Heuristics and biases in cardiovascular disease prevention: How can we improve communication about risk, benefits and harms?

Bonner, Carissa; McKinn, Shannon; Lau, Annie; Jansen, Jesse; Doust, Jenny; Trevena, Lyndal; McCaffery, Kirsten

doi:10.1016/j.pec.2017.12.003

Cited by 23 publications

(22 citation statements)

References 34 publications

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“… 13 Bonner et al in their ‘talk-aloud’ study found that CVD tools that accounted for a greater number of risk factors were seen as more credible. 14 Our study suggests that the number of risk factors might be less important than whether the risk factors used match those that patients perceive as important.…”

Section: Discussionmentioning

confidence: 73%

“…Bonner and colleagues conducted a qualitative analysis of data from 25 Australian participants who were encouraged to ‘talk aloud’ when using two CVD risk communication tools. 14 They concluded that participants needed a reference point (example risk probabilities being anchored to ‘high risk’ and ‘low risk labels) to make sense of the probabilities and additionally found that CVD risk estimates derived from a larger number risk factors were felt to be more credible.…”

Section: Introductionmentioning

confidence: 99%

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‘People like you?’: how people with hypertension make sense of future cardiovascular risk—a qualitative study

2018

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ObjectivesCardiovascular disease (CVD) prevention guidelines recommend that patients’ future CVD risk (as a percentage) is estimated and used to inform shared treatment decisions. We sought to understand the perspectives of patients with hypertension on their future risk of CVD.DesignQualitative, semistructured interviews and thematic analysis.ParticipantsPeople with hypertension who had not experienced a cardiovascular event recruited from primary care.SettingParticipants were purposively sampled from two primary care practices in South London. Interviews were transcribed, and a thematic analysis was conducted.Results24 people participated; participants were diverse in age, sex, ethnicity and socioeconomic status. Younger working-aged people were under-represented. Contrasting with probabilistic risk, many participants understood future CVD as binary and unknowable. Roughly half of participants avoided contemplating future CVD risk; for some, lifestyle change and medication obviated the need to think about CVD risk. Some participants identified with one portion of the probability fraction (‘I’d be one of those ones.’). Comparison with peers (typically partners, siblings and friends of a similar age, including both ‘healthy’ and ‘unhealthy’ people) was most frequently used to describe risk, both among those who engaged with and avoided risk discussion. This contrasts with current risk scores, which describe probabilities in people with similar risk factors; many participants did not identify with such a group, and hence did not find these probabilities meaningful, even where correctly understood.ConclusionsRisk as typically calculated and communicated (eg, the risk of ‘100 people like you’) may not be meaningful for patients who do not identify with the denominator. Comparing an individual’s risk with their peers could be more meaningful.

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Section: Discussionmentioning

confidence: 73%

Section: Introductionmentioning

confidence: 99%

‘People like you?’: how people with hypertension make sense of future cardiovascular risk—a qualitative study

2018

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“…Although substantial work has been done to test the impact of framing effects (the tendency that people have to draw different conclusions from the same risk information, depending on whether it is expressed in terms of gains or losses) on screening or precautionary behaviours, most biases influencing health behaviour change have not yet been targeted. This is an issue since the effect of risk communication interventions could be enhanced with the use of adapted formats or metrics that specifically target such biases . Existing risk communication interventions for people with T2DM have shown mixed results, with many participants barely understanding the explanations of health professionals about risks and having poor recall of risk information .…”

Section: Background and Objectivesmentioning

confidence: 99%

“…This is an issue since the effect of risk communication interventions could be enhanced with the use of adapted formats or metrics that specifically target such biases. 10 Existing risk communication interventions for people with T2DM have shown mixed results, with many participants barely understanding the explanations of health professionals about risks and having poor recall of risk information. 11 There is an urgent need to improve risk communication in this area, making people with T2DM prime candidates to receive an intervention informed by behavioural economics.…”

Section: Backg Round and Objec Tive Smentioning

confidence: 99%

Nudging people with Type 2 diabetes towards better self‐management through personalized risk communication: A pilot randomized controlled trial in primary care

Rouyard

Leal

Baskerville

et al. 2018

Endocrino Diabet & Metabol

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SummaryObjectives: To assess the feasibility in routine primary care consultation and investigate the effect on risk recall and self-management of a new type of risk communication intervention based on behavioural economics ("nudge-based") for people with Type 2 diabetes mellitus (T2DM).Methods: Forty adults with poorly controlled T2DM (HbA1c > 7.5%) were randomized to receive a personalized, nudge-based risk communication intervention (n = 20) or standard care (n = 20). Risk recall and self-management were evaluated at baseline and 12 weeks after the intervention.Results: Both in terms of feasibility and acceptability, this new risk communication intervention was very satisfactory. Study retention rate after 12 weeks was very high (90%) and participants were highly satisfied with the intervention (4.4 out of 5 on the COMRADE scale). Although not powered to identify significant between-group effects, the intervention significantly improved risk recall after 12 weeks and intentions to make lifestyle changes (dietary behaviour) compared to standard care. Conclusions:This pilot study provides the first evidence of the feasibility of implementing in primary care a nudge-based risk communication intervention for people with T2DM. Based on the promising results observed, an adequately powered trial to determine the effectiveness of the intervention on long-term self-management is judged feasible. As a result of this feasibility study, some minor adaptations to the intervention and study methods that would help to facilitate a definitive trial are also reported. K E Y W O R D Sbehavioural economics, pilot randomized trial, primary care, risk communication, selfmanagement, Type 2 diabetes

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“…Recent calculators have generally used a 10-year time frame, and this may be more effective for conveying risk and motivating lifestyle changes. 30 There is increasing interest in 'heart age' calculators, which have been promoted around the world including in Australia, New Zealand and the UK. 31 While there are claims that giving patients an 'older' heart age can motivate them to change their lifestyles, a review of biological age formats found no evidence that this is more effective than absolute risk formats.…”

Section: Communicationmentioning

confidence: 99%

Future directions in cardiovascular disease risk prediction

Doust¹,

Bonner²,

Bell³

2020

Aust J Gen Pract

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Heuristics and biases in cardiovascular disease prevention: How can we improve communication about risk, benefits and harms?

Abstract: Doctors need access to multiple CVD risk formats to communicate effectively about CVD prevention.

Cited by 23 publications

References 34 publications

‘People like you?’: how people with hypertension make sense of future cardiovascular risk—a qualitative study

‘People like you?’: how people with hypertension make sense of future cardiovascular risk—a qualitative study

Nudging people with Type 2 diabetes towards better self‐management through personalized risk communication: A pilot randomized controlled trial in primary care

Future directions in cardiovascular disease risk prediction

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