Article Figures & Data
Tables
Characteristic Perception What it is Goop Liquid Concentrated fats Saturated fats Where it is Fat in the blood Fat in your veins Fats in foods What it is associated with Steaks Pork Butter Lard Overweight What puts you at risk Fatty foods Impure foods Too little exercise Heredity Overweight What it does Clogs arteries Clogs veins Causes heart attacks and strokes - Table 2.
Participants’ Representative Reactions to a Strategy for Communicating Cardiovascular Risk-Adjusted Age
Concerns You’ve got to look at other things that most people won’t look at. Is this clinical information, or is this statistical information? Have they actually ran these people through a series of physical tests to come up with these numbers? Or are they just drawing these numbers from medical records? But you know, you’ve got to keep in mind that it may not be accurate. So you could be reading something on there. And when you walk in to see your physician, he can tell you something a little different. Something like that would make the person probably be concerned. So when he walks in there, now his blood pressure is up. I’m concerned about the numbers that this computer is going to show you which may not be accurate. It might give you a heart attack. You know. I’m thinking that it’s kind of overwhelming. It’s intimidating for a man to come in who is 52 and find out he’s got a heart age of 79. I think it’s gonna be very upsetting. He’s gonna be really shaken. Participant 1: It’s like he has one foot in the grave. Participant 2: Because he’s 50 years old. And you’re saying his heart age is 72. You know? That’s … he’s almost done with life. Participant 3: It is definitely scary. He needs to discuss the problem with his doctor immediately. I think it’s going to be startling to a lot of people. A lot of people will say, yeah, I’m 52; I feel like I’m 60. But when people see figures on a computer that’s supposed to be accurate, they’re going to say I’m 52, and I’ve got a heart of a 72 year old man, I think they’re going to be in shock. Nobody wants to hear the truth. Participant 1: So maybe you need a transition slide that says how can I improve this or what can I do. Participant 2: So they don’t walk away quaking. Benefits That [cardiovascular risk-adjusted age strategy] is easy, I can understand that. Yeah, that spells everything out. You can go to the doctor a year later, and boom [see how the calculated age has changed]. No, you ain’t gonna forget that [the age]. Those numbers [actual age and cardiovascular risk-adjusted age] are a hell of a lot easier than the first 3 you plugged in there, the HDL, whatever the heck that is. I think the idea of [cardiovascular risk-adjusted age] made it personal. Because this is your age. It brought you into it. The other [probability estimate bar chart], I mean, that’s just another graph. It’s too statistical. I think the point is to wake up. I don’t think anyone’s gonna pass out from seeing that [cardiovascular risk-adjusted age]. If something is wrong you need to change the way you’re living. I think the average person looking at that [cardiovascular risk-adjusted age] is going to get depressed. And after they get depressed, they’re probably going to reevaluate their life. I mean that’s very revealing. Your [cardiovascular risk-adjusted age] is telling you there’s something medically going on. And you need to make some more changes.
Additional Files
Supplemental Appendix and Table
Supplemental Appendix 1. Focus Group Question Guide; Supplemental Table 1. Characteristics of Participants of 7 Focus Groups (FG) (N = 50)
Files in this Data Supplement:
- Supplemental data: Appendix 1 - PDF file, 4 pages, 120 KB
- Supplemental data: Table 1 - PDF file, 1 page, 87 KB
The Article in Brief
Patients' Perceptions of Cholesterol, Cardiovascular Disease Risk, and Risk Communication Strategies
Roberta E. Goldman, PhD, and colleagues
Background High cholesterol levels can contribute to cardiovascular (heart) disease, the leading cause of death in the United States. This study uses focus groups to explore people's knowledge of and attitudes toward cholesterol and the risk of cardiovascular disease, as well as their reactions to different methods of communicating the risk of cardiovascular disease.
What This Study Found All participants were aware that high cholesterol levels can harm health, but few were knowledgeable about hypercholesterolemia (high blood cholesterol level) or the risk of cardiovascular disease associated with it. Most participants did not know their own cholesterol numbers and did not think that knowing their numbers would motivate them to change their health habits. Many assumed they had been tested and their cholesterol levels were healthy, even if their physicians had not mentioned it. Participants felt that a communication method that told them their "heart age" was clear and easy to remember, and might motivate people to make healthful changes. (Heart age considers how your cholesterol levels, family health history, and certain aspects of your personal health history affect your risk of having a heart attack. Based on this information, you are assigned a heart age, which may be higher or lower than your actual age.)
Implications
- Complex explanations about cholesterol and cardiovascular disease risk do not appear to be effective in motivating patients to change their health habits. Patients prefer individualized, personally meaningful information that can help them make health care and lifestyle decisions.
- Providing patients with information they can identify with about their personal risk of cardiovascular disease related to cholesterol may help them to understand and make use of other, more general cholesterol education programs.
Annals Journal Club Selections:
May/June 2006
The Annals Journal Club is designed to encourage a learning community of those seeking to improve health care and health through enhanced primary care. Additional information is available on the Journal Club home page.Articles for Discussion
- Frich JC, Ose L, Malterud K, Fugelli P. Perceived vulnerability to heart disease in patients with familial hypercholesterolemia: a qualitative interview study. Ann Fam Med. 2006;4:198-204.
- Goldman RE, Parker D, Eaton C, et al. Patients' perceptions of cholesterol, cardiovascular disease risk, and risk communication strategies. Ann Fam Med. 2006;4:205-212.
Discussion Tips
Both journal club articles in this issue are qualitative research studies. Qualitative research involves methods that are particularly strong for discerning meaning and context from the perspective of the study group. Weaknesses of qualitative methods often relate to the degree of transparency of the analysis, the sampling of participants, and the transportability of the findings to other settings.1Discussion Questions
- Why is an understanding of patients� risk perception important?
- What are the strengths and weaknesses of the focus group study design (Goldman) versus the use of depth interviews (Frich)? How might the findings be different if the study questions were asked by surveys? What biases are apparent in the way the data were collected?
- How transparent does the analysis appear for both studies? Would the results be as trustworthy if the analyses were conducted by an individual rather than a team?
- How does the way the participants were selected affect your interpretation of the findings?
- In qualitative research, the term �saturation� is used to indicate that a sufficient sample has been achieved such that new participants contribute relatively little new information. Do these studies� claims of having reached saturation convince you that the important domains of information have been uncovered?
- What are the main findings of each study? How do the two studies inform each other?
- How transportable are the findings to other settings (particularly to yours)?
- What are the studies� implications for how clinicians should talk (or listen) to patients regarding risk and risk perception?
- With the much-vaunted advent of �personalized medicine�2,3 based on genetic information, how will patients and clinicians reach a shared understanding of familial risk and personal vulnerability to heritable illness? How can the studies' findings help clinicians and patients communicate about inherited disease risk?
- What do these studies say about the whole idea of (genomically) �personalized medicine� and how it might or might not be feasible and ethical in practice?
- What are the implications for training clinicians and educating patients?
- What are the policy implications of these findings, eg for reimbursement for primary care visits?
- To explore the HeartAge calculator, visit www.heartage.com.
References
- Crabtree BF, Miller WL, eds. Doing Qualitative Research. 2nd ed. Newbury Park, California: Sage Publications; 1999.
- Snyderman R, Langheier J. Prospective health care: the second transformation of medicine. Genome Biol. 2006;7:104. Epub 2006 Feb 27.
- Langreth R, Waldholz M. New era of personalized medicine: targeting drugs for each unique genetic profile. Oncologist. 1999;4:426-427.
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