BMJ  2003;327:745-748 (27 September), doi:10.1136/bmj.327.7417.745

Education and debate

Strategies to help patients understand risks

¹ Risk Communication Institute, 5822 NW 91 Boulevard, Gainesville, FL 32653, USA drp@trci.info

Explaining risks to patients in an effective way is an essential part of ensuring that consent is "informed." A consultant in risk communication discusses the strategies that can help doctors to communicate risks clearly, and thereby also build closer relationships with their patients

View larger version (49K): [in this window] [in a new window]   Fig 2 Paling Perspective Scale© —for giving perspective to risks of low order of probability.16 From research report by Small P et al17

 

View larger version (63K): [in this window] [in a new window]   Fig 3 Paling Palette© —for displaying most medical risks with a probability of higher than 1 in 1000.16 The doctor or genetic counsellor fills in the relevant data while sitting beside the patient. This format shows the estimates of positive and negative outcomes simultaneously and presents unambiguous visual representations of the probabilities. The patient may take a printout home for further consideration, or the form may be signed by the patient and a copy kept on file

 

View larger version (19K): [in this window] [in a new window]   Fig 4 Revised Paling Perspective Scale© —for displaying risks covering widely different orders of magnitude16

 

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

Effective risk communication is the basis for informed patient consent for medical treatment, yet until recently doctors have lagged behind other professionals in learning this skill. In other industries where risks have to be conveyed to the public (such as chemical, nuclear, water, and food industries) usually only a few people carry out this task on behalf of their organisations and they are specially trained. In contrast, in health care (where the risks are usually far higher and more uncertain and complex) almost every doctor who interacts with patients has to communicate information on risk, yet few have any training.

Specific strategies can help to remedy this deficiency and improve patients' understanding of risks. Doctors can now choose from a "toolbox" of simple, practical, time efficient techniques that benefit the widest possible variety of patients.

Methods

I have taught risk communication in risk prone professions outside medicine for over a decade.¹ . . . [Full text of this article]

The challenges for doctors

Trade-offs of risks and benefits

How to communicate the numbers

Avoid using descriptive terms only
Use standardised vocabulary
Use consistent denominator
Offer positive and negative outcomes
Use absolute numbers
Use visual aids for probabilities
Ensure that consent is "informed"

Use visual aids to build partnership

Strategies to discuss and elicit responses

Future of risk communication in health care

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Rapid Responses:

Read all Rapid Responses

We need more evidence of effectiveness about ways to communicate risk to patients - a proposal.

Victor M. Montori, et al.
bmj.com, 3 Oct 2003 [Full text]

Relative risk reduction; Absolute risk reduction and number needed to Treat: RAT DIAGRAM

Jaishen Rajah
bmj.com, 4 Oct 2003 [Full text]