Impact of adding a video to patient education on quality of life among adults with atrial fibrillation: a randomized controlled trial

ObjectiveTo assess whether adding a video on atrial fibrillation (AF) to a face-to-face educational session improves quality of life (QoL), knowledge, and health resource utilization (HRU) among AF patients.MethodsIn this parallel clinical trial, adults with AF received a face-to-face educational session on AF and were randomly allocated to watch an educational video or not. Self-reported questionnaires measured QoL (primary outcome; score 0–100), AF knowledge (score 0–25), and HRU. Data were collected before and after interventions. Within- and between-group changes were estimated by mixed models.ResultsSixty participants (age: 56 ± 13 years; men: n = 41) were allocated to watch the video after education (n = 30) or to receive education only (n = 30). Within groups over time, QoL and knowledge significantly improved. Knowledge increased by 2.3 units (95% confidence interval: 0.5–4.1) more in participants who watched the video than in others (P = 0.014). Changes in QoL and HRU were not different between groups.ConclusionComplementing education with a video on AF did not result in additional positive impacts on QoL and HRU among AF adults but led to greater improvements in AF knowledge.Practice ImplicationsThe video on AF could be used as part of educational sessions to increase AF knowledge in AF patients.     

Development of a consent resource for genomic data sharing in the clinical setting

PurposeData sharing between clinicians, laboratories, and patients is essential for improvements in genomic medicine, but obtaining consent for individual-level data sharing is often hindered by a lack of time and resources. To address this issue, the Clinical Genome Resource (ClinGen) developed tools to facilitate consent, including a one-page consent form and online supplemental video with information on key topics, such as risks and benefits of data sharing.MethodsTo determine whether the consent form and video accurately conveyed key data sharing concepts, we surveyed 5,162 members of the general public. We measured comprehension at baseline, after reading the form and watching the video. Additionally, we assessed participants’ attitudes toward genomic data sharing.ResultsParticipants’ performance on comprehension questions significantly improved over baseline after reading the form and continued to improve after watching the video.ConclusionResults suggest reading the form alone provided participants with important knowledge regarding broad data sharing, and watching the video allowed for broader comprehension. These materials are now available at http://www.clinicalgenome.org/share. These resources will provide patients a straightforward way to share their genetic and health information, and improve the scientific community’s access to data generated through routine healthcare.     

Assessment of inflammatory bowel disease educational videos for increasing patient engagement and family and friends’ levels of understanding

ObjectiveWe developed five educational videos through a user-centered approach for patients with inflammatory bowel diseases (IBD) and their families and friends. Here, we assessed if IBD patient activation and family and friends’ abilities to understand IBD patients’ thoughts, feelings, and behaviors (i.e., perspective taking) changed after watching the videos.MethodsThrough a pre-post survey, we assessed patient activation and perspective taking levels in people with a self-reported IBD diagnosis and their family and friends, respectively, before and after watching one of the videos.ResultsAmong 767 participants with IBD, patient activation scores increased significantly after watching each video. In regression analyses, patient activation levels were less likely to increase in biologic-naïve participants after viewing the coping video. Among 232 people who knew someone with IBD, perspective taking scores increased significantly in 8/9 domains, which was more likely to occur among women.ConclusionsEducational videos developed through a user-centered approach were associated with higher self-reported IBD patient activation scores and perspective taking levels among family and friends.Practice implicationsThese videos, which are now widely disseminated on social media, serve as a model for how to create educational materials for improving patient activation and empathy in the social media era.     

Efecto de la formación en soporte vital básico a través de un video difundido en redes sociales

IntroductionUsing videos seems to be a good option to share cardiopulmonary resuscitation (CPR) techniques.AimOur aim was to evaluate the learning effect of viewing a video about why and how to do CPR in young footballers, as well as on how to use an automatic external defibrillator.Material and methodsA prospective, analytical and observational study was conducted that included 65 young footballers (aged between 12 and 33 years old). First of all, basic life support knowledge was assessed using a questionnaire. After that, a video made ad hoc for this study was shared on the social media for a week. Then, 52 of the participants were split into the experimental group (who watched the video), and a control group. Both groups were evaluated using a standardised test scenario.ResultsFifty five per cent of the sample did not have sufficient knowledge, and 81% said that they did not know how to use an automatic external defibrillator. After the video release, a statistical difference was found between both groups in terms of airway opening, depth and correct compressions, thus improving overall CPR quality. The mean time to deliver an effective shock with the automatic external defibrillator was 85 seconds.ConclusionIn conclusion, watching a brief video improves the responsiveness in a cardiac arrest and the CPR quality.     

Sociodemographic,behavioral, and clinical factors associated with low atrial fibrillation knowledge among older adults with atrial fibrillation: The SAGE-AF study

BackgroundManagement of AF requires patient engagement in disease management which requires adequate knowledge about AF.ObjectiveTo identify the patient characteristics associated with low AF knowledge among older adults with AF.MethodsThe SAGE-AF cohort enrolled adults aged ≥65 diagnosed with AF in 2016?2018. Patient characteristics associated with low AF knowledge (<6/8 JAKQ items correct) were examined using multivariable adjusted logistic regression models.ResultsParticipants (N = 950) were on average 74 years old (SD: 6.7), 50 % female, and 87 % non-Hispanic white. The average JAKQ score was 68.7 (SD: 17.1), and 78 % had low AF knowledge. Participants aged ≥ 75 (OR: 1.55, 95 % CI: 1.03, 2.33), without a college degree (OR: 0.46, 95 % CI: 0.32, 0.65), cognitively impaired (OR: 1.72, 95 % CI: 1.15, 2.58), with a history of anxiety (OR: 1.76, 95 % CI: 1.09, 2.83), myocardial infarction (OR: 1.82, 95 % CI: 1.08, 3.07), and heart failure (OR: 1.84, 95 % CI: 1.16, 2.91) were more likely to have low AF knowledge.Practice implicationsCharacteristics available in the electronic medical record may identify patients at risk for low AF knowledge. Formal assessment of AF knowledge may identify areas of weakness and allow for targeted education.     

Comparative analysis of anxiety/depression scores in COVID-19 patients with disease severity,sleep patterns,and certain laboratory test results

IntroductionCoronavirus disease 2019 (COVID-19) is associated with severe emotional changes. This research aims to investigate the prevalence of anxiety and depression in COVID-19 patients and its relationship with disease severity, sleep patterns, lifestyle, and specific laboratory test results.Material and methodsAn observational study of 52 Chinese patients with COVID-19 was conducted to assess the relation between anxiety and depression (evaluated with the Hospital Anxiety and Depression Scale) and laboratory findings (lymphocytes, C-reactive proteins, leukocytes, alanine aminotransferase, aspartate aminotransferase). The relationships between the severity of COVID-19 in patients, the Insomnia Severity Index (ISI) score, and the Hospital Anxiety and Depression Scale (HADS) score were also investigated.ResultsThere were statistically significant associations between disease, smoking, and HADS-A scores (p = 0.011/0.020). The HADS-D score of patients with the disease was higher than in those without a past medical history (p = 0.008). The difference in C-reactive protein (CRP) between different lung infections, the HADS-A and HADS-D scores between different ages and ISI groups, and the correlation between the two scores were statistically significant.ConclusionsAnxiety and depression are associated with poor sleep quality, smoking, and past medical history in patients with COVID-19. Additionally, anxiety and depression were seen to coexist, and there was a positive correlation between them. Further, the inflammatory index CRP was significantly increased in bilateral lung infections.     

Development and effectiveness assessment of a Persian-language smartphone application for celiac patients: A randomized controlled clinical trial

ObjectivesWe aimed to design a Persian-language application for celiac patients and assess its effectiveness on patients` knowledge and adherence to a gluten-free diet (GFD).MethodsIn the present randomized controlled clinical trial, 60 patients were randomly assigned to receive education through a smartphone application (n = 30) or conventional clinical education (n = 30). The primary outcomes were assessing knowledge about celiac disease and GFD, and adherence to GFD that were assessed at baseline and three months after interventions. The knowledge and adherence were assessed by a valid author-designed knowledge questionnaire and the validated celiac disease adherence test (CDAT) respectively.ResultsThe mean disease duration was 4.38 ± 3.27 years. The mean post-intervention score of knowledge about gluten-free foods was significantly higher in the intervention group compared with the placebo group after adjusting for baseline values and characteristics (p-value = 0.03). There was a significant difference in post-intervention CDAT values between the two groups (p-value = 0.01).ConclusionThe smartphone application had a significant effect on celiac patients` knowledge about gluten-free foods and adherence to GFD.Practice ImplicationsThe smartphone applications can be designed according to each country's particular circumstances and can be suggested by nutritionists and physicians to use by celiac patients.     

Efficacy of DiaLife,an Education Program for Relatives of Adults with Diabetes – A Cluster Randomized Controlled Trial

ObjectiveDiabetes affects the lives of patients and their close relatives. Considering the proven benefit of patient education programs, DiaLife was elaborated as the first German education program addressing the needs of relatives. The objective of this study was to investigate its efficacy.MethodsThe evaluation was implemented in the form of a cRCT with longitudinal design and waiting list condition. In total, 179 relatives were recruited. Participants’ diabetes-related knowledge was defined as the primary outcome. Diabetes-related strains, family interaction and other psychosocial factors were determined as secondary outcomes.ResultsA generalized estimating equation model showed a persistent increase of diabetes-related knowledge in the intervention group compared to the control group regardless of the type of diabetes. Concerning secondary outcomes, mixed linear models showed an improvement for relatives of people with type 2 diabetes who participated in the DiaLife program.ConclusionThis study provides evidence of DiaLife’s efficacy regarding a persistent increase of diabetes-related knowledge and a positive effect on psychosocial outcomes in relatives of people with type 2 but not in type 1 diabetes. Adding (an)other psychosocial module(s) might improve their well-being and psychosocial outcomes.Practice ImplicationsDiabetes centers should consider implementing an education program for relatives, such as DiaLife, in their curriculum.Trial registrationThe study was registered at the German Clinical Trials Register (DRKS00015157; date of registration: 24.08.2018).     

Using digital videos displayed on personal digital assistants (PDAs) to enhance patient education in clinical settings

OBJECTIVES: To evaluate the effects of using an audiovisual animation (i.e., digital video) displayed on a personal digital assistant (PDA) for patient education in a clinical setting. METHODS: Quasi-experimental study of a prospective technology intervention conducted in an outpatient infectious diseases clinic at an academic medical center. Subjects responded to questions immediately before, immediately after, and 4-6 weeks after watching a digital video on a PDA. Outcome measures include participant knowledge of disease, knowledge of medications, and knowledge of adherence behaviors; attitudes toward the video and PDA; self-reported adherence; and practicality of the intervention. RESULTS: Fifty-one English-speaking adults who were initiating or taking medications for the treatment of HIV/AIDS participated in the study. At visit one, statistically significant improvements in knowledge of disease (p<0.005; paired t-test), knowledge of medications (p<0.005; paired t-test), and knowledge of adherence behaviors (p<0.05; ANOVA) were measured after participants watched the PDA-based video. At visit two (4-6 weeks later), statistically significant improvements in self-reported adherence to the medication regimens (p<0.005; paired t-test) were reported. Participants liked the PDA-based video and indicated that it was an appropriate medium for learning, regardless of their baseline literacy skills. The video education process was estimated to take 25 min of participant time and was viewed in both private and semi-private locations. CONCLUSIONS: Technology-assisted education using a digital video delivered via PDA is a convenient and potentially powerful way to deliver health messages. The intervention was implemented efficiently with participants of a variety of ages and educational levels, and in a range of locations within clinical environments. Additional study of this methodology is warranted.     

Randomized trial of a patient education tool about leiomyoma

ObjectiveUterine leiomyomata are a frequent indication for women seeking gynecologic care [1]. The objective of our study was to assess whether patient knowledge about leiomyomata, anxiety, or satisfaction with counseling differed in patients who received multimedia counseling versus standard counseling.MethodsWomen with leiomyomata who presented to the gynecology clinic at a single institution were randomized to standard counseling or multimedia counseling using the drawMD OB/GYN iPad™ application. Participants completed a pre-counseling questionnaire, received the designated method of counseling, and completed a post-counseling questionnaire. Outcomes of the study included assessment of patient knowledge, satisfaction, and anxiety.ResultsSeventy-two participants were randomized. There was no significant difference in post-counseling anxiety between the groups (p = 0.86). For both groups, anxiety significantly improved after counseling. Both groups were satisfied with the counseling they received, however, there was no difference between groups. Participants in both groups significantly improved their knowledge about fibroids post-counseling.ConclusionCounseling of patients with leiomyomata improves patient satisfaction and knowledge. The addition of a multimedia tool may or may not enhance patient counseling.Practice ImplicationsThis is the first prospective, randomized controlled trial evaluating the impact of a multimedia tool on patient education and counseling for patients with leiomyomata.     

Causes of death among dengue patients causes of death among hospitalized adults with dengue fever in Tainan, 2015: Emphasis on cardiac events and bacterial infections

IntroductionThe 2015 dengue outbreak in southern Taiwan caused substantial mortality. We analyzed the causes of death among these patients.Materials and methodsThis retrospective study was conducted at a medical center in Tainan from August 2015 to December 2015. Dengue was diagnosed based on the detection of serum dengue NS1 antigen, IgM, or viral RNA in the blood. Causes of death were retrieved from chart reviews by three clinicians.ResultsThere were 4488 cases of dengue in the study hospital, with an in-hospital fatality rate of 1.3% (60 cases). The mean age of the 60 fatal cases was 73 years, among whom 90% were aged ≥65 years. Twenty-eight (46.7%) patients died of severe dengue, and 29 (48.3%) deaths were possibly related to dengue. Of the latter, 24 (40%) died of secondary infections. Thirteen cardiac arrest events, including out-of-hospital (5 events) and in-hospital (8) cardiac arrests in the emergency department, occurred during the dengue epidemic. Seven (53.8%) patients did not receive medical aid before the event. Of the 40 deaths that occurred within one week after hospitalization, 60% died of severe dengue. In contrast, 50% of 20 deaths that occurred one week after hospitalization were related to hospital-acquired infections, mainly pneumonia.ConclusionOf 60 fatal cases, with a predominance of elderly patients, deaths were related to severe dengue within the first week after admission and secondary infections thereafter. The absence of medical care before cardiac arrest events highlights the importance of health education for warning signs of dengue.     

Areas of intervention for genetic counselling of dementia: Cross-cultural comparison between Italians and Americans

ObjectivePurposes of this study are: (1) to evaluate attitudes, beliefs and experiences towards dementia among relatives of Italian familial cases; (2) to perform a cross-cultural comparison between Italian and American samples; (3) to identify predictors of intentions to undergo hypothetical genetic testing.MethodsParticipants were 134 relatives of patients affected by familial forms of dementia. We administered tests measuring health psychological styles, social variables, illness perceptions, intentions regarding genetic testing, and perceptions of the pros and cons of genetic testing.ResultsRespondents had a poor Alzheimer's disease knowledge and a low perceived dementia threat. When compared to Americans, Italians reported greater willingness to undergo genetic testing and perceived a different subset of benefits and risks. The strongest predictors of test intention were decisional balance, homemaker status and two beliefs concerning dementia causes.ConclusionsItalians had a poor knowledge of the disease and a low awareness of personal risk of developing dementia. As compared to Americans, they expressed higher intentions to undergo genetic testing and they have a different perception of benefits and risks.Practice ImplicationsUnderstanding of cultural differences in knowledge, attitudes and perception of the disease is important to design optimal health services and education programs for dementia.     

The use of video for patient information and education: A scoping review of the variability and effectiveness of interventions

ObjectiveTo provide an overview of video interventions used for patient information and education, and of the tools used to evaluate their effectiveness, in order to consider the feasibility of developing generic guidelines and appraisal tools for the use of video in patient care.MethodsA scoping review was carried out to describe and synthesise emerging knowledge, using thematic analysis of data. Studies focussed upon videos for health professional education were excluded, as were those which consider the impact of videos available via social media.ResultsA narrative overview of 65 identified papers provides insight into the range and scope of studies. Common themes emerge, notably the aim of reducing anxiety and the variety of instruments designed to measure this. The use of self-report questionnaires was common, but their design is variable.ConclusionTargeted video-based intervention can improve patient experience and outcomes. High utility guidelines and appraisal tools, transferable between contexts, are needed to facilitate deployments at scale for sustainable outcomes.Practice implicationsVideo production guidelines and appraisal tools will be of value to those engaged in video development and deployment. Guidance should be based upon emerging evidence of effectiveness and incorporate an emphasis on reusability.     

Soluble PD1 levels are increased with disease activity in paediatric onset autoimmune hepatitis and inflammatory bowel disease

Abstract

Introduction: Immune mediated liver diseases entail a broad category which are associated with increased morbidity and mortality amongst the paediatric population. Programmed Death 1 (PD1) is an inhibitory receptor mainly expressed by T cells, and when activated shed into plasma as soluble PD1(sPD1). The AIM of this study was to evaluate sPD1 levels in plasma of paediatric patients with Autoimmune Hepatitis (AIH), Primary Sclerosing Cholangitis (PSC), AIH and PSC overlap, Inflammatory Bowel Disease (IBD) alone, and concurrent PSC/IBD and AIH/IBD in order to identify a biomarker to response or predict relapse verses remission.

Methods: Plasma samples were collected from 41 paediatric patients. AIH patients were further categorized into active, incomplete responders and responders, based on response to standard therapy. sPD1 levels were measured and compared between PSC, PSC/AIH, IBD alone, PSC/IBD and AIH/IBD patients and between active AIH, incomplete responders and responders. Flow cytometry was performed to further analyze CD45RA+, CD3CD4, CD8, CCR7, CXCR3, CD38 and PD1.

Results: In the AIH group, those with active disease demonstrated a significantly higher sPD1 levels in comparison to responders (*p?>?.001). However, the incomplete responders didn’t show a reduction in sPD1 in comparison to active AIH and patients with IBD alone. Interestingly, patients with PSC showed significantly lower level of sPD1 compared to active AIH (*p?<?.002), whereas, patients with PSC in conjunction with AIH (*p?<?.006) or IBD (*p?<?.02) demonstrated a significant increase in sPD1. In addition, we have observed increased levels of circulating CD4 and CD8 bound PD1 in active AIH but not in PSC or responders suggesting T cells activation. CD4+ PD1 double positive cells demonstrated increased expression of CXCR3. Thus, suggesting the activation of PD1?+?T cells is mediating through CXCR3 in Autoimmune hepatitis.

Conclusions: Our study demonstrates that sPD1 levels correlate with active disease state of AIH and IBD. sPD1 levels did not correlate with PSC. However, PSC in conjunction with AIH or IBD showed higher levels of sPD1. This suggests that T cell activation plays a critical role in active AIH and IBD but not in PSC. Soluble PDI levels could be used as a clinical biomarker to assess response in patients with AIH and for prospectively monitoring PSC patients for development of IBD or AIH.     

Effects of joy and sorrow on pulse-graph parameters in healthy female college students based on emotion-evoked experiments

ObjectiveTo explore the effects of joy and sorrow on pulse-graph parameters in healthy subjects and analyze their potential effect to provide preliminary evidence that pulse diagnosis can identify human emotional changes.Design and interventionForty healthy female college students from Beijing University of Chinese Medicine were recruited. The emotion-evoking experiment was conducted to observe the effects of joy and sorrow on pulse-graph parameters, taking neutral emotion as a control. The experiment included the following criteria. (1) Emotions evoked and evaluated: the same subjects watched three emotional videos which were, respectively, neutral, joyful and sorrowful to evoke the corresponding emotions. They completed the “subjective emotion evaluation form” (SEEF) before watching each video (T₀), immediately after watching the video (T₁) and 15 min after watching the video (T₂) to conduct subjective emotion evaluation. Simultaneously, their heart rate, galvanic skin response and heart rate variability were collected with a 16-lead physiological recorder to conduct an objective evaluation of emotional arousal. (2) Collection of pulse-graph parameters: pulse-graph parameters of the subjects at T₀, T₁ and T₂ were collected with a pulse condition analyzer.ResultsWhen watching the joy video, the rapid ejection phase extended significantly, both the left ventricular diastole and the cardiac cycle shortened significantly. When watching the sorrow video, the left ventricular diastole extended significantly, the cardiac cycle showed an upward trend, and heart rate showed a downward trend.ConclusionJoy and sorrow have a certain effect on pulse-graph parameters of the subjects. The mechanisms may be that joy contributes to rapid ejection phase extension and a shortening of the left ventricular diastole and the cardiac cycle, while sorrow extends the left ventricular diastole. According to the theory of Traditional Chinese Medicine (TCM), the visceral functions can be mediated through human qi flow. Moderate joy and sorrow can promote, respectively, the smooth qi flow of the heart and the lung. However, excessive or long-term joy and sorrow can lead to disharmonious qi flow of the two viscera. Therefore, maintaining moderate emotions is beneficial to the physiological functions of the viscera. Great emotional fluctuations may damage the visceral functions. Future studies with effects of other emotions on pulse-graph parameters are warranted to determine the reliability of the association of emotions and pulse diagnosis.     

Effectiveness of mandala coloring in reducing anxiety in women with early-stage breast cancer receiving chemotherapy for the first time

ContextMany people with cancer experience fear or anxiety when starting chemotherapy for the first time. Mandala coloring is an art therapy approach commonly used for anti-stress therapy.ObjectiveTo assess whether mandala coloring reduces the anxiety experienced by women with early-stage breast cancer during their first chemotherapy session.DesignA quasi-experimental controlled study with pretest/posttest design.SettingThe study was conducted in the outpatient chemotherapy unit of the Istanbul University Institute of Oncology between March 2017 and May 2018.ParticipantsEight-four women with early-stage breast cancer who presented for their first session of chemotherapy were included, 41 in the intervention group and 43 in the control group.InterventionPatients in the intervention group were asked to color a mandala for 30 min while receiving premedication prior to chemotherapy. No intervention was applied to the control group.Main outcome measuresLevels of distress and anxiety were assessed before and after premedication using the distress thermometer and State–Trait Anxiety Inventory.ResultsThe sample group consisted primarily of women who had primary school education, were married, and were homemakers. Average distress levels were low in both the intervention and control group before premedication, and state anxiety scores did not differ statistically between the groups before or after premedication. However, patients in the intervention group who had high distress levels before premedication showed a significant decrease in state anxiety score after premedication, while patients in the control group showed no decrease.     

Can causal explanations about endothelial pathophysiology benefit patient education? A cluster randomized controlled trial in cardiac rehabilitation

ObjectiveTo examine whether explaining causal links among endothelial pathophysiology, cardiac risk factors, symptoms and health behaviors (termed causal information) enhances patients’ depth of knowledge about cardiovascular disease self-management and their perceptions of the cardiac rehabilitation and secondary prevention (CRSP) program.MethodsNewly referred CRSP patients (N = 94) were cluster randomized to usual care (control; UC) or usual care with causal information (intervention; UC + CI). Depth of knowledge (factual vs. deep) was measured with an adapted cognitive-reasoning task. Patients’ cardiovascular knowledge and beliefs about the efficacy of a CRSP program were assessed.ResultsAfter controlling for education level, patients in UC + CI demonstrated deeper knowledge about cardiovascular management than did those in UC. The UC + CI group showed higher factual knowledge than their counterparts after covarying education, occupation status and BMI. The UC + CI group also rated the CRSP program as more credible than those in UC, after controlling for age. Deep knowledge mediated the relationship between group conditions and perceived credibility of CRSP.ConclusionCausal information can enhance the depth of patients’ understanding of cardiovascular disease management and perceived treatment credibility of the CRSP program.Practice implicationsExplaining causal links may help improve patient education delivery and enhance patient engagement in CRSP.     

“I know what you told me,but this is what I think:” Perceived risk of Alzheimer disease among individuals who accurately recall their genetics-based risk estimate

PurposeThis study evaluates the Alzheimer disease risk perceptions of individuals who accurately recall their genetics-based Alzheimer disease risk assessment.MethodsTwo hundred forty-six unaffected first-degree relatives of patients with Alzheimer disease were enrolled in a multisite randomized controlled trial examining the effects of communicating APOE genotype and lifetime Alzheimer disease risk information.ResultsAmong the 158 participants who accurately recalled their Alzheimer disease risk assessment 6 weeks after risk disclosure, 75 (47.5%) believed their Alzheimer disease risk was more than 5% points different from the Alzheimer disease risk estimate they were given. Within this subgroup, 69.3% believed that their Alzheimer disease risk was higher than what they were told (discordant high), whereas 30.7% believed that their Alzheimer disease risk was lower (discordant low). Participants with a higher baseline risk perception were more likely to have a discordant-high risk perception (P < 0.05). Participants in the discordant-low group were more likely to be APOE ε4 positive (P < 0.05) and to score higher on an Alzheimer disease controllability scale (P < 0.05).ConclusionOur results indicate that even among individuals who accurately recall their Alzheimer disease risk assessment, many people do not take communicated risk estimates at face value. Further exploration of this clinically relevant response to risk information is warranted.