Communicating statin evidence to support shared decision-making

Bruce Barrett, Jason Ricco, Margaret Wallace, David Kiefer, Dave Rakel

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Background: The practice of clinical medicine rests on a foundation of ethical principles as well as scientific knowledge. Clinicians must artfully balance the principle of beneficence, doing what is best for patients, with autonomy, allowing patients to make their own well-informed health care decisions. The clinical communication process is complicated by varying degrees of confidence in scientific evidence regarding patient-oriented benefits, and by the fact that most medical options are associated with possible harms as well as potential benefits. Discussion: Evidence-based clinical guidelines often neglect patient-oriented issues involved with the thoughtful practice of shared decision-making, where individual values, goals, and preferences should be prioritized. Guidelines on the use of statin medications for preventing cardiovascular events are a case in point. Current guidelines endorse the use of statins for people whose 10-year risk of cardiovascular events is as low as 7.5 %. Previous guidelines set the 10-year risk benchmark at 20 %. Meta-analysis of randomized trials suggests that statins can reduce cardiovascular event rates by about 25 %, bringing 10-year risk from 7.5 to 5.6 %, for example, or from 20 to 15 %. Whether or not these benefits should justify the use of statins for individual patients depends on how those advantages are valued in comparison with disadvantages, such as side effect risks, and with inconveniences associated with taking a pill each day and visiting clinicians and laboratories regularly. Conclusions: Whether or not the overall benefit-harm balance justifies the use of a medication for an individual patient cannot be determined by a guidelines committee, a health care system, or even the attending physician. Instead, it is the individual patient who has a fundamental right to decide whether or not taking a drug is worthwhile. Researchers and professional organizations should endeavor to develop shared decision-making tools that provide up-to-date best evidence in easily understandable formats, so as to assist clinicians in helping their patients to make the decisions that are right for them.

Original languageEnglish (US)
Article number41
JournalBMC Family Practice
Volume17
Issue number1
DOIs
StatePublished - Apr 6 2016

Bibliographical note

Funding Information:
The authors would like to thank Joseph Chase for assembling the Table, Terry Little and Mary Checovich for assistance with manuscript submission and tracking, and Allen Last for thoughtful reading and comments. During the writing of this paper, Bruce Barrett was supported by a midcareer investigator award (K24AT006543) from the National Center for Complementary and Integrative Health (NCCIH), Margaret Wallace and Jason Ricco were primary care research fellows supported by a National Research Service Award (NRSA) from the Health Resources and Services Administration (T32HP10010), and David Kiefer was a complementary and alternative medicine research fellow supported by a NRSA grant from NCCIH (T32AT006956).

Publisher Copyright:
© 2016 Barrett et al.

Keywords

  • Attitude to health
  • Cholesterol
  • Clinical significance
  • Cost-benefit analysis
  • Decision making
  • Evidence-based medicine
  • Guidelines
  • Lipids
  • Minimal important difference
  • Outcomes
  • Patient preference
  • Preventive cardiology
  • Primary care
  • Quality of life
  • Shared decision-making
  • Statins

Fingerprint

Dive into the research topics of 'Communicating statin evidence to support shared decision-making'. Together they form a unique fingerprint.

Cite this