Evidence-Based Risk Communication

Zipkin, Daniella A.; Umscheid, Craig A.; Keating, Nancy L.; Allen, Elizabeth S.; Aung, KoKo; Beyth, Rebecca J.; Kaatz, Scott; Mann, David; Sussman, Jeremy B.; Korenstein, Deborah; Schardt, Connie; Nagi, Avishek; Sloane, Richard; Feldstein, David

doi:10.7326/m14-0295

Cited by 322 publications

(313 citation statements)

References 98 publications

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“…A core component of patient-centered communication processes is accurate information exchange about the diagnosis and risks and benefits of treatment options (29) that includes plain language, describes absolute instead of relative risks, and uses tables and graphs (30,31). In this study and our previous work, almost all patients reported not receiving adequate information about the risk of lung cancer, and most substantially overestimated this risk (17)(18)(19).…”

Section: Original Researchmentioning

confidence: 67%

Distress and Patient-Centered Communication among Veterans with Incidental (Not Screen-Detected) Pulmonary Nodules. A Cohort Study

et al. 2015

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Rationale: Incidental pulmonary nodule detection is postulated to cause distress, but the frequency and magnitude of that distress have not been reported. The quality of patient-clinician communication and the perceived risk of lung cancer may influence distress Objectives: To evaluate the association of communication processes with distress and the perceived risk of lung cancer using validated instruments. Methods:We conducted a prospective cohort study of patients with incidentally detected nodules who received care at one Department of Veterans Affairs Medical Center. We measured distress with the Impact of Event Scale and patient-centered communication with the Consultation Care Measure, both validated instruments. Risk of lung cancer was self-reported by participants. We used multivariable adjusted logistic regression to measure the association of communication quality with distress.Measurements and Main Results: Among 122 Veterans with incidental nodules, 23%, 12%, and 4% reported experiencing mild, moderate, and severe distress, respectively, at the time they were informed of the pulmonary nodule. Participant-reported risk of lung cancer was not associated with distress. In the adjusted model, high-quality communication was associated with decreased distress (odds ratio [OR] = 0.28, 95% confidence interval [CI] = 0.08-1.00, P = 0.05). Among participants who reported a risk of malignancy of 30% or less, high-quality communication was associated with decreased distress (OR = 0.15, 95% CI = 0.02-0.92, P = 0.04), but was not associated with distress for those who reported a risk greater than 30% (OR = 0.12 (95% CI = 0.00-3.97, P = 0.24), although the P value for interaction was not significant. Conclusions:Veterans with incidental pulmonary nodules frequently reported inadequate information exchange regarding their nodule. Many patients experience distress after they are informed that they have a pulmonary nodule, and high-quality patient-clinician communication is associated with decreased distress. Communication strategies that only target improved knowledge of the risk of malignancy may not be sufficient to reduce the distress associated with nodule detection.

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Section: Original Researchmentioning

confidence: 67%

Distress and Patient-Centered Communication among Veterans with Incidental (Not Screen-Detected) Pulmonary Nodules. A Cohort Study

et al. 2015

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“…Studies about evidence-based risk communication have found that relative risk reductions are harder to understand and generate more unrealistic expectations compared to the same information presented as absolute risk reductions. 16,17 If the aim of communication is to assist women to understand the likelihood of a benefit, relative risks should be avoided in favour of absolute risks, and the harms should be presented in the same way using the same denominator, so that the chances of experiencing benefits and harms are directly comparable. 16 Women were often directly encouraged to attend, but were not given specific estimates of the benefit.…”

Section: Problems With Current Practicementioning

confidence: 99%

“…16,17 If the aim of communication is to assist women to understand the likelihood of a benefit, relative risks should be avoided in favour of absolute risks, and the harms should be presented in the same way using the same denominator, so that the chances of experiencing benefits and harms are directly comparable. 16 Women were often directly encouraged to attend, but were not given specific estimates of the benefit. For example one invitation letter says, 'The purpose is to reduce the number of cases and mortality from cervical cancer' (Norway), and an information leaflet says, 'Early detection and treatment of changes in the cells of the cervix can prevent cervical cancer' (Ireland).…”

Section: Problems With Current Practicementioning

confidence: 99%

Do invitations for cervical screening provide sufficient information to enable informed choice? A cross-sectional study of invitations for publicly funded cervical screening

et al. 2016

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SummaryObjective: To investigate whether invitations for publicly funded cervical screening provide sufficient information to enable an informed choice about participation. Design: Cross-sectional study using a checklist of 23 information items on benefits and harms from cervical screening and the risks related to cervical cancer. Material: Invitations to publicly funded cervical screening in 10 Scandinavian and English-speaking countries. Setting: Ten Scandinavian and English speaking countries. Participants: Sixteen screening units representing 10 Scandinavian and English speaking countries. Main outcome measures: Number of information items presented in invitations for cervical screening. Results: We contacted 21 coordinating units from 11 countries and 20 (95%) responded. Of these, four units did not issue invitations, but the remaining 16 coordinating units in 10 different countries supplied a sample. The invitations for cervical screening were generally information poor and contained a median of only four out of 23 information items possible (17%), ranging from 0 to 12 (0-52%). The most important harms of cancer screening, overdiagnosis and overtreatment, were typically downplayed or unmentioned. The same applied to other important harms, such as falsepositive results and the psychological consequences from an abnormal test result. The majority of invitations took a paternalistic approach. While only two invitations (17%) included a pre-assigned appointment date, eight (70%) of the invitations contained strong appeals for participation. Conclusions: Invitations to cervical cancer screening were information poor and biased in favour of participation. This means that informed choice is not possible, which is in conflict with modern requirements for personal involvement in medical decisions.

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“…In the 1980s and 1990s, the concept of danger was confined to the field of natural disasters and disaster management was meant to limit the extent of the consequences and the vulnerability to hazards [6]. However later on, the term "risk" was used in various areas such as natural disasters, human disasters (including; crime, health-related consequences, traffic accidents, air pollution and terror), different sciences (including insurance and economics, psychology and statistics) [5][6][7][8][9][10].…”

mentioning

confidence: 99%

Different Perception, Different Behavior, Necessity of Consensus Over “Risk” Term

Keykaleh

Zavareh

Safarpour

et al. 2018

hdq

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Evidence-Based Risk Communication

Abstract: None.

Cited by 322 publications

References 98 publications

Distress and Patient-Centered Communication among Veterans with Incidental (Not Screen-Detected) Pulmonary Nodules. A Cohort Study

Distress and Patient-Centered Communication among Veterans with Incidental (Not Screen-Detected) Pulmonary Nodules. A Cohort Study

Do invitations for cervical screening provide sufficient information to enable informed choice? A cross-sectional study of invitations for publicly funded cervical screening

Different Perception, Different Behavior, Necessity of Consensus Over “Risk” Term

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