9th Conference European Sociological Association

RN16 Sociology of Health and Illness

2009-09-05 11:00:00 2009-09-05 12:30:00 Saturday, 5 September 11:00 - 12:30 Public Health, Health Promotion and Risk II Building I, 1E4

A qualitative study of physician perspectives on risk communication in preventive encounters - results from focus group discussions in the context of the Austrian periodic health examination

Background
Utilized by 821.655 participants (12,2% of those eligible) in 2007, the Austrian Periodic Health Examination (PHE) is available free of charge annually to adults aged 18 and older irrespective of insurance status. Three-quarters of all PHEs are delivered by general practitioners (GPs) in private practice. Program content focuses on evidence-based interventions with lifestyle counselling and individual risk appraisal as well as cancer screening advice. Physicians are encouraged to assess participants' readiness to screening participation and provide information on benefits, risks and uncertainties of these examinations. Also, GPs are supposed to assess individual global cardiovascular risk by means of a predictive risk tool.

Aims
To identify the experiences and views of a group of primary care physicians engaging in risk communication in clinical preventive encounters, exploring barriers and opportunities. Particularly, to get a better understanding of GP perspectives on cancer screening discussions and their role in cardiovascular risk assessment and lifestyle counselling.

Methods
Based on a review of the literature and consultation with experts, focus groups checklists in semi-structured interview format were constructed. Five focus groups of primary care physicians with longstanding experience in PHE delivery were audio-taped, transcribed verbatim, and qualitatively analyzed. MAXqda was used for analysis.

Results
Beliefs about the legitimacy and effectiveness of lifestyle counselling were mixed, depending on the type of intervention. Positive attitudes were expressed with respect to risk calculator utilization, with physicians using these tools particularly for patient education. With respect to cancer screening, physicians appeared less at ease in discussing benefit and harm "fairly" and completely so that participants were well informed. Physicians expressed fear of discouraging screening participation by disclosing risks.

Conclusion
Physicians recognise the importance of discussions enabling fully informed decision making; however, GPs express uncertainty in cancer screening communication and in appropriately framing risk information. Cardiovascular risk calculators appear to be used as educational tools rather than assessment or screening tools. Implementation should focus on professional efforts supporting physicians in risk communication. Also, patients' views on risk communication, particularly with respect to cancer screening and prevention should be explored.