Absolute Cardiovascular Disease Risk and Shared Decision Making in Primary Care: A Randomized Controlled Trial
Open accessAbstract
PURPOSE: We wanted to determine the effect of promoting the effective communication of absolute cardiovascular disease (CVD) risk and shared decision making through disseminating a simple decision aid for use in family practice consultations. METHODS: The study was based on a pragmatic, cluster randomized controlled trial (phase III) with continuing medical education (CME) groups of family physicians as the unit of randomization. In the intervention arm, 44 physicians (7 CME groups) consecutively recruited 550 patients in whom cholesterol levels were measured. Forty-seven physicians in the control arm (7 CME groups) similarly included 582 patients. Four hundred sixty patients (83.6%) of the intervention arm and 466 patients (80.1%) of the control arm were seen at follow-up. Physicians attended 2 interactive CME sessions and received a booklet, a paper-based risk calculator, and individual summary sheets for each patient. Control physicians attended 1 CME-session on an alternative topic. Main outcome measures were patient satisfaction and participation after the index consultation, change in CVD risk status, and decisional regret at 6 months' follow-up. RESULTS: Intervention patients were significantly more satisfied with process and result (Patient Participation Scale, difference 0.80, P<.001). Decisional regret was significantly lower at follow-up (difference 3.39, P = .02). CVD risk decreased in both groups without a significant difference between study arms. CONCLUSION: A simple transactional decision aid based on calculating absolute individual CVD risk and promoting shared decision making in CVD prevention can be disseminated through CME groups and may lead to higher patient satisfaction and involvement and less decisional regret, without negatively affecting global CVD risk.
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In Krones 2008, intervention providers had better results in two out of three consultation process outcomes.
“Similarly, intervention providers had better results in two out of three consultation process outcomes in Krones 2008; and in one of two in Loh 2007.”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Krones 2008
In Krones 2008, intervention patients reported less decisional regret.
“Similarly, Krones 2008 reported less decisional regret in intervention patients; and Loh 2007 found better participation in shared decision making, although they found no difference in adherence to treatment.”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Krones 2008
Four of the six studies in intervention category 4 assessed satisfaction.
“Four of the six studies assessed this outcome (Glasgow 2004; Kinmonth 1998; Krones 2008; Loh 2007)”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Krones 2008
In Krones 2008, intervention patients reported positive effects of intervention in the one satisfaction outcome measured.
“Similarly intervention patients in Krones 2008 and Loh 2007 reported positive effects of intervention in the one outcome they each measured.”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Krones 2008
The remaining studies (Glasgow 2004; Krones 2008; Loh 2007) did not find any benefit of intervention on health status.
“The remaining studies (Glasgow 2004; Krones 2008; Loh 2007) did not find any benefit of intervention on health status.”
From Interventions for providers to promote a patient-centred approach in clinical consultations (2012) · cites this paper as Krones 2008
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- Authors
- Krones, T., Keller, H., Sonnichsen, A., Sadowski, E.-M., Baum, E., Wegscheider, K., Rochon, J., & Donner-Banzhoff, N.
- Affiliations
- Philipps University of Marburg (DE)
- Universität Hamburg (DE)
- University Hospital Regensburg (DE)
- Corresponding author
- Krones, T.
- Venue
- The Annals of Family Medicine
- Publisher
- Annals of Family Medicine
- Published
- 2008-05-01
- Volume
- 6
- Issue
- 3
- Pages
- 218-227
- ISSN
- 1544-1709 (ISSN-L)
- 1544-1717
- PMC
- PMC2384995
- OpenAlex
- W2169727328
- Cited by
- 204
- References
- 47
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 18 · 2023: 4 · 2022: 9 · 2021: 14 · 2020: 9 · 2019: 16 · 2018: 7 · 2017: 6 · 2016: 16 · 2015: 9 · 2014: 10 · 2013: 18 · 2012: 19
- FWCI
- 25.79
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- The Annals of Family Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Keywords
- shared decision-making, decision aids, cardiovascular risk communication, cholesterol screening, general practitioners, continuing medical education, patient satisfaction, decision regret, cardiovascular disease prevention, risk calculator
- MeSH terms
- Adult, Aged, Cardiovascular Diseases, Decision Making, Decision Support Techniques, Female, Humans, Male, Middle Aged, Patient Education as Topic, Patient Participation, Physician-Patient Relations, Physicians, Family, Primary Health Care, Health Behavior, Patient Satisfaction, Risk Assessment
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