Patient attitudes to commonly promoted medical interventions

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.

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).

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.

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.

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).

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.