In the current era of “media-driven social amplification” of radiation risk, authors of a clinical perspective published in the April edition of the American Journal of Roentgenology provided strategies for managing “radiophobia” and communicating the risks and benefits of diagnostic imaging to patients.
“As public awareness of medical radiation exposure has increased, there has been heightened awareness among patients, physicians and regulatory agencies of the importance and need for holistic benefit-and-risk discussion as the basis of informed consent in medicine,” wrote Lawrence T. Dauer, PhD, of the department of medical physics of Memorial Sloan-Kettering Cancer Center in New York City, and colleagues.
Informed consent, continued the authors, is a process of communication that supports shared decision making between patients and providers. To that end, Dauer and colleagues shared psychologic factors that impact radiation risk communication, including:
- Affect and reason. Instinct and intuition may cloud a patient’s understanding of the facts and detract from the ability to make an informed decision.
- Anxiety and decision-making. Stress-induced “mental noise” may make it difficult for patients to comprehend information.
- Feelings of dread and outrage may heighten a patient’s perception of risk.
- Anticipated regret. Patients may underestimate the natural risk of cancer and assume that any future cancer will be caused by the proposed study.
- Information source perceptions. Perception of risk is influenced by patients’ and providers’ biases, values and beliefs as well as their levels of information and knowledge.
- Competence and care issues. Patients’ trust and confidence in a provider correlate with the perception of risk.
Pitfalls and problems
Dauer and colleagues outlined challenges associated with typical radiation risk communication approaches. Specifically:
- The traditional paternalistic approach of 'physician knows best' no longer suffices as the standard of care.
- A strict focus on risk comparison, such as examples that correlate an x-ray with a specific number of plane trips, fails to adequately capture the elements of risk, explained the researchers.
- Risk numerology, or complicated mathematical statements about risk, may be difficult for patients to understand or may confuse patients. The authors noted that statements can either magnify risk or emphasize the likelihood of a normal outcome depending on how they are framed. For example, one could express a scan as doubling the risk of cancer (from 0.3 percent to 0.6 percent) or point to nearly equivalent cancer risks among similar patients, one imaged with ionizing radiation and one not.
- Quality assurance statements such as meeting specific organizational guidelines do not address risks in a quantifiable manner or present the overall risk perspective.
Dauer and colleagues suggested that physicians adhere to a few basic strategies to communicate the risks and benefits of diagnostic radiation with their patients. They recommended “simple clear messages at a sixth-grade reading level, devoid of jargon, technical terms and acronyms,” and use of standardized risk vocabulary with absolute numbers, common denominators and visual aids. They emphasized the importance of an interactive dialogue with the patient that focuses on both the risks and benefits of the imaging procedure. Finally, the authors advised physicians to assess the patient’s understanding of the message.
Additional research is needed, summed Dauer et al. Key unanswered questions include:
- How effective are strategies (e.g., dialogue, visual aids and risk scales) for helping patients understand benefit and risk?
- Is the training that radiologists and other physicians receive in communicating benefit and risk to patients adequate?
- How can such training be increased and improved?
- What cultural, age, sex, or other factors play a role?
- How do we most effectively tailor our approach for different populations?