While clinical guidelines and scientific evidence are the major factors driving treatment decisions, media coverage and advertising when presented by patients do have some influence on clinicians’ prescribing behavior, particularly negative news coverage, according to a survey of 150 CardioSurve members and 253 primary care physicians (PCPs).
The survey, designed to look at factors influencing physician treatment choices, found that nearly all PCPs and cardiologists have responded to a patient inquiry regarding pharmacologic treatments covered in the media.
While the survey results suggest that PCPs are slightly more likely to field media-related questions, cardiologists are certainly not immune. According to clinicians, one out of five patients inquire about treatments which received negative news coverage. Approximately the same number of patients raise questions regarding pharmaceutical company advertisements. To a lesser extent, patients ask about treatments which received positive news coverage or inquire about advertisements related to lawsuits or personal injury claims concerning patient treatments.
“Public communication is favorable in that patients are more informed, more likely to express concerns previously left unasked, unfavorable in that trivial matters are exaggerated in the media.”– Primary Care Physician, Southeast US
Patient preference stemming from media coverage can have an impact in prescribing behavior, particularly when the risk is lower. PCPs are more likely than cardiologists to consider patient references in response to news coverage or advertising. More than 50% of PCPs indicate they had changed a patient prescription or treatment based on information the patient received from the media and advertising. News coverage, both negative and positive, was the primary driver of prescription or treatment changes among cardiologists (49% and 39%, respectively). According to the survey results, the more common patient scenarios for considering patient preferences in response to news coverage or advertising were when the possibility or risk of adverse events was low. In a hypothetical atrial fibrillation patient case scenario concerning the use of novel oral anticoagulants, both PCPs (57%) and cardiologists (63%) say they would be more likely to consider a patient’s request of this type if they had a CHADS2 score of 1.
Likelihood to honor the patient request falls with the increase in disease complexity. In patients presenting with a CHADS2 score ≥ 2, notably fewer cardiologists (31%) and PCPs (39%) would consider the patient request. Some clinicians are also likely to change prescribing behavior if the media coverage evokes concern, particularly for PCPs. Approximately 40% of PCPs say they would consider patient preference due to their own treatment concerns based on news coverage compared to roughly 20% of cardiologists. Also of note, 22% of cardiologists say they do not consider patient preference based on media concerns at all, compared to only 8% of PCPs.
In addition to indirect influence on care decisions through patient preference, the survey finds that media coverage and advertising also have an impact on physician/patient communications. Negative news coverage is most likely to lead to increased communication between physician and patient, as well as place more pressure on the justification of the prescribed regimen. According to PCPs, negative news coverage is the primary communication facilitator leading most often to conversations with patients (72%), followed by pharmaceutical ads (62%), positive news coverage (60%) and legal claim ads (49%). In comparison, cardiologists indicate fewer discussions around pharmaceutical ads (41%) and lawsuits or personal injury claims (37%), while negative and positive news coverage are the biggest drivers of discussions at 71% and 55%, respectively.
The survey highlights the uphill battle cardiologists, PCPs and others face in remaining abreast of media coverage as well as having accurate information from credible sources to discuss and present to patients regarding treatment options. “Consumer advertising and news coverage are affecting the clinician patient dynamic,” said one cardiologist. “The clinician must be prepared to respond and provide adequate reasoning to support his viewpoint.”
The ACC, working with other specialty societies and consumer groups, has an opportunity to help clinicians anticipate these conversations with their patients and plan for them by closely monitoring the latest news and advertisements making headlines and helping to develop patient-friendly education materials that present options and provide guidance on the benefits and risks of specific treatments and therapies. One example of this is the College’s new Anticoagulation Initiative. This program currently underway is geared towards helping both patients and providers navigate the world of new oral anticoagulants, information from clinical trials and research, negative advertising, symptomatic presentation and treatment risks and benefits.
This research was conducted to support ACC’s Anticoagulation Initiative, which is sponsored by Boehringer Ingelheim Pharmaceuticals, Inc. and Janssen Pharmaceuticals, Inc.
“The patients are given a ‘spin’ by the press and we (the cardiology experts) give them the true picture. That is why they come to us for care.” – Cardiologist, Southwest U.S.