Skip to main content
The British Journal of General Practice logoLink to The British Journal of General Practice
. 2001 Apr;51(465):276–279.

Patients' responses to risk information about the benefits of treating hypertension.

D Misselbrook 1, D Armstrong 1
PMCID: PMC1313976  PMID: 11458479

Abstract

BACKGROUND: The medical profession is often presented with information on the value of treatment in terms of likely risk reduction. If this same information was presented to patients--so enabling them to give proper informed consent--would this affect their decision to be treated? AIM: To examine patients' choice about treatment in response to different forms of risk presentation. DESIGN OF STUDY: Postal questionnaire study. SETTING: The questionnaire was sent to 102 hypertensive patients and 207 matched non-hypertensive patients aged between 35 and 65 years in a UK general practice. METHODS: Patients were asked the likelihood, on a four-point scale, of their accepting treatment for a chronic condition (mild hypertension) on the basis of relative risk reduction, absolute risk reduction, number needed to treat, and personal probability of benefit. RESULTS: An 89% response rate was obtained. Of these, 92% would accept treatment using a relative risk reduction model, 75% would accept treatment using an absolute risk reduction model, 68% would accept treatment using a number needed to treat model, and 44% would accept treatment with a personal probability of benefit model. CONCLUSION: Many patients may prefer not to take treatment for mild hypertension if the risks were fully explained. However, given that the form of the explanation has a strong influence on the patient's decision, it is not clear how decision-making can be fully shared nor what should constitute informed consent to treatment in this situation.

Full Text

The Full Text of this article is available as a PDF (66.4 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bucher H. C., Weinbacher M., Gyr K. Influence of method of reporting study results on decision of physicians to prescribe drugs to lower cholesterol concentration. BMJ. 1994 Sep 24;309(6957):761–764. doi: 10.1136/bmj.309.6957.761. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Chatellier G., Zapletal E., Lemaitre D., Menard J., Degoulet P. The number needed to treat: a clinically useful nomogram in its proper context. BMJ. 1996 Feb 17;312(7028):426–429. doi: 10.1136/bmj.312.7028.426. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Cook R. J., Sackett D. L. The number needed to treat: a clinically useful measure of treatment effect. BMJ. 1995 Feb 18;310(6977):452–454. doi: 10.1136/bmj.310.6977.452. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Fagard R., Staessen J., Thijs L., Amery A. Influence of antihypertensive drugs on exercise capacity. Drugs. 1993;46 (Suppl 2):32–36. doi: 10.2165/00003495-199300462-00007. [DOI] [PubMed] [Google Scholar]
  5. Fahey T., Newton J. Conveying the benefits and risks of treatment. Br J Gen Pract. 1995 Jul;45(396):339–341. [PMC free article] [PubMed] [Google Scholar]
  6. Haynes R. B., Sackett D. L., Taylor D. W., Gibson E. S., Johnson A. L. Increased absenteeism from work after detection and labeling of hypertensive patients. N Engl J Med. 1978 Oct 5;299(14):741–744. doi: 10.1056/NEJM197810052991403. [DOI] [PubMed] [Google Scholar]
  7. Hux J. E., Naylor C. D. Communicating the benefits of chronic preventive therapy: does the format of efficacy data determine patients' acceptance of treatment? Med Decis Making. 1995 Apr-Jun;15(2):152–157. doi: 10.1177/0272989X9501500208. [DOI] [PubMed] [Google Scholar]
  8. Jachuck S. J., Brierley H., Jachuck S., Willcox P. M. The effect of hypotensive drugs on the quality of life. J R Coll Gen Pract. 1982 Feb;32(235):103–105. [PMC free article] [PubMed] [Google Scholar]
  9. Malenka D. J., Baron J. A., Johansen S., Wahrenberger J. W., Ross J. M. The framing effect of relative and absolute risk. J Gen Intern Med. 1993 Oct;8(10):543–548. doi: 10.1007/BF02599636. [DOI] [PubMed] [Google Scholar]
  10. Marteau T. M. Screening in practice: Reducing the psychological costs. BMJ. 1990 Jul 7;301(6742):26–28. doi: 10.1136/bmj.301.6742.26. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. McNeil B. J., Pauker S. G., Sox H. C., Jr, Tversky A. On the elicitation of preferences for alternative therapies. N Engl J Med. 1982 May 27;306(21):1259–1262. doi: 10.1056/NEJM198205273062103. [DOI] [PubMed] [Google Scholar]
  12. O'Connor A. M., Pennie R. A., Dales R. E. Framing effects on expectations, decisions, and side effects experienced: the case of influenza immunization. J Clin Epidemiol. 1996 Nov;49(11):1271–1276. doi: 10.1016/s0895-4356(96)00177-1. [DOI] [PubMed] [Google Scholar]
  13. Prisant L. M., Carr A. A., Bottini P. B., Solursh D. S., Solursh L. P. Sexual dysfunction with antihypertensive drugs. Arch Intern Med. 1994 Apr 11;154(7):730–736. [PubMed] [Google Scholar]
  14. Sever P., Beevers G., Bulpitt C., Lever A., Ramsay L., Reid J., Swales J. Management guidelines in essential hypertension: report of the second working party of the British Hypertension Society. BMJ. 1993 Apr 10;306(6883):983–987. doi: 10.1136/bmj.306.6883.983. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Shaper A. G., Pocock S. J., Walker M., Phillips A. N., Whitehead T. P., Macfarlane P. W. Risk factors for ischaemic heart disease: the prospective phase of the British Regional Heart Study. J Epidemiol Community Health. 1985 Sep;39(3):197–209. doi: 10.1136/jech.39.3.197. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Smith G. D., Egger M. Who benefits from medical interventions? BMJ. 1994 Jan 8;308(6921):72–74. doi: 10.1136/bmj.308.6921.72. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Stoate H. G. Can health screening damage your health? J R Coll Gen Pract. 1989 May;39(322):193–195. [PMC free article] [PubMed] [Google Scholar]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners

RESOURCES