Does information form matter when giving tailored risk information to patients in clinical settings? A review of patients’ preferences and responses

Abstract

Neoliberal emphasis on “responsibility” has colonized many aspects of public life, including how health care is provided. Clinical risk assessment of patients based on a range of data concerned with lifestyle, behavior, and health status has assumed a growing importance in many health systems. It is a mechanism whereby responsibility for self (preventive) care can be shifted to patients, provided that risk assessment data is communicated to patients in a way which is engaging and motivates change. This study aimed to look at whether the form in which tailored risk information was presented in a clinical setting (for example, using photographs, online data, diagrams etc.), was associated with differences in patients’ responses and preferences to the material presented. We undertook a systematic review using electronic searching of nine databases, along with handsearching specialist journals and backward and forward citation searching. We identified eleven studies (eight with a randomized controlled trial design). Seven studies involved the use of computerized health risk assessments in primary care. Beneficial effects were relatively modest, even in studies merely aiming to enhance patient–clinician communication or to modify patients’ risk perceptions. In our paper, we discuss the apparent importance of the accompanying discourse between patient and clinician, which appears to be necessary in order to impart meaning to information on “risk,” irrespective of whether the material is personalized, or even presented in a vivid way. Thus, while expanding computer technologies might be able to generate a highly personalized account of patients’ risk in a time efficient way, the need for face-to-face interactions to impart meaning to the data means that these new technologies cannot fully address the resource issues attendant with this type of approach.

Comparing how patients value and respond to information on risk given in three different forms during dental check-ups: the PREFER randomised controlled trial

“…Perhaps significant is that while practice type predicted first preference for both verbal and QLF information, practice type did not predict a preference for TL information. One explanation for this might be that the TL system is effective in standardising patient communication between practices, even if it less preferred than a more tailored discussion with clinicians which contextualises risk information to make it meaningful at a truly personal level [30]. So while the new system, which is a key part of NHS dental contract reforms, may not have much impact as a risk communication tool, promoting patients’ behaviour, it could still have utility as a quality improvement tool for dental practice.…”

The use of visual risk communication and its significance for risk understanding and health literacy in out-clinic settings – a literature review

“…Systematic reviews within the area of visual risk communication are characterised by heterogeneity (7,15) and metanalysis could not be done (7). This might be due to diverse methodological quality, a broad definition of visual communication (e.g.…”

“…During recent years, the focus on personalised risk communication and shared decision-making has increased (7,8). The development of online devices has enabled patients to independently access risk information and reflect on questions before consulting a doctor (9,10).…”

Risk work in dental practices: an ethnographic study of how risk is managed in NHS dental appointments

“…2017, Harris et al . 2017). The implementation of risk stratification tools in the clinical setting is an important issue for practitioners since their everyday practice routinely involves the challenge of balancing adherence to professional care protocols regarding educating their patients to adopt healthier behaviours while maintaining courteous, long‐term and professional relationships with people who may not be receptive to such advice (Hill et al .…”