): for absolute risk difference--"1.4% fewer patients had heart attacks"--42% assented; for inverted absolute risk--"treat 71 persons for 5 years to prevent one heart attack"--only 31% accepted treatment. When the data were extrapolated to disease-free survival--"average gain of 15 weeks"--40% consented. Similar responses were obtained for descriptions of an antihypertensive drug: 89% assented to therapy when given relative risk reduction but only 46% when given absolute risk reduction. The subjects were confident in both acceptance and refusal: 93% of the decisions were rated "somewhat certain" to "completely certain." The authors conclude that patients' views of medical therapy are shaped by the formats in which potential benefits are presented. Multiple complementary formats may be most appropriate. The results imply that many patients may decline treatment if briefed on the likelihood or extent of benefit.
1995
Hux JE; Naylor CD
Medical Decision Making
1995
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1177/0272989x9501500208" target="_blank" rel="noreferrer">10.1177/0272989x9501500208</a>
Child death in high-income countries
Child; Humans; Perinatal Care; cause of death; child mortality; Developed Countries; Early Diagnosis; Primary Prevention
Reductions in child mortality in high-income settings have been substantial over recent decades, although variations remain between and within countries. A three-part Series outlines the epidemiology of child mortality and a standardised approach to child death reviews in high-income countries. The Series authors delineate patterns of child mortality at different ages into five broad categories (perinatal causes, congenital abnormalities, acquired natural causes, external causes, and unexplained deaths), and describe contributory factors across four broad domains—biological and psychological factors, the physical environment, the social environment, and service delivery. In a Comment, the conclusions of these three reports are reviewed, and practical recommendations on strategies are proposed in three key areas: perinatal causes, notably preterm birth; acquired natural causes, such as sepsis or acute respiratory problems; and external causes, including road traffic fatalities.
2014-09
Petrou S; Fraser J; Sidebotham P
Lancet
2014
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/S0140-6736(14)61372-6" target="_blank" rel="noreferrer">10.1016/S0140-6736(14)61372-6</a>