Victor Montori, M.D., a Mayo Clinic endocrinologist, has led research into effective communication with patients and helping them to make treatment decisions, such as whether to take a statin to prevent heart attack, based on an accurate understanding of the risks and benefits. He was recently interviewed about his research by Australia’s ABC Radio National, and that interview is available this morning as a podcast on the ABC Australia site.
Dr. Montori tells how — communicating through colorful flash cards (which you can’t see in the audio presentation, but you can visualize thanks to the interviewing skill of Norman Swan, host of The Health Report) — patients were 20 times more likely to be able to verbalize their risk for a heart attack and how that risk would be reduced by medication, as opposed to a control group that didn’t have the discussion based on the flash cards. Patients who used this decision aid were three times more likely to stick with their decision three months later; if they decided to have a statin prescription they were more likely to be actually taking the medication, because they understood what it likely meant for them. And 70 percent of the prescriptions in the intervention arm of the study went to those at highest risk of heart attack; in the control arm (not using the decision aid), those at low risk of heart attack were just as likely to get a prescription. Here’s a portion of the transcript:
Norman Swan: So they are already getting a huge amount of information in the control group and this is on top and so you’ve got that magnitude of difference on top.
Victor Montori: And the reason is the pertinence of the information, when we videotaped this, we videotape all the stuff that we do, when we videotaped this is what we observed was that the clinicians in the control group were spending a lot of time explaining to patients the biology. So why cholesterol is important, how it coats the arteries and blocks them and leads to heart attacks and how cholesterol reduction will reduce, with the medication, will reduce those plaques and help you. All that stuff is kind of interesting, it’s rather cool, yet it doesn’t help you to decide if those are actually good for you. It gives you the impression that everyone’s arteries are covered with this stuff, everyone will actually have a decreasing net cover of cholesterol with the drug and therefore everyone benefits. And our study shows that in fact that’s not the case.
Norman Swan: What was the difference in decisions to go for a statin versus not?
Victor Montori: What we saw was that in the lower risk groups, let me put it this way, I’m going to get this number probably wrong, but it was around 70% of the prescriptions in the intervention, so they got a decision aid, went to the highest risk group. The distribution of prescriptions in the control group was actually risk blind, in other words we were treating as aggressively those at highest risk as we were treating those at lowest risk.
Norman Swan: So this was self selecting so if you got the decision tool, if they were at low risk and their numbers were not high they were kind of making a reasonably sensible decision it might not be worth doing. Whereas if it was high risk they were tending to make kind of the right decision, right being evaluated more.
Victor Montori: That’s right, yes, so you try to avoid making judgements about what is the correct decision because again we don’t know exactly what patient preferences are. But it is reassuring to see some degree of correlation between what their choices are for a medication that lowers risk with what the level of risk is.
You can hear the full podcast (29:13) here.