Oncologists and their patients are increasingly challenged with making difficult decisions about screening, prevention and treatment. Unfortunately, most patients are neither armed with adequate knowledge nor the means of interpreting the information they do have in a qualitatively and quantitatively useful way.
In a commentary published Sept. 19 in the Journal of the National Cancer Institute, Angela Fagerlin, Ph.D., of the Center for Bioethics and Social Sciences in Medicine at the University of Michigan and the VA Ann Arbor Center for Clinical Management Research, and colleagues highlight 10 recommendations for improved communication to patients.
These methods have been shown to improve patients' understanding of the information they are presented with when asked to make important decisions.
The authors first outline typical problems that arise when physicians must present complex medical information to patients and break it down in simple terms. Patients often don't have the health literacy needed to understand what their doctors say to them and have difficulty grasping the reading materials they obtain through the health providers. Patients also tend to lack the numeracy skills needed to comprehend useful statistics such as risk and benefit statistics.
The researchers recommend that doctors use plain language to make their written and verbal materials more understandable and present only information that is relevant to patients. They also say the order of presenting types of information is important: citing the "recency effect," which shows that patients better remember the most recent information presented to them.
Presenting information in terms of absolute risks (the specific chances of developing the disease under different circumstances) rather than relative risks (e.g., "50% greater risk") is another strategy the researchers recommend.
Research has shown that when relative risk is used, risk reduction appears larger and treatments are viewed more favorably, which can inappropriately lead patients and physicians to choose treatments, they write. The authors also urge doctors to always emphasize the element of time, because patients may make different decisions based on the time period presented. For example, presenting a patient's lifetime risk (e.g., instead of the risk within a ten-year interval) can lead to different perception of the risk in a patient's mind.
In their summary, the authors point out that their commentary is not a systematic review of the literature but focuses on some of the most commonly accepted recommendations for risk communication. They write, "We believe it is the responsibility of all cancer educators, decision aid developers, and clinicians to be familiar with the growing body of rigorous research that has tested effective methods of presenting probabilistic information, so that patients can use it to make an informed decision."
- Angela Fagerlin, Brian J. Zikmund-Fisher, and Peter A. Ubel. Helping Patients Decide: Ten Steps to Better Risk Communication. J Natl Cancer Inst, September 19, 2011 DOI: 10.1093/jnci/djr318
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