Transcript Communicating Risk

Communicating
Risk
Dr Katherine Teare
GP Educator Fellow
RISK
‘The probability that a hazard will
give rise to harm’
Risk Communication
Probability of risk occuring
Importance of the adverse event
Effect on the patient
Perception - how it
varies
Awareness of risk in question
Understanding of risk including
statistics
Dependent upon information
presented to patients
May be at odds with public health
message - population level
Problems with
communicating risk
Patients, AND DOCTORS, struggle
to understand numbers and
statistics
Basic numeracy also an issue for
some
Methods: Framing
Attribute framing: ‘Positive’ vs
‘Negative’ e.g. 82% chance survival
5yrs post diagnosis breast cancer or
18% chance dying
Goal framing: describe
consequences as gain vs loss e.g.
screening will improve chance
survival vs not participating will
reduce survival
Method: Presenting
Risk
RRR:
reduction Reduction
of risk in intervention group
relative to risk control group e.g. early detection
breast cancer reduces risk dying from breast
cancer by 15%
ARR: difference risk between two groups e.g.
early detection with mammography reduces risk
dying from breast cancer by 0.05%
NNT: number of patients who need to be treated
(or screened) to prevent one additional adverse
outcome e.g. 2000 women need to have regular
mammograms for more than 10 years to prolong
one life
Method:
Personalising risk
information
Give population based risk estimate
OR on basis individual risk factors
Personalised risk info in screening
context leads to more accurate risk
perception, improved knowlesge
and increased uptake screening
Method: Decision
Aids
Clear evidence based information
on choices available
Improve patient participation in
decision making
Case Study
Bridget Jones - just turned 50, fit
and well, no reg meds. Menarche
14yrs, no FHx breast cancer, first
child aged 26yrs. Sister told her
mammogram will detect a cancer
before she can feel a lump but she
is concerned about false alarms and
unnecessary treatment
Case Study cont...
NHS National Prescribing Centre has a breast
screening decision aid
Explains if 1000 women aged 50-70 attend
regular mammograms for 10 years 970 will not
have breast cancer but 130 of these will have
had unnecessary investigations
30 will have breast cancer, 4 would have been
clinically inconsequential, for 23 the fact that
detected during screening does not alter
outcome but 3 women will live longer because
found at screening
Other cases to
discuss
Concerned 63 year old man with 1 x nocturia re
PSA testing
Cardiff Health Check: 31 year old woman,
alleged sexual assault in teens but never in
another sexual relationship re cervical screening
Newly diagnosed 57 year old hypertensive male
patient with QRISK score 21% who has heard
only bad things about statins
References
Communicating risk. Ahmed H, Naik
G, Willoughby H, Edwards A. BMJ
2012;344:e3996