Intended for healthcare professionals

Primary Care

Factors involved in deciding to start preventive treatment: qualitative study of clinicians' and lay people's attitudes

BMJ 2003; 327 doi: (Published 09 October 2003) Cite this as: BMJ 2003;327:841
  1. David K Lewis (David.Lewis{at}, GP fellow in public health1,
  2. Jude Robinson, deputy director2,
  3. Ewan Wilkinson, consultant in public health1
  1. 1 Department of Public Health, Central Liverpool Primary Care Trust, Hamilton House, Liverpool L3 6AL
  2. 2 Health and Community Care Research Unit, Thompson Yates Building, University of Liverpool, Liverpool L69 3GB
  1. Correspondence to: D K Lewis, Vauxhall Primary Health Care, Liverpool L5 8XR
  • Accepted 28 July 2003


Objectives To explore the views of clinicians and lay people about the minimum benefit needed to justify drug treatment to prevent heart attacks, and to explore the rationale behind treatment decisions.

Design Qualitative study using semi-structured interviews.

Participants 4 general practitioners, 4 practice nurses, and 18 lay people.

Setting 8 general practices and 6 community settings across Liverpool.

Results Participants varied widely in the minimum acceptable benefits chosen. Most people found the concepts difficult initially, and few appreciated that increased length of treatment should increase absolute benefits. Lay people usually wanted to make decisions for themselves, and clinicians supported this. Participants wanted to consider adverse effects and costs of treatment. Dislike of drug taking was common, and many people preferred lifestyle change to an imperfect treatment. Quality of life and personal views were more important than an individual's age.

Conclusions Evidence based guidelines make assumptions about people's preferences, and, by using 10 year estimates of risk, inflate the apparent benefits of treatment. It is unlikely that guidelines could incorporate the wide range of people's preferences, and true dialogue is necessary between clinicians and patients before starting long term preventive treatment.


  • Contributors DKL had the idea for the study. DKL and EW designed the study. DKL recruited and interviewed participants and analysed the transcripts for themes. JR reviewed the data and validated the analysis. All authors discussed key themes and concepts. DKL wrote the paper, and all authors revised it. DKL is guarantor for the study.

  • Funding DKL was funded by a North West Regional Health Authority Public Health Fellowship.

  • Competing interests None declared.

  • Ethical approval The study was approved by the local research ethics committee.

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