What do we want to know?
Scoring systems for cardiovascular risk, such as QRISK, aim to quantify how likely an individual is to get cardiovascular disease in the future, based on information about their demographics, behaviours and clinical measurements (for example, blood pressure, cholesterol). They are widely used as communication tools to help people understand their risk and make decisions about treatments and behaviour. This review aimed to understand individuals’ and clinicians’ views and experiences of the communication of cardiovascular risk, and identify barriers to the use of risk scoring.
Who wants to know?
This independent research report was commissioned by the National Institute for Health Research Policy Research Programme for the Department of Health and Social Care. The project aimed to inform policy thinking around the development of the NHS Health Check programme, in which the communication of cardiovascular risk scores is a key focus.
What did we find?
The review included 37 qualitative studies. The findings show that many people do not see risk scores as practically relevant. Some people are sceptical about the validity of risk models, and are not concerned by risk scores rated as moderate or high risk. They may make their own estimates of risk, for example based on their lifestyles or family history, and reject the results of clinical risk assessment if they conflict. Data on the impact of risk communication are mixed: many people report that learning their risk score motivates them to change behaviours, but for others it makes little difference.
Clinicians have broadly positive views of risk assessment, but identify several barriers for patients, including: understanding of probability or risk; excessive anxiety about risk, or indifference to future risks; and low risk scores removing motivation for lifestyle change. They find that individuals vary widely in their perceptions and reactions, and have a range of strategies for adapting risk communication.
Some clear preferences for risk communication are found in the data. People generally prefer visually engaging formats, and the ability to manipulate data inputs (for example, to see what difference behavioural changes would make).
What are the conclusions?
The findings suggest that ways of communicating risk which provide some comparison or reference point may be more promising. There is potential to explore ways of presenting risk information in ways which are more relevant than an isolated, abstract probability score.
The context of risk communication is important. People understand risk scores alongside broader messages about, for example, treatments and lifestyles, and clinicians consciously modify how they communicate risk depending on the individual, even where the scoring tool is standardised. In some cases, the emotional dimensions of risk communication may be more important than the factual content of information about risk.
How did we get these results?
This was a systematic review of qualitative evidence. We searched four databases for English-language qualitative studies reporting data on cardiovascular risk communication in high-income countries. Studies were critically appraised for rigour in sampling, data collection and other methodological domains.