Can postponement of an adverse outcome be used to present risk reductions to a lay audience? A population survey

In 2004 a random sample of 1,367 non-institutionalized Danes aged 40+ was interviewed in person. The participants were asked for demographic information and asked to consider a hypothetical preventive drug treatment. The respondents were randomized to the magnitude of treatment effectiveness (heart attack postponement of 1 month, 6 months, 12 months, 2 years, 4 years and 8 years) and subsequently asked whether they would take such a therapy. They were also asked whether they had hypercholesterolemia or had experienced a heart attack.In total 58% of the respondents consented to the hypothetical treatment. The proportions accepting treatment were 39%, 52%, 56%, 64%, 67% and 73% when postponement was 1 month, 6 months, 12 months, 2 years, 4 years and 8 years respectively. Participants who thought that the effectiveness information was difficult to understand, were less likely to consent to therapy (p = 0.004).Lay people can discriminate between levels of treatment effectiveness when they are presented in terms of postponement of an adverse event. The results indicate that such postponement is a comprehensible measure of effectiveness.Prevention and treatment of chronic disease processes such as atherosclerosis, diabetes and osteoporosis represent an important challenge for health care systems in most countries. Preventive interventions, however, often need to be long lasting or even life long in order to realize their full potential [1]. There is evidence that many patients discontinue therapy because they are not convinced about their need for treatment, consider the efficacy to be poor or experience adverse events [2]. Also, patients with dyslipidaemia are more likely to discontinue medication in primary than in secondary prevention [3]. This pattern of discontinuation may partly reflect lack of ability to judge the effectiveness amongst patients. It is therefore important to develop quantitative measures for risk reduction such that clinicians as well as lay people