Dafina Petrova1, Rocio Garcia-Retamero2,3, Andrés Catena2, Edward Cokely3,4, Ana Heredia Carrasco2, Antonio Arrebola Moreno5, José Antonio Ramírez Hernández5. 1. Mind, Brain, and Behavior Research Center, University of Granada, Campus Universitario de Cartuja s/n, 18071, Granada, Spain. dafinapetrova@ugr.es. 2. Mind, Brain, and Behavior Research Center, University of Granada, Campus Universitario de Cartuja s/n, 18071, Granada, Spain. 3. Max Planck Institute for Human Development, Berlin, Germany. 4. National Institute for Risk and Resilience, and Department of Psychology, University of Oklahoma, Norman, OK, USA. 5. Cardiology Department, University Hospital Virgen de las Nieves, Granada, Spain.
Abstract
BACKGROUND: Many patients delay seeking medical attention during acute coronary syndromes (ACS), profoundly increasing their risk for death and major disability. Although research has identified several risk factors, efforts to improve patient decision making have generally been unsuccessful, prompting a call for more research into psychological factors. PURPOSE: The purpose of this study is to estimate the relationship between ACS decision delay and numeracy, a factor closely related to general decision making skill and risk literacy. METHODS: About 5 days after experiencing ACS, 102 survivors (mean age = 58, 32-74) completed a questionnaire including measures of numeracy, decision delay, and other relevant factors (e.g., anxiety, depression, symptom severity, knowledge, demographics). RESULTS: Low patient numeracy was related to longer decision delay, OR = 0.64 [95 % confidence interval (CI) 0.44, 0.92], which was in turn related to higher odds of positive troponin on arrival at the hospital, OR = 1.37 [95 % CI 1.01, 2.01]. Independent of the influence of all other assessed factors, a patient with high (vs. low) numeracy was about four times more likely to seek medical attention within the critical first hour after symptom onset (i.e., ORhigh-low = 3.84 [1.127, 11.65]). CONCLUSIONS: Numeracy may be one of the largest decision delay risk factors identified to date. Results accord with theories emphasizing potentially pivotal roles of patient deliberation, denial, and outcome understanding during decision making. Findings suggest that brief numeracy assessments may predict which patients are at greater risk for life-threatening decision delay and may also facilitate the design of risk communications that are appropriate for diverse patients who vary in risk literacy.
BACKGROUND: Many patients delay seeking medical attention during acute coronary syndromes (ACS), profoundly increasing their risk for death and major disability. Although research has identified several risk factors, efforts to improve patient decision making have generally been unsuccessful, prompting a call for more research into psychological factors. PURPOSE: The purpose of this study is to estimate the relationship between ACS decision delay and numeracy, a factor closely related to general decision making skill and risk literacy. METHODS: About 5 days after experiencing ACS, 102 survivors (mean age = 58, 32-74) completed a questionnaire including measures of numeracy, decision delay, and other relevant factors (e.g., anxiety, depression, symptom severity, knowledge, demographics). RESULTS: Low patient numeracy was related to longer decision delay, OR = 0.64 [95 % confidence interval (CI) 0.44, 0.92], which was in turn related to higher odds of positive troponin on arrival at the hospital, OR = 1.37 [95 % CI 1.01, 2.01]. Independent of the influence of all other assessed factors, a patient with high (vs. low) numeracy was about four times more likely to seek medical attention within the critical first hour after symptom onset (i.e., ORhigh-low = 3.84 [1.127, 11.65]). CONCLUSIONS: Numeracy may be one of the largest decision delay risk factors identified to date. Results accord with theories emphasizing potentially pivotal roles of patient deliberation, denial, and outcome understanding during decision making. Findings suggest that brief numeracy assessments may predict which patients are at greater risk for life-threatening decision delay and may also facilitate the design of risk communications that are appropriate for diverse patients who vary in risk literacy.
Entities:
Keywords:
Acute coronary syndrome; Decision making, risk literacy; Delay in seeking medical attention; Health literacy; Heart attack; Numeracy
Authors: Martha H Mackay; Adam Chruscicki; Jim Christenson; John A Cairns; Terry Lee; Ricky Turgeon; John M Tallon; Jennifer Helmer; Joel Singer; Graham C Wong; Christopher B Fordyce Journal: J Am Coll Emerg Physicians Open Date: 2022-06-08