Risk communication in medicine
DOI:
https://doi.org/10.4000/cp.11386Keywords:
risk communication, consultation, shared decisionAbstract
Risk communication (CR) is one of the biggest challenges for public health and in clinical practice.
The desire of health professionals and users is for the best decisions to be made. However, the way the clinician conveys information shapes the subject's choices. He can make choices that are not in line with the evidence revealed by science. Science can impose decisions on him that are not in line with their values. This messaging process involves a messenger, a message and a recipient who intends to decide on an action. Effective CR is central to an informed decision. In CR, the professional must be conscious of their attitudes towards decision making, in a clinical context, know the communication tools and adapt their behaviours to the patient's needs.
The present work focuses on CR in the face-to-face meeting between healthcare professionals and patients. Based on the narrative review of literature and the author's experience, the intent is to propose a structured strategy model for the CR process in clinical practice.
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References
Adams, J. (1995). Risk: The policy implications of risk compensation and plural rationalities. London: UCL Press.
Ahl, A. S., Acree, J. A., Gipson, P. S., McDowell, R. M., Miller, L., & McElvaine, M. D. (1993). Standardization of nomenclature for animal health risk analysis. Revue Scientifique et Technique (International Office of Epizootics), 12(4), 1045–1053. https://doi.org/10.20506/rst.12.4.744.
DOI : 10.20506/rst.12.4.744
Aleksandr, S., Peters, E., Tusler, M., & Fraenkel, L. (2015). Presenting numeric information with percentages and descriptive risk labels: A randomized trial. Medical Decision Making, 35(8), 937–947. https://doi.org/10.1177/0272989X15584922.
DOI : 10.1177/0272989X15584922
Barratt, A., Edwards, A., Trevena, L., McCaffery, K., Woloshin, S., Bekker, H., … Charvet, A. (2005). Presenting probabilities. IPDAS Collaboration Background Document, (c), 1–54.
Bell, N. R., Dickinson, J. A., Grad, R., Singh, H., Kasperavicius, D., & Thombs, B. D. (2018). Understanding and communicating risk: Measures of outcome and the magnitude of benefits and harms. Canadian Family Physician, 64(3), 181–191.
Bielenia-Grajewska, M. (2015). Metaphors and risk cognition in the discourse on food-borne diseases. Risk and Cognition, 80, 89-105.. https://doi.org/10.1007/978-3-662-45704-7_4.
DOI : 10.1007/978-3-662-45704-7_4
Blalock, S. J., DeVellis, R. F., Chewning, B., Sleath, B. L., & Reyna, V. F. (2016). Gist and verbatim communication concerning medication risks/benefits. Patient Education and Counseling, 99(6), 988–994. https://doi.org/10.1016/j.pec.2015.12.001.
DOI : 10.1016/j.pec.2015.12.001
Blanch-Hartigan, D., van Eeden, M., Verdam, M. G. E., Han, P. K. J., Smets, E. M. A., & Hillen, M. A. (2019). Effects of communication about uncertainty and oncologist gender on the physician-patient relationship. Patient Education and Counseling, 102(9), 1613–1620. https://doi.org/10.1016/j.pec.2019.05.002.
DOI : 10.1016/j.pec.2019.05.002
Bonner, C., McKinn, S., Lau, A., Jansen, J., Doust, J., Trevena, L., & McCaffery, K. (2018). Heuristics and biases in cardiovascular disease prevention: How can we improve communication about risk, benefits and harms? Patient Education and Counseling, 101(5), 843–853. https://doi.org/10.1016/j.pec.2017.12.003.
DOI : 10.1016/j.pec.2017.12.003
Büchter, R. B., Fechtelpeter, D., Knelangen, M., Ehrlich, M., & Waltering, A. (2014). Words or numbers? Communicating risk of adverse effects in written consumer health information: A systematic review and meta-analysis. BMC Medical Informatics and Decision Making, 14(1), 1–11. https://doi.org/10.1186/1472-6947-14-76.
DOI : 10.1186/1472-6947-14-76
Cheung, Y. B., Wee, H. L., Thumboo, J., Goh, C., Pietrobon, R., Toh, H. C., … Tan, S. B. (2010). Risk communication in clinical trials: A cognitive experiment and a survey. BMC Medical Informatics and Decision Making, 10(1). https://doi.org/10.1186/1472-6947-10-55.
DOI : 10.1186/1472-6947-10-55
Damman, O. C., Vonk, S. I., van den Haak, M. J., van Hooijdonk, C. M. J., & Timmermans, D. R. M. (2018). The effects of infographics and several quantitative versus qualitative formats for cardiovascular disease risk, including heart age, on people’s risk understanding. Patient Education and Counseling, 101(8), 1410–1418. https://doi.org/10.1016/j.pec.2018.03.015.
DOI : 10.1016/j.pec.2018.03.015
Deborah L. Helitzer, LaNoue, M., Wilson, B., Hernandez, B. U. de, Warner, T., & Roter, D. (2011). A randomized controlled trial of communication training with primary care providers to improve patient-centeredness and health risk communication. Patient Education and Counseling, 82(1), 21–29. https://doi.org/10.1016/j.pec.2010.01.021.
DOI : 10.1016/j.pec.2010.01.021
Ea, A., Ad, O., Herrin, J., Ge, V., Terrenato, I., Sperati, F., … Schünemann, H. (2011). Using alternative statistical formats for presenting risks and risk reductions (Review). Cochrane Database of Systematic Reviews, 2011(3). https://doi.org/10.1002/14651858.CD006776.pub2.
DOI : 10.1002/14651858.CD006776.pub2
Edwards, A. G. K., Naik, G., Ahmed, H., Elwyn, G. J., Pickles, T., Hood, K., & Playle, R. (2013). Personalised risk communication for informed decision making about taking screening tests. Cochrane Database of Systematic Reviews, 2013(2), 1–96. https://doi.org/10.1002/14651858.CD001865.pub3.
DOI : 10.1002/14651858.CD001865.pub3
Edwards, A., Gray, J., Clarke, A., Dundon, J., Elwyn, G., Gaff, C., … Thornton, H. (2008). Interventions to improve risk communication in clinical genetics: Systematic review. Patient Education and Counseling, 71(1), 4–25. https://doi.org/10.1016/j.pec.2007.11.026.
DOI : 10.1016/j.pec.2007.11.026
Edwards, Adrian, Elwyn, G., Covey, J., Matthews, E., & Pill, R. (2001). Presenting risk information: A review of the effects of “framing’ and other manipulations on patient outcomes. Journal of Health Communication, 6(1), 61–82. https://doi.org/10.1080/10810730150501413.
DOI : 10.1080/10810730150501413
Edwards, Adrian, Elwyn, G., Hood, K., Robling, M., Atwell, C., Holmes-Rovner, M., … Russell, I. (2003). The development of COMRADE - A patient-based outcome measure to evaluate the effectiveness of risk communication and treatment decision making in consultations. Patient Education and Counseling, 50(3), 311–322. https://doi.org/10.1016/S0738-3991(03)00055-7.
DOI : 10.1016/S0738-3991(03)00055-7
Entwistle, V. A., & Watt, I. S. (2006). Patient involvement in treatment decision-making: The case for a broader conceptual framework. Patient Education and Counseling, 63(3), 268–278. https://doi.org/10.1016/j.pec.2006.05.002.
DOI : 10.1016/j.pec.2006.05.002
European Commission. (2009). Guideline on summary of product characteristics. Notice to Applicants, 2C, 2, 1–29. https://doi.org/10.2903/j.efsa.2015.4206.OJ.
Eyler, R. F., Cordes, S., Szymanski, B. R., & Fraenkel, L. (2017). Utilization of continuous “spinners” to communicate risk. Physiology and Behavior, 37(6), 725–729. https://doi.org/10.1177/0272989X17707198.
DOI : 10.1177/0272989X17707198
Fischhof, B. (1995). Risk perception and communication unplugged: Twenty years of process. Risk Analysis, 15(2), 137–145.
DOI : 10.1111/j.1539-6924.1995.tb00308.x
Flynn, D., Ford, G. A., Stobbart, L., Rodgers, H., Murtagh, M. J., & Thomson, R. G. (2013). A review of decision support, risk communication and patient information tools for thrombolytic treatment in acute stroke: Lessons for tool developers. BMC Health Services Research, 13(1), 1. https://doi.org/10.1186/1472-6963-13-225.
DOI : 10.1186/1472-6963-13-225
Fraenkel, L., Reyna, V., Cozmuta, R., Cornell, D., Nolte, J., & Wilhelms, E. (2018). Do visual aids influenced patients’ risk perceptions for rare and very rare risks? Patient Education and Counseling, 101(11), 1900–1905. https://doi.org/10.1016/j.pec.2018.06.007.
DOI : 10.1016/j.pec.2018.06.007
Fransen, M., Meertens, R., & Schrander-Stumpel, C. (2006). Communication and risk presentation in genetic counseling: Development of a checklist. Patient Education and Counseling, 61(1), 126–133. https://doi.org/10.1016/j.pec.2005.02.018.
DOI : 10.1016/j.pec.2005.02.018
French, D. P., Cameron, E., Benton, J. S., Deaton, C., & Harvie, M. (2017). Can communicating personalised disease risk promote healthy behaviour change? A systematic review of systematic reviews. Annals of Behavioral Medicine, 51(5), 718–729. https://doi.org/10.1007/s12160-017-9895-z.
DOI : 10.1007/s12160-017-9895-z
Furedi, A. (1999). The public health implications of the 1995 “pill scare.” Human Reproduction Update, 5(6), 621–626. https://doi.org/10.1093/humupd/5.6.621.
DOI : 10.1093/humupd/5.6.621
Gamhewage, G. (2014). An introduction to risk communication. Who, (November 2013), 1–6. Disponível em: https://www.who.int/risk-communication/introduction-to-risk-communication.pdf.
Garcia-Retamero, R., Okan, Y., & Cokely, E. T. (2012). Using visual aids to improve communication of risks about health: A review. The Scientific World Journal, 562637. https://doi.org/10.1100/2012/562637.
DOI : 10.1100/2012/562637
Ghanouni, A., Nuttall, E., Wardle, J., & von Wagner, C. (2017). Testing whether barriers to a hypothetical screening test affect unrelated perceived benefits and vice versa: A randomised, experimental study. Patient Education and Counseling, 100(2), e1–e24. https://doi.org/10.1016/j.pec.2016.09.007.
DOI : 10.1016/j.pec.2016.09.007
Gigerenzer, G., & Edwards, A. (2003). Simple tools for understanding risks: From innumeracy to insight. British Medical Journal, 327(7417), 741–744. https://doi.org/10.1136/bmj.327.7417.741.
DOI : 10.1136/bmj.327.7417.741
Gigerenzer, G., Gaissmaier, W., Kurz-Milcke, E., Schwartz, L. M., & Woloshin, S. (2007). Helping doctors and patients make sense of health statistics. Psychological Science in the Public Interest, 8(2), 53–96. https://doi.org/10.1111/j.1539-6053.2008.00033.x.
DOI : 10.1111/j.1539-6053.2008.00033.x
Gouveia, M., Rodrigues, I. P., & Pinto, D. (2018). Importância da validação dos modelos de risco cardiovascular nos cuidados de saúde primários. Revista Portuguesa de Clínica Geral, 24(3), 101–103. https://doi.org/10.32385/rpmgf.v34i3.12449.
DOI : 10.32385/rpmgf.v34i3.12449
Grady, A., Carey, M., Bryant, J., Sanson-Fisher, R., & Hobden, B. (2017). A systematic review of patient-practitioner communication interventions involving treatment decisions. Patient Education and Counseling, 100(2), 199–211. https://doi.org/10.1016/j.pec.2016.09.010.
DOI : 10.1016/j.pec.2016.09.010
Guan, Y., Roter, D. L., Wolff, J. L., Gitlin, L. N., Christensen, K. D., Roberts, J. S., & Erby, L. H. (2018). The impact of genetic counselors’ use of facilitative strategies on cognitive and emotional processing of genetic risk disclosure for Alzheimer’s disease. Patient Education and Counseling, 101(5), 817–823. https://doi.org/10.1016/j.pec.2017.11.019.
DOI : 10.1016/j.pec.2017.11.019
Halley, M. C., Rendle, K. A. S., & Frosch, D. L. (2013). A conceptual model of the multiple stages of communication necessary to support patient-centered care. Journal of Comparative Effectiveness Research, 2(4), 421–433. https://doi.org/10.2217/cer.13.46.
DOI : 10.2217/cer.13.46
Hamstra, D. A., Johnson, S. B., Daignault, S., Zikmund-Fisher, B. J., Taylor, J. M., Larkin, K., … Angela Fagerlin. (2015). The impact of numeracy on verbatim knowledge of the longitudinal risk for prostate cancer recurrence following radiation therapy. Medical Decision Making, 35(1), 27–36. https://doi.org/10.1177/0272989X14551639.
DOI : 10.1177/0272989X14551639
Han, P. K. J., Klein, W. M. P., Killam, B., Lehman, T., Massett, H., & Freedman, A. N. (2012). Representing randomness in the communication of individualized cancer risk estimates: Effects on cancer risk perceptions, worry, and subjective uncertainty about risk. Patient Education and Counseling, 86(1), 106–113. https://doi.org/10.1016/j.pec.2011.01.033.
DOI : 10.1016/j.pec.2011.01.033
Helitzer, D. L., LaNoue, M., Wilson, B., de Hernandez, B. U., Warner, T., & Roter, D. (2011). A randomized controlled trial of communication training with primary care providers to improve patient-centeredness and health risk communication. Patient Education and Counseling, 82(1), 21–29. https://doi.org/10.1016/j.pec.2010.01.021.
DOI : 10.1016/j.pec.2010.01.021
Henneman, L., Marteau, T. M., & Timmermans, D. R. M. (2008). Clinical geneticists’ and genetic counselors’ views on the communication of genetic risks: A qualitative study. Patient Education and Counseling, 73(1), 42–49. https://doi.org/10.1016/j.pec.2008.05.009.
DOI : 10.1016/j.pec.2008.05.009
Hooker, C., Capon, A., & Leask, J. (2017). Communicating about risk: Strategies for situations where public concern is high but the risk is low. Public Health Research and Practice, 27(1), 1–5. https://doi.org/10.17061/phrp2711709.
DOI : 10.17061/phrp2711709
Kahneman, D. (2017). Pensar depressa e devagar. Lisboa: Circulo de Leitores.
Knapp, P., Gardner, P. H., & Woolf, E. (2016). Combined verbal and numerical expressions increase perceived risk of medicine side-effects: A randomized controlled trial of EMA recommendations. Health Expectations, 19(2), 264–274. https://doi.org/10.1111/hex.12344.
DOI : 10.1111/hex.12344
Kunneman, M., Stiggelbout, A. M., & Pieterse, A. H. (2020). Do clinicians convey what they intend? Lay interpretation of verbal risk labels used in decision encounters. Patient Education and Counseling, 103(2), 418–422. https://doi.org/10.1016/j.pec.2019.08.035.
DOI : 10.1016/j.pec.2019.08.035
Leiss, W. (1996). Three phases in the evolution of risk communication practice. The ANNALS of the American Academy of Political and Social Science, 545(1), 85–94. https://doi.org/10.1177/0002716296545001009.
DOI : 10.1177/0002716296545001009
Mendes, J. M. (2016). Sociologia do risco: Uma breve introdução e algumas lições. Coimbra: Imprensa da Universidade de Coimbra. https://doi.org/10.14195/978-989-26-1066-5.
DOI : 10.14195/978-989-26-1066-5
Navar, A. M., Stone, N. J., & Martin, S. S. (2016). What to say and how to say it: Effective communication for cardiovascular disease prevention Current Opinion in Cardiology, 31(5), 537–544. https://doi.org/:10.1097/HCO.0000000000000322.
DOI : 10.1097/HCO.0000000000000322
O’Connor, A. M., Drake, E. R., Wells, G. A., Tugwell, P., Laupacis, A., & Elmslie, T. (2003). A survey of the decision-making needs of Canadians faced with complex health decisions. Health Expectations, 6(2), 97–109. https://doi.org/10.1046/j.1369-6513.2003.00215.x.
DOI : 10.1046/j.1369-6513.2003.00215.x
O’Connor, A. M., Tugwell, P., Wells, G. A., Elmslie, T., Jolly, E., Hollingworth, G., … Drake, E. (1998). A decision aid for women considering hormone therapy after menopause: Decision support framework and evaluation. Patient Education and Counseling, 33(3), 267–279. https://doi.org/10.1016/S0738-3991(98)00026-3.
DOI : 10.1016/S0738-3991(98)00026-3
Patel, R. S., Lagord, C., Waterall, J., Moth, M., Knapton, M., & Deanfield, J. E. (2016). Online self-assessment of cardiovascular risk using the Joint British Societies (JBS3)-derived heart age tool: a descriptive study. BMJ Open, 6(9), e011511. https://doi.org/10.1136/bmjopen-2016-011511.
DOI : 10.1136/bmjopen-2016-011511
Rippl, S. (2002). Cultural theory and risk perception: A proposal for a better measurement. Journal of Risk Research, 5(2), 147–165. https://doi.org/10.1080/13669870110042598.
DOI : 10.1080/13669870110042598
Röttele, N., Schöpf-Lazzarino, A. C., Becker, S., Körner, M., Boeker, M., & Wirtz, M. A. (2020). Agreement of physician and patient ratings of communication in medical encounters: A systematic review and meta-analysis of interrater agreement. Patient Education and Counseling, 103(10):1873-1882https://doi.org/10.1016/j.pec.2020.04.002.
DOI : 10.1016/j.pec.2020.04.002
Sandman, P. M. (2012). Responding to community outrage: Strategies fpr effective risk communication. S.l.: Americam Industrial Hygiene Association.
Schiavo, R., May Leung, M., & Brown, M. (2014). Communicating risk and promoting disease mitigation measures in epidemics and emerging disease settings. Pathogens and Global Health, 108(2), 76–94. https://doi.org/10.1179/2047773214Y.0000000127.
DOI : 10.1179/2047773214Y.0000000127
Sisk, B. A., Mack, J. W., & DuBois, J. (2019). Knowing versus doing: The value of behavioral change models for emotional communication in oncology. Patient Education and Counseling, 102(12), 2344–2348. https://doi.org/10.1016/j.pec.2019.07.023.
Skolbekken, J.-A. (1998). Communicating the risk reduction achieved by cholesterol reducing drugs. British Medical Journal, 316, 1956–1958. https://doi.org/10.1136/bmj.313.7055.438.
DOI : 10.1136/bmj.313.7055.438
Slovic, P., & Peters, E. (2006). Risk perception and affect. Current Directions in Psychological Science, 15(6), 322–325. https://doi.org/10.1111/j.1467-8721.2006.00461.x.
DOI : 10.1111/j.1467-8721.2006.00461.x
Sopory, P. (2017). Metaphor in health and risk communication. Oxford Research Encyclopedia of Communication, (June), 1–22. https://doi.org/10.1093/acrefore/9780190228613.013.304.
DOI : 10.1093/acrefore/9780190228613.013.304
Speiser, D., Rebitschek, F. G., Feufel, M. A., Brand, H., Besch, L., & Kendel, F. (2019). Accuracy in risk understanding among BRCA1/2-mutation carriers. Patient Education and Counseling, 102(10), 1925–1931. https://doi.org/10.1016/j.pec.2019.05.007.
DOI : 10.1016/j.pec.2019.05.007
Stellamanns, J., Ruetters, D., Dahal, K., Schillmoeller, Z., & Huebner, J. (2017). Visualizing risks in cancer communication: A systematic review of computer-supported visual aids. Patient Education and Counseling, 100(8), 1421–1431. https://doi.org/10.1016/j.pec.2017.02.003.
DOI : 10.1016/j.pec.2017.02.003
Stephens, A. L., & Bruce, C. R. (2018). Setting expectations for ECMO: Improving communication between clinical teams and decision makers. Methodist DeBakey Cardiovascular Journal, 14(2), 120–125. https://doi.org/10.14797/mdcj-14-2-120.
Tannenbaum, M. B., Hepler, J., Zimmerman, R. S., Saul, L., Jacobs, S., Wilson, K., & Albarracin, D. (2015). Appealing to fear: A meta-analysis of fear appeal effectiveness and theories. Psychological Bulletin, 141(6), 1178–1204. https://doi.org/10.1037/a0039729.
DOI : 10.1037/a0039729
Thomson, R., Robinson, A., Greenaway, J., Lowe, P., Parkin, D., Eccles, M., … Hutchinson, E. (2002). Development and description of a decision analysis based decision support tool for stroke prevention in atrial fibrillation. Quality and Safety in Health Care, 11(1), 25–31. https://doi.org/10.1136/qhc.11.1.25.
DOI : 10.1136/qhc.11.1.25
Timmermans, D., Molewijk, B., Stiggelbout, A., & Kievit, J. (2004). Different formats for communicating surgical risks to patients and the effect on choice of treatment. Patient Education and Counseling, 54(3), 255–263. https://doi.org/10.1016/S0738-3991(03)00238-6.
DOI : 10.1016/S0738-3991(03)00238-6
Visschers, V. H. M., Meertens, R. M., Passchier, W. W. F., & De Vries, N. N. K. (2009). Probability information in risk communication: A review of the research literature. Risk Analysis, 29(2), 267-287. https://doi.org/10.1111/j.1539-6924.2008.01137.x.
DOI : 10.1111/j.1539-6924.2008.01137.x
Welkenhuysen, M., Evers-Kiebooms, G., & D’Ydewalle, G. (2001). The language of uncertainty in genetic risk communication: Framing and verbal versus numerical information. Patient Education and Counseling, 43(2), 179–187. https://doi.org/10.1016/S0738-3991(00)00161-0.
DOI : 10.1016/S0738-3991(00)00161-0
Zikmund-Fisher, Brian J. Fagerlin, A., & Ubel, P. A. (2010). Risky feelings: Why a 6% risk of cancer doesn’t always feel like 6%. Patient Education and Counseling, 81(S1), 87–93. https://doi.org/doi:10.1016/j.pec.2010.07.041.
DOI : 10.1016/j.pec.2010.07.041
Zipkin, D. A., Umscheid, C. A., Keating, N. L., Allen, E., Aung, K., Beyth, R., … Feldstein, D. A. (2014). Evidence-based risk communication: A systematic review. Annals of Internal Medicine, 161(4), 270–280. https://doi.org/10.7326/M14-0295.
DOI : 10.7326/M14-0295
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