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Speaking of risk, managing uncertainty: decision-making about cholesterol-reducing treatment in general practice

Adrian Edwards, Mette Bech Ris?r, Pia Kirkegaard, Anne Gram Junge, Janus Laust Thomsen

BackgroundDecision making regarding treatment options and risk communication between health professionals and patients have become key areas of research and quality improvement. Decisions are directed towards applying evidence, exploring individual patient concerns, and addressing medical uncertainty. Compared with research on health professionals’ views on higher stakes decisions, relatively little attention has been paid to improving decision making and risk communication for lifestyle-related risk conditions involving lower stakes or longer term treatment options, such as medication to reduce risk of future disease. AimTo examine general practitioners (GPs) who experienced difficulties with decision making regarding treatment options and risk communication with asymptomatic patients with high cholesterol and risk of cardiovascular disease. MethodsAn exploratory qualitative and ethnographically informed approach was used. Danish GPs (six male, six female, average age 48 years),were interviewed in three groups. Interviews were transcribed and coded, while analytical concepts about medical uncertainty were identified. ResultsThe study identified two modalities of medical uncertainty: epistemological uncertainty about scientific knowledge and evidence-based medicine; and situational uncertainty produced in the one-to-one relationship between the GP and the patient during the consultation. The study also stressed that the decision making about cholesterol-reducing treatment is interpreted by the GPs as reversible and provisional. ConclusionThese modalities of medical uncertainty can be addressed proactively when developing concepts, tools and training interventions to optimise communication about treatment options in primary care.