Patient priorities for behavioral change: selecting from multiple coronary disease risk factors

When a physician advises a patient to modify unhealthy behaviors, the physician may be tempted to prescribe a target for change by selecting the single "risk factor" that poses the greatest threat to health. The present study was conducted to determine how frequently a statistical approach to health risk appraisal would conflict with a patient's priorities for lifestyle change, even when the patient was fully informed of the rationale for the advice. Coronary artery disease (CAD) risk factor assessment was performed using the American Heart Association's RISKO scale, a validated health risk appraisal instrument. Two hundred forty-one patients were seen in an ambulatory clinic that specialized in heart disease prevention. Risk of CAD was estimated based on age, sex, smoking status, blood pressure, body weight, and serum cholesterol. Using RISKO, patients were told which single risk factor posed the greatest threat to health; patients then selected a personal priority for risk factor intervention. The overall rate of agreement between the patients' priorities and RISKO targets was 63%. If weight loss is considered a nonpharmacologic "target" for controlling hypertension, then the agreement rate rises to 70%. Disagreement was observed even though patients were fully informed of the relative importance of all possible risk factor choices. Since risk factor intervention efforts are less successful unless the target of the intervention is negotiated with the patient, these data should be of clinical importance in devising plans for behavioral change interventions by practitioners.