One area for improvement in health care delivery is getting relevant information to patients and involving them in decisions about their care. This should lead to more patient satisfaction, better outcomes and possibly reduced costs. Two studies reported in the Public Library of Science (Medicine) help construct the best ways to present information to patients that they can understand and use to make decisions consistent with the values. (PLoS Article)
Both studies were done through the internet, did not involve actual patients making actual decisions and may not be fully generalizable to the overall patient population, but they do provide insight into how people make medical decisions. In one study, patients were asked to make a decision about whether to take a statin to lower cholesterol. Patients were asked questions designed to elucidate their values around the benefits and costs of taking a statin and assigned a value score. They were presented information in various formats and asked to decide if they would take the statin. More people decided to take a statin when presented with relative risk reduction information than when given other information formats. The authors suggested that natural frequency presentations may help patients make decisions most consistent with their values.
The second study looked at a decision to take antibiotics for a sore throat, again finding a score for patients’ values and then presenting information in various formats. In this case, patients found bar charts of duration of symptoms most helpful and made decisions consistent with their values most often when presented data in this format.
This series of studies demonstrates the importance of understanding a specific patient’s values in regard to a particular medical decision and how presentation of information may bias a decision in ways not necessarily consistent with those values. There is complexity in creating a decision-making environment that honors patients’ values, but also wanting to push patients toward decisions policymakers or physicians may think best, i.e. less use of antibiotics where they often make no difference and more use of statins to control heart disease. These types of studies have great value in identifying how to appropriately involve patients in medical decisions.
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Relative risk reduction is a deceptive metric. I learned about this with the covid-19 vaccine and Paxlovid studies. With many treatments perhaps to include statins, a more valid metric is to look at Absolute risk reduction. Often the improvement is trivial. Worse, usually no data on adverse effects or comparative morbidity and mortality.