The effect of how outcomes are framed on decisions about whether to take antihypertensive medication: a randomized trial

Cheryl L L Carling, Doris Tove Kristoffersen, Andrew D. Oxman, Signe Flottorp, Atle Fretheim, Holger J. Schünemann, Elie A. Akl, Jeph Herrin, Thomas D. MacKenzie, Victor Manuel Montori

Research output: Contribution to journalArticle

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Abstract

Background: We conducted an Internet-based randomized trial comparing three valence framing presentations of the benefits of antihypertensive medication in preventing cardiovascular disease (CVD) for people with newly diagnosed hypertension to determine which framing presentation resulted in choices most consistent with participants' values. Methods and Findings: In this second in a series of televised trials in cooperation with the Norwegian Broadcasting Company, adult volunteers rated the relative importance of the consequences of taking antihypertensive medication using visual analogue scales (VAS). Participants viewed information (or no information) to which they were randomized and decided whether or not to take medication. We compared positive framing over 10 years (the number escaping CVD per 1000); negative framing over 10 years (the number that will have CVD) and negative framing per year over 10 years of the effects of antihypertensive medication on the 10-year risk for CVD for a 40 year-old man with newly diagnosed hypertension without other risk factors. Finally, all participants were shown all presentations and detailed patient information about hypertension and were asked to decide again. We calculated a relative importance score (RIS) by subtracting the VAS-scores for the undesirable consequences of antihypertensive medication from the VAS-score for the benefit of CVD risk reduction. We used logistic regression to determine the association between participants' RIS and their choice. 1,528 participants completed the study. The statistically significant differences between the groups in the likelihood of choosing to take antihypertensive medication in relation to different values (RIS) increased as the RIS increased. Positively framed information lead to decisions most consistent with those made by everyone for the second, more fully informed decision. There was a statistically significant decrease in deciding to take antihypertensives on the second decision, both within groups and overall. Conclusions:For decisions about taking antihypertensive medication for people with a relatively low baseline risk of CVD (70 per 1000 over 10 years), both positive and negative framing resulted in significantly more people deciding to take medication compared to what participants decided after being shown all three of the presentations. Trial Registration: International Standard Randomised Controlled Trial Number Register ISRCTN 33771631.

Original languageEnglish (US)
Article numbere9469
JournalPLoS One
Volume5
Issue number3
DOIs
StatePublished - Mar 1 2010

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antihypertensive agents
Antihypertensive Agents
drug therapy
cardiovascular diseases
Cardiovascular Diseases
Visual Analog Scale
hypertension
Hypertension
antihypertensive effect
Risk Reduction Behavior
Broadcasting
risk reduction
Internet
Logistics
Volunteers
volunteers
Randomized Controlled Trials
Logistic Models
Association reactions
risk factors

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Carling, C. L. L., Kristoffersen, D. T., Oxman, A. D., Flottorp, S., Fretheim, A., Schünemann, H. J., ... Montori, V. M. (2010). The effect of how outcomes are framed on decisions about whether to take antihypertensive medication: a randomized trial. PLoS One, 5(3), [e9469]. https://doi.org/10.1371/journal.pone.0009469

The effect of how outcomes are framed on decisions about whether to take antihypertensive medication : a randomized trial. / Carling, Cheryl L L; Kristoffersen, Doris Tove; Oxman, Andrew D.; Flottorp, Signe; Fretheim, Atle; Schünemann, Holger J.; Akl, Elie A.; Herrin, Jeph; MacKenzie, Thomas D.; Montori, Victor Manuel.

In: PLoS One, Vol. 5, No. 3, e9469, 01.03.2010.

Research output: Contribution to journalArticle

Carling, CLL, Kristoffersen, DT, Oxman, AD, Flottorp, S, Fretheim, A, Schünemann, HJ, Akl, EA, Herrin, J, MacKenzie, TD & Montori, VM 2010, 'The effect of how outcomes are framed on decisions about whether to take antihypertensive medication: a randomized trial', PLoS One, vol. 5, no. 3, e9469. https://doi.org/10.1371/journal.pone.0009469
Carling CLL, Kristoffersen DT, Oxman AD, Flottorp S, Fretheim A, Schünemann HJ et al. The effect of how outcomes are framed on decisions about whether to take antihypertensive medication: a randomized trial. PLoS One. 2010 Mar 1;5(3). e9469. https://doi.org/10.1371/journal.pone.0009469
Carling, Cheryl L L ; Kristoffersen, Doris Tove ; Oxman, Andrew D. ; Flottorp, Signe ; Fretheim, Atle ; Schünemann, Holger J. ; Akl, Elie A. ; Herrin, Jeph ; MacKenzie, Thomas D. ; Montori, Victor Manuel. / The effect of how outcomes are framed on decisions about whether to take antihypertensive medication : a randomized trial. In: PLoS One. 2010 ; Vol. 5, No. 3.
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