Patient attitudes to commonly promoted medical interventions

OBJECTIVE: To survey attitudes about three "best practice" medical interventions (hormone replacement therapy [HRT], thrombolysis for acute myocardial infarction [THROM] and coronary artery by-pass surgery [CABS]) in a sample of patients, and identify factors associated with those attitudes. SETTINGS: Metropolitan tertiary care hospital outpatient clinics (survey 1, April 1997), two general practice surgeries (survey 2, May 1997), and one general practice surgery (survey 3, October 1997). DESIGN: Patients completed a questionnaire while waiting for their clinical consultation. Attitude scores were measured on an 11-category Likert scale ranging from -5 (definitely would not) to +5 (definitely would) for acceptance of proposed medication or surgery. PARTICIPANTS: 85 (participation rate, 85%), 77 (94%) and 95 (97%) in surveys 1, 2 and 3, respectively. Surveys 1 and 2 constituted the primary study group (n = 162). Patients aged > or = 50 years or reporting heart disease were excluded from the HRT analyses; patients aged > or = 65 years were excluded from the THROM and CABS analyses. RESULTS: The median attitude scores for HRT (n = 58), THROM and CABS (n = 111) were -2.95 (95% CI, -5 to -2.1), -0.5 (95% CI, -0.9 to 0) and -0.1 (95% CI, -0.5 to +1.3), respectively. Decreasing the risk-benefit ratio fourfold for HRT in survey 3 (n = 68) increased the median score to -0.75 (95% CI, -2.3 to 0). CONCLUSIONS: Patients do not view favourably the risk-benefit ratio of the three surveyed medical interventions. These attitudes may present a major impediment to most primary prevention programs.