Effects of Cardiovascular Disease Risk Communication for Patients With Type 2 Diabetes Mellitus on Risk Perception in a Randomized Controlled Trial
The @RISK Study
OBJECTIVE Patients with type 2 diabetes mellitus (T2DM) underestimate their risk of developing severe complications, and they do not always understand the risk communication by their caregivers. The aim of this study was to investigate the effects of an intervention focused on the communication of the absolute 10-year risk of developing cardiovascular disease (CVD) in patients with T2DM.
RESEARCH DESIGN AND METHODS A randomized controlled trial was performed in T2DM patients newly referred to the Diabetes Care System (DCS) West-Friesland, a managed-care system in the Netherlands. The intervention group (n = 131) received a six-step CVD risk communication. Control subjects (n = 130) received standard managed care. The primary outcome measure was appropriateness of risk perception (difference between actual CVD risk calculated by the UKPDS risk engine and risk perception). Secondary outcome measures were illness perceptions, attitude and intention to change behavior, satisfaction with the communication, and anxiety and worry about CVD risk. Patients completed questionnaires at baseline, at 2 weeks (immediately after the intervention), and at 12 weeks.
RESULTS Appropriateness of risk perception improved between the intervention and control groups at 2 weeks. This effect disappeared at 12 weeks. No effects were found on illness perceptions, attitude and intention to change behavior, or anxiety and worry about CVD risk. Patients in the intervention group were significantly more satisfied with the communication.
CONCLUSIONS This risk communication method improved patients’ risk perception at 2 weeks but not at 12 weeks. Negative effects were not found, as patients did not become anxious or worried after the CVD risk communication.
COMMENT: Another in a long line of studies that conclude that while risk engine-generated information does not do any harm, neither does it do any good. Sort of like the grisly picture of horrific auto accidents they used to show on three-day weekends in the ‘50s and ‘60s. While in theory the truth will make you free, it actuality the truth is not enough. Changing behavior in asymptomatic persons with predictable risks may be one of the largest challenges that we in the health care and public health communities face in the 21st centrury.