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Open Access Highly Accessed Research article

Communicating cardiovascular disease risk: an interview study of General Practitioners’ use of absolute risk within tailored communication strategies

Carissa Bonner12, Jesse Jansen12, Shannon McKinn12, Les Irwig1, Jenny Doust13, Paul Glasziou13 and Kirsten McCaffery12*

Author Affiliations

1 Screening and Test Evaluation Program (STEP), Sydney School of Public Health, Edward Ford Building A27, The University of Sydney, Sydney, NSW 2006, Australia

2 Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), Edward Ford Building A27, The University of Sydney, Sydney, NSW 2006, Australia

3 Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4226, Australia

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BMC Family Practice 2014, 15:106  doi:10.1186/1471-2296-15-106

Published: 29 May 2014

Abstract

Background

Cardiovascular disease (CVD) prevention guidelines encourage assessment of absolute CVD risk - the probability of a CVD event within a fixed time period, based on the most predictive risk factors. However, few General Practitioners (GPs) use absolute CVD risk consistently, and communication difficulties have been identified as a barrier to changing practice. This study aimed to explore GPs’ descriptions of their CVD risk communication strategies, including the role of absolute risk.

Methods

Semi-structured interviews were conducted with a purposive sample of 25 GPs in New South Wales, Australia. Transcribed audio-recordings were thematically coded, using the Framework Analysis method to ensure rigour.

Results

GPs used absolute CVD risk within three different communication strategies: ‘positive’, ‘scare tactic’, and ‘indirect’. A ‘positive’ strategy, which aimed to reassure and motivate, was used for patients with low risk, determination to change lifestyle, and some concern about CVD risk. Absolute risk was used to show how they could reduce risk. A ‘scare tactic’ strategy was used for patients with high risk, lack of motivation, and a dismissive attitude. Absolute risk was used to ‘scare’ them into taking action. An ‘indirect’ strategy, where CVD risk was not the main focus, was used for patients with low risk but some lifestyle risk factors, high anxiety, high resistance to change, or difficulty understanding probabilities. Non-quantitative absolute risk formats were found to be helpful in these situations.

Conclusions

This study demonstrated how GPs use three different communication strategies to address the issue of CVD risk, depending on their perception of patient risk, motivation and anxiety. Absolute risk played a different role within each strategy. Providing GPs with alternative ways of explaining absolute risk, in order to achieve different communication aims, may improve their use of absolute CVD risk assessment in practice.

Keywords:
Cardiovascular disease risk; Prevention; General practice; Primary care; Doctor-patient communication; Risk communication; Risk perception