Clinical Review

Communicating risk

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e3996 (Published 18 June 2012) Cite this as: BMJ 2012;344:e3996
  1. Haroon Ahmed, general practice specialty academic trainee12,
  2. Gurudutt Naik, associate academic fellow3,
  3. Hannah Willoughby, general practice specialty academic trainee2,
  4. Adrian G K Edwards, research professor in general practice3
  1. 1The Foundry Town Clinic, Aberdare, UK
  2. 2Department of Postgraduate General Practice Education, Cardiff University School of Medicine, Cardiff, UK
  3. 3Cochrane Institute of Primary Care and Public Health, Cardiff University School of Medicine, Cardiff CF14 4YS, UK
  1. Correspondence to: A G K Edwards edwardsag{at}cf.ac.uk

Summary points

  • Risk communication is the open two way exchange of information and opinion about harms and benefits; it aims to improve understanding of risk and promote better decisions about clinical management

  • Strong evidence suggests that the format in which risk information is presented affects patients’ understanding and perception of risk

  • There is emerging evidence that effective risk communication can lead to more informed decision making in screening

  • Decision aids can be an effective adjunct to risk communication and can improve knowledge, awareness, and decision making

  • The presentation of data uncertainty is one of the most difficult aspects of risk communication

The communication of risk is an important and often difficult aspect of clinical practice. This clinical review aims to provide practising clinicians with a comprehensive and up to date overview of current evidence in this developing area.

What is risk communication?

Risk is the probability that a hazard will give rise to harm.1 Risk communication is defined as the open two way exchange of information and opinion about harms and benefits, with the aim of improving the understanding of risk and of promoting better decisions about clinical management.2 Risk communication should therefore cover the probability of the risk occurring, the importance of the adverse event being described, and the effect of the event on the patient.3

Risk messages are common. We hear that “there is a risk of flooding” or “the terrorism threat level is orange.” In medicine, we may tell people that their “risk of a heart attack is 15%” or “stopping smoking will reduce their risk of lung cancer,” but what do clinicians hope to achieve by providing this information? Box 1 outlines a clinical scenario that requires effective risk communication.

Box 1 Ms Jones’s dilemma

Ms Jones has just celebrated her 50th birthday. She is fit and well and takes no regular drugs. She …

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