General considerations

Communicating risk is essential for informed consent and shared decision-making.

Effective communication should also be part of careful support to reduce CVD risk through lifestyle modifications and prescribing medicines, considering the person’s preferences and understanding of their health status.

Risk communication is most effective when the practitioner understands the person, their health literacy, and their social and cultural background, and tailors messages accordingly.

Evidence from other areas of health care supports the principle that healthcare providers should consider people’s diverse and often changing health literacy needs and learning styles when communicating risk.⁶

Be aware that an understanding of CVD risk varies from person to person, including what is and is not a risk factor, and the relationship between CVD risk factors and reducing risk or managing their condition.

Practice points

When communicating risk:

• Communicate risk as either a percentage or as a frequency (e.g. 15% or “15 out of 100 people like you will have a heart attack or stroke in the next 5 years”).¹³⁴,¹³⁵
• Consider the person’s receptivity, understanding and acceptance of risk, health literacy, and learning preferences.
• Provide the information in multiple formats (e.g. numerical percentage, 100-person charts) suitable for the person’s receptivity and understanding.
• Use relevant decision aids to improve knowledge and guide management discussions.
• Repeat this discussion about risk over several consultations, where appropriate.
• Emphasise the relevance of the information by relating it to aspects of the person’s own experiences such as a recent illness, a new diagnosis in a friend or family member, the person’s life stage (e.g. adulthood, pregnancy), or family medical history.
• Discuss relevant CVD risk factors such as smoking, alcohol intake or obesity.
• It may be more effective to emphasise the benefits of treatment and lifestyle^* modification to reducing risk, rather than focusing on negative health outcomes.
• Ensure that people with limited health literacy receive information they can easily understand and act upon, considering cultural and linguistic diversity and socioeconomic situation.
• Communicate risk in a culturally safe way. Where appropriate, engage with the person’s family members, carers and other members of their community (e.g. community navigators), to help communicate risk information effectively and safely to people whose culture or language is different from your own.
• Consider and communicate the need to refer to other healthcare professionals to support the person in addressing their risk.

First Nations people

There is substantial burden of CVD within some First Nations families and communities. In some instances, this can result in perceptions that developing CVD is inevitable.¹³⁶

Effectively communicating CVD risk and how to respond to risk is important for First Nations communities; literature demonstrates that poor understanding affects risk management.¹³⁶-¹³⁹

Having a positive, trusting relationship with a health practitioner and health service is important for supporting First Nations people receiving CVD risk assessment and management.¹³⁸-¹⁴²

It is important that a conversation about risk involves identifying and supporting positive actions to reduce risk.

Practice Points

When communicating risk with First Nations people consider (in addition to the practice advice above):

• First Nations concepts of health and wellbeing differ from the Western biomedical model of health
• Engaging an Aboriginal health practitioner/worker to optimise a conversation about risk
• The person’s primary language, and engage an interpreter as required
• Using First Nations specific risk communication tools where relevant and available.

Resources

1. Cardiovascular disease risk communication with Aboriginal and Torres Strait Islander Peoples: Toolkit for health professionals - ANU Healthy Heart Communities project

Support for the recommendations

Evidence from four randomised controlled trials (RCTs) suggests that effectively communicating CVD risk may lead to behaviour changes that result in an improvement in predicted CVD risk assessed after 12 months.¹⁴³

A 2021 systematic review found that using ‘heart age’ did not appear to motivate lifestyle behaviour change more than communicating CVD risk, but found that either approach can improve clinical outcomes when combined with other behaviour change strategies.¹⁴⁴

Studies of repeated risk information, or risk information and repeated counselling, showed small reductions (up to 2%) in predicted CHD risk over 10 years. However, studies in which CHD risk was communicated only once seemed to be ineffective in improving knowledge, heart health management or risk.¹⁴³

Systematic reviews have found that decision aids can lead to improved knowledge, compared with usual care.¹⁴⁵ However, this evidence is mainly from studies focusing on conditions other than CVD.

* This guideline refers to certain modifiable risk factors as ‘lifestyle’ factors. However, it is recognised that these behaviours are not necessarily an individual’s choice, but reflect the complex interplay of social, cultural, and environmental factors, which may be further influenced by clinical conditions. Use of the term ‘lifestyle’ does not attribute blame to a person.

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3a. Reclassification factors & other considerations

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5. Manage CVD Risk