BMJ 2002;324:827-830 ( 6 April )

Clinical review

Explaining risks: turning numerical data into meaningful pictures

Adrian Edwards, senior lecturer ^a, Glyn Elwyn, senior lecturer ^a, Al Mulley, chief of general medical division ^b. 

^a Department of General Practice, University of Wales College of Medicine, Llanedeyrn Health Centre, Llanedeyrn, Cardiff CF3 7PN, ^b Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston MA 02114, USA

Correspondence to: A Edwards Edwardsag@cf.ac.uk

The first 150 words of the full text of this article appear below.

The way in which information is presented affects both how health professionals introduce it and how patients use it

The "information age" has profound implications for the way we work. The volume of information derives from biomedical and clinical evaluative sciences and is increasingly available to clinicians and patients through the world wide web.¹ We need to process information, derive knowledge, and disseminate the knowledge into clinical practice. This is particularly challenging for doctors in the context of the consultation. Information often highlights uncertainties, including collective professional uncertainty, which we address with more and better research; individual professional uncertainty, which we address with professional education and support for decisions; and stochastic uncertainty (the irreducible element of chance), which we address with effective risk communication about the harms and benefits of different options for treatment or care.

In this article we discuss whether the shift towards a greater use of information . . . [Full text of this article]

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Video decision support tool for advance care planning in dementia: randomised controlled trial

Angelo E Volandes, Michael K Paasche-Orlow, Michael J Barry, Muriel R Gillick, Kenneth L Minaker, Yuchiao Chang, E Francis Cook, Elmer D Abbo, Areej El-Jawahri, and Susan L Mitchell
BMJ 2009 338: b2159. [Abstract] [Full Text] [PDF]

Patient consent—decision or assumption?

Glyn Elwyn
BMJ 2008 336: 1259-1260. [Extract] [Full Text] [PDF]

Two decision aids for mode of delivery among women with previous caesarean section: randomised controlled trial

Alan A Montgomery, Clare L Emmett, Tom Fahey, Claire Jones, Ian Ricketts, Roshni R Patel, Tim J Peters, Deirdre J Murphy DiAMOND Study Group
BMJ 2007 334: 1305. [Abstract] [Full Text] [PDF]

Health professionals' and service users' interpretation of screening test results: experimental study

Ros Bramwell, Helen West, and Peter Salmon
BMJ 2006 333: 284. [Abstract] [Full Text] [PDF]

Women need better information on routine mammography: Framing is important in presenting risk information

Tom P Marshall
BMJ 2003 327: 868. [Extract] [Full Text]

Discussion of risk pervades doctor-patient communication

Andrew F Smith
BMJ 2002 325: 548. [Extract] [Full Text]

Visual aids help patients understand risk
BMJ 2002 324: 0. [Full Text]

This article has been cited by other articles:

• Garcia-Retamero, R., Galesic, M. (2009). Communicating Treatment Risk Reduction to People With Low Numeracy Skills: A Cross-Cultural Comparison. AJPH 99: 2196-2202 [Abstract] [Full text]  
• Sanders, L. M., Shaw, J. S., Guez, G., Baur, C., Rudd, R. (2009). Health Literacy and Child Health Promotion: Implications for Research, Clinical Care, and Public Policy. Pediatrics 124: S306-S314 [Abstract] [Full text]  
• Price, H. C, Dudley, C., Barrow, B., Kennedy, I., Griffin, S. J, Holman, R. R (2009). Use of focus groups to develop methods to communicate cardiovascular disease risk and potential for risk reduction to people with type 2 diabetes. Fam Pract 26: 351-358 [Abstract] [Full text]  
• Keller, C., Siegrist, M. (2009). Effect of Risk Communication Formats on Risk Perception Depending on Numeracy. Med Decis Making 29: 483-490 [Abstract]  
• Zier, L. S., Burack, J. H., Micco, G., Chipman, A. K., Frank, J. A., White, D. B. (2009). Surrogate Decision Makers' Responses to Physicians' Predictions of Medical Futility. Chest 136: 110-117 [Abstract] [Full text]  
• Volandes, A. E, Paasche-Orlow, M. K, Barry, M. J, Gillick, M. R, Minaker, K. L, Chang, Y., Cook, E F., Abbo, E. D, El-Jawahri, A., Mitchell, S. L (2009). Video decision support tool for advance care planning in dementia: randomised controlled trial. BMJ 338: b2159-b2159 [Abstract] [Full text]  
• Clarke, M.G., Kennedy, K.P., MacDonagh, R.P. (2009). Development of a Clinical Prediction Model to Calculate Patient Life Expectancy: The Measure of Actuarial Life Expectancy (MALE). Med Decis Making 29: 239-246 [Abstract]  
• Sanders, L. M., Federico, S., Klass, P., Abrams, M. A., Dreyer, B. (2009). Literacy and Child Health: A Systematic Review. Arch Pediatr Adolesc Med 163: 131-140 [Abstract] [Full text]  
• Siegrist, M., Orlow, P., Keller, C. (2008). The Effect of Graphical and Numerical Presentation of Hypothetical Prenatal Diagnosis Results on Risk Perception. Med Decis Making 28: 567-574 [Abstract]  
• Elwyn, G. (2008). Patient consent--decision or assumption?. BMJ 336: 1259-1260 [Full text]  
• Shepherd, H. L., Tattersall, M. H.N., Butow, P. N. (2008). Physician-Identified Factors Affecting Patient Participation in Reaching Treatment Decisions. JCO 26: 1724-1731 [Abstract] [Full text]  
• Zoe Hilton, N., Carter, A. M., Harris, G. T., Sharpe, A. J. B. (2008). Does Using Nonnumerical Terms to Describe Risk Aid Violence Risk Communication?: Clinician Agreement and Decision Making. J Interpers Violence 23: 171-188 [Abstract]  
• Chapple, A., Ziebland, S., Hewitson, P., McPherson, A. (2008). Why Men in the United Kingdom Still Want the Prostate Specific Antigen Test. Qual Health Res 18: 56-64 [Abstract]  
• Politi, M. C., Han, P. K. J., Col, N. F. (2007). Communicating the Uncertainty of Harms and Benefits of Medical Interventions. Med Decis Making 27: 681-695 [Abstract]  
• Montgomery, A. A, Emmett, C. L, Fahey, T., Jones, C., Ricketts, I., Patel, R. R, Peters, T. J, Murphy, D. J, DiAMOND Study Group, (2007). Two decision aids for mode of delivery among women with previous caesarean section: randomised controlled trial. BMJ 334: 1305-1305 [Abstract] [Full text]  
• Chauhan, U. (2007). Cardiovascular disease prevention in primary care. Br Med Bull 0: ldm002v1-15 [Abstract] [Full text]  
• Drife, J. (2007). Putting risk into context. The Obstetrician and Gynaecologist 9: 42-47 [Abstract] [Full text]  
• Ancker, J. S., Senathirajah, Y., Kukafka, R., Starren, J. B. (2006). Design Features of Graphs in Health Risk Communication: A Systematic Review. J. Am. Med. Inform. Assoc. 13: 608-618 [Abstract] [Full text]  
• Marshall, T, Bryan, S, Gill, P, Greenfield, S, Gutridge, K, Birmingham Patient Preferences Group, (2006). Predictors of patients' preferences for treatments to prevent heart disease. Heart 92: 1651-1655 [Abstract] [Full text]  
• Bramwell, R., West, H., Salmon, P. (2006). Health professionals' and service users' interpretation of screening test results: experimental study. BMJ 333: 284- [Abstract] [Full text]  
• Black, W. C. (2006). Randomized Clinical Trials for Cancer Screening: Rationale and Design Considerations for Imaging Tests. JCO 24: 3252-3260 [Abstract] [Full text]  
• Donnan, P. T., Donnelly, L., New, J. P., Morris, A. D. (2006). Derivation and Validation of a Prediction Score for Major Coronary Heart Disease Events in a U.K. Type 2 Diabetic Population.. Diabetes Care 29: 1231-1236 [Abstract] [Full text]  
• French, D. P., Hevey, D., Sutton, S., Kinmonth, A. L., Marteau, T. M. (2006). Personal and Social Comparison Information about Health Risk: Reaction to Information and Information Search. J Health Psychol 11: 497-510 [Abstract]  
• Reventlow, S., Bang, H. (2006). Brittle bones: Ageing or threat of disease Exploring women's cultural models of osteoporosis. Scand J Public Health 34: 320-326 [Abstract]  
• Goldman, R. E., Parker, D. R., Eaton, C. B., Borkan, J. M., Gramling, R., Cover, R. T., Ahern, D. K. (2006). Patients' Perceptions of Cholesterol, Cardiovascular Disease Risk, and Risk Communication Strategies. Ann Fam Med 4: 205-212 [Abstract] [Full text]  
• Elmore, J. G., Gigerenzer, G. (2005). Benign Breast Disease -- The Risks of Communicating Risk. NEJM 353: 297-299 [Full text]  
• Elmore, J. G., Armstrong, K., Lehman, C. D., Fletcher, S. W. (2005). Screening for Breast Cancer. JAMA 293: 1245-1256 [Abstract] [Full text]  
• Griffiths, F., Green, E., Tsouroufli, M. (2005). The nature of medical evidence and its inherent uncertainty for the clinical consultation: qualitative study. BMJ 330: 511- [Abstract] [Full text]  
• Steures, P., Berkhout, J. C., Hompes, P. G.A., van der Steeg, J. W., Bossuyt, P. M.M., van der Veen, F., Habbema, J. D. F., Eijkemans, M. J.C., Mol, B. W.J. (2005). Patients' preferences in deciding between intrauterine insemination and expectant management. Hum Reprod 20: 752-755 [Abstract] [Full text]  
• Vasan, R. S., D'Agostino, R. B. Sr (2005). Age and Time Need Not and Should Not Be Eliminated From the Coronary Risk Prediction Models. Circulation 111: 542-545 [Full text]  
• Heesen, C., Kasper, J., Segal, J., Kopke, S., Muhlhauser, I. (2004). Decisional role preferences, risk knowledge and information interests in patients with multiple sclerosis. Mult Scler 10: 643-650 [Abstract]  
• Fuller, R, Dudley, N, Blacktop, J (2004). Older people's understanding of cumulative risks when provided with annual stroke risk information. Postgrad. Med. J. 80: 677-678 [Abstract] [Full text]  
• Fraenkel, L, Bogardus, S T, Concato, J, Felson, D T, Wittink, D R (2004). Patient preferences for treatment of rheumatoid arthritis. Ann Rheum Dis 63: 1372-1378 [Abstract] [Full text]  
• Nettleton, S. (2004). The Emergence of E-Scaped Medicine?. Sociology 38: 661-679 [Abstract]  
• Knapp, P, Raynor, D K, Berry, D C (2004). Comparison of two methods of presenting risk information to patients about the side effects of medicines. Qual Saf Health Care 13: 176-180 [Abstract] [Full text]  
• Epstein, R. M., Alper, B. S., Quill, T. E. (2004). Communicating Evidence for Participatory Decision Making. JAMA 291: 2359-2366 [Abstract] [Full text]  
• Pfeffer, N (2004). "If you think you've got a lump, they'll screen you." Informed consent, health promotion, and breast cancer. J. Med. Ethics 30: 227-230 [Abstract] [Full text]  
• Elwyn, G, Edwards, A, Britten, N (2003). "Doing prescribing": how might clinicians work differently for better, safer care. Qual Saf Health Care 12: i33-36 [Abstract] [Full text]  
• Ostor, A. J. K., O'Gradaigh, D. R., Jenner, J. R. (2003). Methotrexate for rheumatoid arthritis: what should the patient be told?. Rheumatology (Oxford) 42: 1576-1578 [Full text]  
• Heller, R. F, Buchan, I., Edwards, R., Lyratzopoulos, G., McElduff, P., Leger, S. S. (2003). Communicating risks at the population level: application of population impact numbers. BMJ 327: 1162-1165 [Full text]  
• Kennedy, J. G (2003). "Doc, tell me what I need to know"--a doctor's perspective. BMJ 327: 862-863 [Full text]  
• Marshall, T. P (2003). Women need better information on routine mammography: Framing is important in presenting risk information. BMJ 327: 868-868 [Full text]  
• Edwards, A. (2003). Communicating risks. BMJ 327: 691-692 [Full text]  
• Sedgwick, P., Hall, A. (2003). Teaching medical students and doctors how to communicate risk. BMJ 327: 694-695 [Full text]  
• Gigerenzer, G., Edwards, A. (2003). Simple tools for understanding risks: from innumeracy to insight. BMJ 327: 741-744 [Full text]  
• Paling, J. (2003). Strategies to help patients understand risks. BMJ 327: 745-748 [Full text]  
• Say, R. E, Thomson, R. (2003). The importance of patient preferences in treatment decisions--challenges for doctors. BMJ 327: 542-545 [Full text]  
• Getz, L., Sigurdsson, J. A, Hetlevik, I. (2003). Is opportunistic disease prevention in the consultation ethically justifiable?. BMJ 327: 498-500 [Full text]  
• Fletcher, S. W., Elmore, J. G. (2003). Mammographic Screening for Breast Cancer. NEJM 348: 1672-1680 [Full text]  
• Smith, A. F (2002). Discussion of risk pervades doctor-patient communication. BMJ 325: 548-548 [Full text]  
• Brindle, P., Fahey, T. (2002). Primary prevention of coronary heart disease. BMJ 325: 56-57 [Full text]  

Rapid Responses:

Read all Rapid Responses

ARE THE RISKS OF HORMONE THERAPY EXPLAINED?

Bill Misner Ph.D.
bmj.com, 11 Apr 2002 [Full text]

Explaining risks: The importance of GPs’ understanding

Duncan Short, et al.
bmj.com, 11 Apr 2002 [Full text]

Risk communication is not just about understanding the numbers

Michael Gent
bmj.com, 15 Apr 2002 [Full text]

Patient decision making. Is there room for persuasion?

Julie Leask
bmj.com, 16 Apr 2002 [Full text]

Comparing medical risks with everday risks is equally likely to be misunderstood by patients

Richard Fuller, et al.
bmj.com, 19 Apr 2002 [Full text]

Risk discourse pervades doctor-patient communication

Andrew F Smith
bmj.com, 8 May 2002 [Full text]

Online poll

Find out more >>