What are the challenges facing risk communication in healthcare?
Risk communication is an open discussion between experts and people facing threats to their health, economic or social well-being. This enables those at risk to make informed decisions to protect themselves.
In healthcare, risk is inherent in public health screening programmes, medical and surgical treatment options, lifestyle risk factors and prognostic health scores.
Challenges for clinicians communicating risk include:
the difference in ability between patients and doctors to understand health statistics;
the spread of misinformation online.
The doctor-patient relationship should be viewed as a partnership. Both parties should be well informed and make shared decisions to implement the best management plan for the patient. Risk communication is an essential component of this, yet it remains to be a challenge for clinicians.
Discussing risk involves presenting risk statistics in a clear and digestible way to the patient. This is an important and challenging skill that clinicians must conquer. Common communication techniques used by clinicians include manipulating sentence structure, presenting risk reduction statistics, personalising risk information and using decision aids.
Furthermore, there are social factors that influence the patient’s ability to understand risk. These must be recognised by the clinician to allow them to tailor their approach accordingly. The patient’s level of numerical competency is one such example.
Our research group has been interviewing GPs directly. GPs have described how patients that are less educated find it more difficult to understand numbers. They therefore require more time to understand information regarding risk, which GPs find particularly difficult to manage within the constraint of a 10-minute consultation. However this issue is not just restricted to patients. In fact physicians themselves, and society overall, struggle to interpret statistics. This is known as collective statistical illiteracy. As a result, both patients and professionals alike, appear to require further improvement in the ability to manage risk information, or else miscommunication may occur.
Another complexity in risk communication is the Internet’s influence on patients’ ideas, concerns and expectations. Patients are no longer restricted to clinicians as their unique source of healthcare information. There is greater exposure to unofficial websites on the Internet, such as blogs and social media, which present and spread misinformation, in some cases. This creates a barrier to effective risk communication, as the clinician must first attempt to dispel and explain misconceptions from online sources that the patient may believe, before discussing risk.
While collective statistical illiteracy is reported as the most common obstacle to risk communication, presenting uncertainty about data may be the one of the most difficult. There is little guidance given on whether uncertainty, for example about medical tests and treatments, should be communicated to the patient, and to what detail. Clinicians must find the balance between adequate information provision and ensuring the patient can accurately understand what is being presented to them.
In summary, research into the field of risk communication is still inconclusive. This article has highlighted some of the key challenges that clinicians encounter, and we hope to investigate this further in our commissioned project. We are currently performing a comprehensive literature review and aim to combine our findings from this, with primary data that we have collected from talking directly to GPs across the country. Our end product will be a focused report with conclusions that we hope will help clinicians to communicate risk more effectively.
About the author
Hera Asad is a fifth-year medical student at the University of Cambridge. Her team is composed of Lucia Algara, Luc Francis, Olivia Healey and Daniel Muller under Branch Editor Anna Yakovleva.