COMMUNICATING THE BENEFITS OF CHRONIC PREVENTIVE THERAPY - GOES THE FORMAT OF EFFICACY DATA DETERMINE PATIENTS ACCEPTANCE OF TREATMENT

Patients' informed acceptance of chronic medical therapy hinges on com municating the potential benefits of drugs in quantitative terms. In a hypothetical scenario of treatment initiation, the authors assessed h ow three different formats of the same data affected the willingness o f 100 outpatients to take what were implied to be three different lipi d-lowering drugs. Side-effects were declared negligible and costs insu red. Subjects make a ''yes-no'' decision about taking such a medicatio n, and graded the decision on a certainty scale. Advised of a relative risk reduction-''34% reduction in heart attacks''-88% of the patients assented to therapy. All other formats elicited significantly more re fusals (p < 0.0001): for absolute risk diffference-''1.4% fewer patien ts had heart attacks''-42% assented; for inverted absolute risk-''trea t 71 persons for 5 years to prevent one heart attack''-only 31% accept ed treatment. When the data were extrapolated to disease-free survival -''average gain of 15 weeks''-40% consented. Similar responses were ob tained for descriptions of an antihypertensive drug: 89% assented to t herapy when given relative risk reduction but only 46% when given abso lute risk reduction. The subjects were confident in both acceptance an d refusal: 93% of the decisions were rated ''somewhat certain'' to ''c ompletely certain.'' The authors conclude that patients' views of medi cal therapy are shaped by the formats in which potential benefits are presented. Multiple complementary formats may be most appropriate. The results imply that many patients may decline treatment if briefed on the likelihood or extent of benefit.