• Annals of family medicine · May 2008

    Randomized Controlled Trial

    Absolute cardiovascular disease risk and shared decision making in primary care: a randomized controlled trial.

    • Tanja Krones, Heidemarie Keller, Andreas Sönnichsen, Eva-Maria Sadowski, Erika Baum, Karl Wegscheider, Justine Rochon, and Norbert Donner-Banzhoff.
    • Department of General Practice/Family Medicine, Phillips-University Marburg, Marburg, Germany. krones@med.uni-marburg.de
    • Ann Fam Med. 2008 May 1;6(3):218-27.

    PurposeWe 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.MethodsThe 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.ResultsIntervention 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.ConclusionA 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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