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Dr. Uwe Popert

Philipps-Universität Marburg

Abteilung für Allgemeinmedizin

Karl-von-Frisch-Str. 4

35043 Marburg

Projektmanagement:

Nikita Jegan

Sarah Kürwitz

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OptRisk: Optimisation of risk consultancy through presentation of changeability of individual life expectancy

S. Kürwitz, N. Jegan, L. Kramer, S. Celemin-Heinrich, O. Hirsch, U. Siebert, U. Popert, N. Donner-Banzhoff

 

Introduction

Decision aids have nowadays come to be widespread in GP practices as an accepted and effective element of the patient-oriented care of the chronically ill. In this respect, the comprehensible and valid presentation of the prognosis and intervention effects plays a particularly important role. In the area of cardiovascular diseases, the instrument arriba®, with an estimation of the 10-year prognosis on the basis of individual risk factors, has proven to be successful. A point of criticism of this method is that in younger patients, a 10-year prognosis can lead to an overlooking of high-risk states which might only have an effect beyond the ten years. Based on this criticism, for the planned study in the area of cardiovascular diseases, a comparative examination is undertaken of different presentations from the perspective of affected patients as well as consulting physicians.

 

Objectives and research questions

The aim of this project is to improve the presentation of risks and costs in a widespread decision aid for cardiovascular diseases. Central to the research project is in particular the comparison of the presentation on the basis of 1) the absolute risk employed so far (10-year prognosis), and 2) the event-free lifetime. In this respect, the following research questions are of particular interest: Which presentations of prognosis and therapeutic effects are particularly suitable in patient consulting – absolute risk or lifetime? What acceptance and effects does information about treatment costs have for the patient?

 

Methods

First of all, in phase 1, five different presentations of the prognosis for cardiovascular events will be qualitatively examined (absolute risk in the presentation forms of bars, Smileys (natural frequency) and distribution, event-free lifetime as timelines and vessel age in an adapted form of vessel presentation). In this respect, time expenditure, understanding, preference of patients and physicians are taken into particular account. Based on this investigation, three presentations are selected which are tested further in phase II. In phase II, by means of a questionnaire survey, the preferences of patients and physicians will be estimated in five fictitious patients. In parallel to phases I and II, the statistical modelling of the lifetime presentation ensues through a Markov model. Finally, in phase III, a randomised comparison takes place in real consulting situations, which examines the two most suitable forms of presentation. Dependent variables are congruence between consulting outcome and values/beliefs of the patient (primary); acceptance of the consulting by the patient and adherence of patient behaviour.

 

Results

As of May 2012, the first two phases are complete. On the basis of the qualitative results of the first phase, three presentations were selected which were tested in phase II. The evaluation of these results is still underway and is expected to be concluded in the coming weeks.

 

Discussion

See results.

 

Outlook

The improved consulting as well as the associated improved congruence of outcome and the values of the patient will possibly also be reflected in a lower morbidity and mortality of different risk populations.




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