The Pharmaceutical Journal
Vol 278 No 7453 p602
26 May 2007

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Treatment preferences shifted by patients' knowledge of drug name

Patients' treatment choices may be influenced by knowing a drug's name despite their initial decisions being based solely on risks and benefits, according to research published in the journal of the Canadian Medical Association (CMAJ 2007;176:1583).

Researchers conducted a randomised controlled trial in 98 patients aged 65 years or older to investigate the impact of different decision aids (decision board, decision booklet with audiotape or interactive computer program) and graphic presentation of data (pie chart or pictogram) on patients’ comprehension and choice of three treatments for anticoagulation: treatment A (warfarin); treatment B (aspirin); and treatment C (no treatment).

The researchers also tested the effects of blinding to treatment name in a before-after comparison.

Regardless of format or graphic presentation, comprehension scores (maximum 10) increased by an absolute mean of 3.1 (P<0.01) after exposure to a decision aid, with 96 per cent of subjects believing that the aid helped them to make their treatment choice.

However, the most remarkable finding, say the researchers, is that, despite identical presentations of information, 36 per cent of the group changed their choice once the treatment name was known. This included 46 per cent of those who initially chose warfarin and 78 per cent of those who initially chose no treatment.

This reaction to warfarin and to no treatment, say the researchers, reflects the many seemingly irrational influences on treatment behaviours. “These influences may well outweigh strictly evidence-based data or detailed numerical benefit:harm analyses, even if the latter are fully understood. This is an important finding, since some of the participants in our study chose a less effective treatment simply because of its name,” say the researchers.

The author of an accompanying commentary (ibid, p1597) points out that knowing the name of the drug may bring to mind other attributes of the process involved, such as ease of access and the need for monitoring, which are not obvious in descriptions based solely on outcomes.