Helping patients decide: ten steps to better risk communication

Abstract

With increasing frequency, patients are being asked to make complex decisions about cancer screening, prevention, and treatment. These decisions are fraught with emotion and cognitive difficulty simultaneously. Many Americans have low numeracy skills making the cognitive demands even greater whenever, as is often the case, patients are presented with risk statistics and asked to make comparisons between the risks and benefits of multiple options and to make informed medical decisions. In this commentary, we highlight 10 methods that have been empirically shown to improve patients' understanding of risk and benefit information and/or their decision making. The methods range from presenting absolute risks using frequencies (rather than presenting relative risks) to using a risk format that clarifies how treatment changes risks from preexisting baseline levels to using plain language. We then provide recommendations for how health-care providers and health educators can best to communicate this complex medical information to patients, including using plain language, pictographs, and absolute risks instead of relative risks.

Figures

Figure 1

Pictograph format to communicate risk information. Pictograph used in the “Guide to Decide” web-based decision aid [see (26) and (27) for details] to highlight the additional risk of cataracts (one of the several side effects of tamoxifen) faced by women taking tamoxifen (dark blue) as compared with the baseline risk for women of the same age (light blue). Each rectangle represents 1 out of 100 individuals.

Figure 2

Bar graph format to communicate risk information. Bar graph format based on the decision support tool Adjuvant! Online to display estimated survival and mortality risks for breast cancer patients who are deciding between different adjuvant therapy options. Reproduced from Zikmund-Fisher et al. (51) with permission from John Wiley & Sons Inc.

Figure 3

Binary choice pictograph format to communicate risk information. Binary format showing the incremental survival benefit to a breast cancer patient of adding chemotherapy to hormonal therapy. Each rectangle represents 1 out of 100 individuals. Reproduced from Zikmund-Fisher et al. (49) with permission from the authors.