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Background Cardiovascular disease (CVD) prevention guidelines encourage assessment of absolute CVD risk - the probability of a CVD event within a fixed time period, based on the most predictive risk factors. However, few general practitioners (GPs) use absolute CVD risk consistently, and communication difficulties have been identified as a barrier to changing practice. This study aimed to explore GPs' descriptions of their CVD risk communication strategies, including the role of absolute risk. Methods Semi-structured interviews were conducted with a purposive sample of 25 GPs in New South Wales, Australia. Transcribed audio-recordings were thematically coded, using the Framework Analysis method to ensure rigour. Results GPs used absolute CVD risk within three different communication strategies: 'positive', 'scare tactic', and 'indirect'. A 'positive' strategy, which aimed to reassure and motivate, was used for patients with low risk, determination to change lifestyle, and some concern about CVD risk. Absolute risk was used to show how they could reduce risk. A 'scare tactic' strategy was used for patients with high risk, lack of motivation, and a dismissive attitude. Absolute risk was used to 'scare' them into taking action. An 'indirect' strategy, where CVD risk was not the main focus, was used for patients with low risk but some lifestyle risk factors, high anxiety, high resistance to change, or difficulty understanding probabilities. Non-quantitative absolute risk formats were found to be helpful in these situations. Conclusions This study demonstrated how GPs use three different communication strategies to address the issue of CVD risk, depending on their perception of patient risk, motivation and anxiety. Absolute risk played a different role within each strategy. Providing GPs with alternative ways of explaining absolute risk, in order to achieve different communication aims, may improve their use of absolute CVD risk assessment in practice. [ABSTRACT FROM AUTHOR]

The article presents a study which aims to identify the influence of using absolute risk (AR) assessment by general practitioners (GPs) in cardiovascular disease (CVD) risk assessment. The study made used of the semi-structured interviews of practising Gps in New South Wales between October 2011 and May 2012. The result of the study shows that a range of strategies was used by GPs in different situations.

The article focuses on the frequency, goals and outcomes of second-opinion consultations for cancer diseases at the Sydney Cancer Centre in Sydney, New South Wales. Proportion and demographic characteristics of patients who were seeking second-opinion are identified. Information related to treatment and reassurance about recommended treatment are the major reasons for seeking second-opinions. Patients are observed to be more educated due to their preference to acquire more detailed information.

The article discusses how women respond to the nature and extent of overdiagnosis in breast cancer screening. According to the authors, some women began thinking about their screening choices, where as on some it had a limited impact on their attitude. The level of overdiagnosis varied widely, and the public awareness was low, and some women found overdiagnosis concerning, but when they had to decide about breast cancer screening and treatment, they were concerned about its risk.

Objectives: To explore older people's perspectives and experiences with shared decision-making (SDM) about medication for cardiovascular disease (CVD) prevention., Design, Setting and Participants: Semi-structured interviews with 30 general practice patients aged 75 years and older in New South Wales, Australia, who had elevated CVD risk factors (blood pressure, cholesterol) or had received CVD-related lifestyle advice. Data were analysed by multiple researchers using Framework analysis., Results: Twenty eight participants out of 30 were on CVD prevention medication, half with established CVD. We outlined patient experiences using the four steps of the SDM process, identifying key barriers and challenges: Step 1. Choice awareness: taking medication for CVD prevention was generally not recognised as a decision requiring patient input; Step 2. Discuss benefits/harms options: CVD prevention poorly understood with emphasis on benefits; Step 3. Explore preferences: goals, values and preferences (eg, length of life vs quality of life, reducing disease burden vs risk reduction) varied widely but generally not discussed with the general practitioner; Step 4. Making the decision: overall preference for directive approach, but some patients wanted more active involvement. Themes were similar across primary and secondary CVD prevention, different levels of self-reported health and people on and off medication., Conclusions: Results demonstrate how older participants vary widely in their health goals and preferences for treatment outcomes, suggesting that CVD prevention decisions are preference sensitive. Combined with the fact that the vast majority of participants were taking medications, and few understood the aims and potential benefits and harms of CVD prevention, it seems that older patients are not always making an informed decision. Our findings highlight potentially modifiable barriers to greater participation of older people in SDM about CVD prevention medication and prevention in general., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: Cardiovascular disease (CVD) prevention guidelines recommend medication based on the probability of a heart attack/stroke in the next 5-10 years. However, heuristics and biases make risk communication challenging for doctors. This study explored how patients interpret personalised CVD risk results presented in varying formats and timeframes., Methods: GPs recruited 25 patients with CVD risk factors and varying medication history. Participants were asked to 'think aloud' while using two CVD risk calculators that present probabilistic risk in different ways, within a semi-structured interview. Transcribed audio-recordings were coded using Framework Analysis., Results: Key themes were: 1) numbers lack meaning without a reference point; 2) risk results need to be both credible and novel; 3) selective attention to intervention effects. Risk categories (low/moderate/high) provided meaningful context, but short-term risk results were not credible if they didn't match expectations. Colour-coded icon arrays showing the effect of age and interventions were seen as novel and motivating. Those on medication focused on benefits, while others focused on harms., Conclusion: CVD risk formats need to be tailored to patient expectations and experiences in order to counteract heuristics and biases., Practice Implications: Doctors need access to multiple CVD risk formats to communicate effectively about CVD prevention., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Context: Increasing evidence suggests a link between patients' expectancies and post-chemotherapy side effects. However, it remains unclear whether asking patients about their expectancies might actually increase side effects., Objectives: The present study tested whether questioning first-time chemotherapy patients about their pretreatment expectancies for four common side effects influences the occurrence and/or severity of these side effects post-treatment and whether these pretreatment expectancies are predictive of post-treatment side effects., Methods: Ninety-one first-time chemotherapy patients were randomly allocated to have their expectancies for nausea, fatigue, feelings of sadness, and loss of appetite assessed before their first infusion or to no such assessment. All patients then rated the occurrence and severity of these side effects at the end of their first chemotherapy cycle., Results: There were no statistically significant differences in occurrence or severity of side effects in those who had their expectancies assessed compared with those who did not. There was, however, evidence of a statistically significant positive relationship between patients' pretreatment expectancies and their post-treatment reports of nausea, loss of appetite, and feelings of sadness, after controlling for age, sex, and baseline symptom levels., Conclusion: These findings suggest that patient expectancies might be a useful point of intervention for attempting to reduce the burden of chemotherapy-related side effects, as there do not appear to be any detrimental effects of asking patients to report their expectancies and their expectancies do appear related to the occurrence of post-treatment side effects., (Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.)