Increased knowledge makes a difference! – general practitioners’ experiences of pictorial information about subclinical atherosclerosis for primary prevention: an interview study from the VIPVIZA trial

Abstract

Objectives

To explore how pictorial information on subclinical atherosclerosis affects GPs’ perception of patient cardiovascular disease (CVD) risk, their communication with patients, and GPs’ attitude to the treatment of CVD risk factors.

Design, setting and subjects

Fifteen individual interviews were conducted between March 2014 and December 2016, with GPs who had received pictorial information regarding their patients’ subclinical atherosclerosis. The pictorial information was also received by the patients together with written information regarding atherosclerosis and CVD risk prior to the appointment with their GP. The interviews were recorded, transcribed and analyzed using qualitative content analysis.

Results

Three categories were identified in the analysis. Increased knowledge makes a difference: When patients had more in-depth knowledge regarding atherosclerosis, the consultation became more patient-centered and moved towards shared decision making. This is real, not just a number: GPs described their risk assessment and the patient’s risk perception as more accurate with pictorial information about subclinical atherosclerosis. How to deal with the result – A passive to active approach: Some GPs acted promptly on the pictorial information while others took no action.

Conclusion and implications

Pictorial information regarding patients’ subclinical atherosclerosis affected GPs’ assessment of CVD risk. The communication shifted towards shared decision-making although the GPs’ attitude to the result and treatment of CVD risk factors varied. Informing patients about examination results, both in writing and pictures, prior to a consultation can facilitate shared decision making and enhance preventive measures.

Trial registration

https://clinicaltrials.gov/ct2/show/NCT01849575.

KEY POINTS

• Providing pictorial information about carotid ultrasound results and information regarding atherosclerosis to GPs and patients affects primary prevention:

• •Informing patients about examination results prior to a consultation can be useful in clinical practice to enhance preventive measures

• •GPs experienced that increased patient knowledge resulted in a more patient-centered consultation and improved shared decision-making

• •GPs described their risk assessment and patients’ risk perception as more accurate with pictorial information about subclinical atherosclerosis

Keywords:

• Cardiovascular disease
• consultation process
• family practice
• pictorial information
• qualitative research
• risk

Acknowledgements

The authors would like to thank the GPs who participated in the study, the research nurses Carola Sundholm and Maria Backlund for their valuable input, and Rachel Nicoll for language review.

Ethical approval and participant consent

Ethical approval for the study was obtained from the Regional Ethical Review Board (Dnr 2011-445-31M, 2012-463-22M). All interviewees gave verbal consent to participate in the interview. The trial is registered at www.clinicaltrials.gov identifier NCT01849575. The authors confirm all personal identifiers have been removed or disguised so the persons described are not identifiable and cannot be identified through the details of the story.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was financially supported by grants from The Heart Foundation of Northern Sweden, Visare Norr Northern County Councils, Norrbotten County Council in agreement with Umeå University, The Swedish Medical Association [Dnr SLS-405351, SLS-503111], and The Swedish Research Council [Dnr 521-2013-2708].