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What Works Best In Terms Of Translating Statistical Data On Health Risks Into Information Patients Can Use To Make Informed Decisions About Treatment Or Non Treatment?

1269 words - 5 pages

The increase in patient involvement in decision making regarding their own health in recent years have led to relevant changes in doctor-patient communication. Doctors need to start accepting the increased involvement of patients and engage in shared decision making instead of adopting the autonomous role (Godolphin, 2003). Risk communication is one way of providing more information to enable patients to make confident risk-relevant decisions (Edwards, 2003). There are some arguments that risk communication is futile due to the lack of statistical understanding in lay people. However, there is evidence that this statistical innumeracy problem should not only be attributed to the mental deficiency of the recipient, but is largely due to poor representation of the information (Gigerenzer, 2002). There are various ways of communicating risk, and most are confusing. Risk communicators need to represent risk information in ways that would be unambiguous and easily interpretable by lay people.Figures and estimates should always be used instead of subjective descriptive terms such as low risk. Doctors need to present information in a neutral and objective way as patients tend to look for clues, no matter how subtle, that could tell them what to do. Logically equivalent information could be expressed in different ways (Wilson, Purdon & Wallston, 1988) and these have been shown to affect interpretation and decision making (Kahneman & Tversky, 1979). For example, positive framing: "97% chance of survival" is found to be more effective in persuading people to take a risky option than a negative framing: "3% chance of fatality" (Kühberger, 1998). Another example is it is more effective when considering the potential losses from not taking a test, say in mammography: loss of good health, longevity and family relationships; than the potential gains such as maintenance of good health (Edwards, Elwyn & Mulley, 2002). To avoid unintentional manipulation, doctors should provide both positive and negative outcomes.One of the numerical representations that can cause confusion is in the form of single event probabilities. Take for example, a case where a psychiatrist prescribed fluoxetine and informed his patients using a probability statement about the occurrence of a side effect: "fluoxetine has a 30% to 50% chance of causing a sexual problem", such as impotence or lack of libido. The problem with the probability statement is the ambiguity regarding the class of events referred to by the probability (Gigerenzer & Edwards, 2003). Different interpretations could be made using different reference classes. For instance, does the statement mean that 30% of the people taking the drug become impotent or that the patient could be impotent in 30% of his sexual encounters? Upon learning about the ambiguity of single event probabilities, the psychiatrist changed the way he communicated risk by using frequency statements: "3 to 5 of every 10 people who...

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