Risk management

Firstly need to define how much the patient wants to know, and in what form. 20% of patients want to know less!

  • Involving patients in decisions about their treatment or care improves health outcomes

  • Successful involvement of patients requires effective communication of risks

  • Having a range of risk communication tools from which to choose when discussing treatment options is likely to be more appropriate and flexible for clinical practice than single new strategies

  • Different presentation formats include verbal descriptions of risks, numerical data, and graphical depiction of the information

  • Graphical presentation of data on risk can be effective and save time in general practice consultations

  • Patients often desire more information than is currently provided

  • Communicating about risks should be a two way process in which professionals and patients exchange information and opinions about those risks

  • Professionals need to support patients in making choices by turning raw data into information that is more helpful to the discussions than the data

  • “Framing” manipulations of information, such as using information about relative risk in isolation of base rates, to achieve professionally determined goals should be avoided

  • “Decision aids” can be useful as they often include visual presentations of risk information and relate the information to more familiar risks

Risk language proposal, derived from Paling

The effects of framing and other manipulations

  • Information on relative risk is more persuasive than absolute risk data

  • “Loss” framing (for example, the potential losses from not having a mammogram) influences screening uptake more than “gain” framing

  • Positive framing (for example, chance of survival) is more effective than negative framing (chance of death) in persuading people to take risky options, such as treatments

  • More information, and information that is more understandable to the patient, is associated with a greater wariness to take treatments or tests

Relative vs absolute risk, and NNT

The LBBH (likelihood of being helped or harmed) has been suggested as one way of presenting information to patients

Design of risk information formats for patients

  • Graphical displays of information increase the effectiveness of risk communication

  • Simple bar charts may be preferred over “representations” (faces, stick figures, etc)

  • Avoid using areas or volumes to depict quantities

  • Absolute risks (with appropriate scales) should be given greater prominence than relative risksin both information for patients and journals for professionals

  • Lifetime risks should be given, with relevant information about risks in relevant time spans as additional information

  • The influence of framing should be countered by using dual representations (loss and gain, mortality and survival data)

  • Be clear about whether the task is to read an exact value, compare two risks, assess trends, or judge proportions; a display should provide the relevant but minimum information needed for these tasks

  • Comparison with everyday risks is valuable, such as where the risk (for example, stroke in atrial fibrillation) is compared with other well known risks (for example, road crashes). These comparisons should be integrated into patient information materials

Specific areas

Further Reading

 

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