AHRA: Absolute terms, visual aids can help patients understand risks

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ORLANDO, Fla.—Doctors and patients view risks differently, and because of this, effective patient communication requires more than simply “dumbing down” information, according to the opening keynote presentation Aug. 13 at the 40th annual meeting of AHRA: the Association for Medical Imaging Management.

In any setting, effective collaboration requires an understanding and response to another’s needs, outlined speaker John Paling, PhD, an author and filmmaker who has worked to improve understanding of comparative risks and benefits. When people who need to collaborate have different perspectives, problems can arise.

Transferring this idea to the practice of medicine, Paling explained that physicians and patients have very different perspectives when it comes to risk. Physicians tend to remove emotion and talk in numbers, while for patients, feelings win out over facts and they are rarely able to set emotion aside. Physicians take caring for granted, while patients might do the same for medical competence, said Paling. Trust requires the patient to both respect a physician’s medical knowledge, but also requires the physician to express care for the patient.

“Never trust a doctor whose office plants have died,” said Paling, who attributed the line to his wife.

Patients often misunderstand what the true risks are when couched in terms such as “low risk” or “rare.” Paling said these terms can mean different things to different patients. Moreover, the media often uses relative risk numbers that can exaggerate the perceived risk of a procedure or a condition. For example, a 50 percent increase in cancer rates sounds grave, but it could be misleading if the actual numbers are small to begin with.

This is why Paling recommends communicating in absolute terms. An increase from two out of 1,000 to three out of 1,000 reduces the ambiguity of simply saying “a 50 percent increase.” Within radiology, this concept has implications for the way radiation dose risks are expressed to patients. Parents may be reluctant to subject their children to a CT scan if they’ve read that cumulative doses of 50 mGy triple the risk of brain tumors, but in reality the absolute risks remain relatively small and are often outweighed by the risks involved with not undergoing imaging.

Positive framing also can influence a patient’s decisions, according to Paling. He said that when communicating the outcomes for surgical treatment of breast cancer, patients were more favorable to the treatment when told the survival rate was 90 percent as opposed to being told the mortality rate was 10 percent. When given the survival rate, 84 percent of patients elected to undergo surgery, compared with 50 percent who were given the mortality rate.

Simple visual aids can further help illustrate risks to patients. Paling demonstrated one chart that looked like a football field, with various risks for everyday activities such as driving or bathing plotted as points. When medical risks are then added alongside these points, patients can better understand how these risks compare with tasks they perform daily. Likewise, a palette chart that expresses absolute risks such as one out of 1,000 by highlighting a single figure in a field of 1,000 illustrated figures can help patients visualize the risks.

Paling said physicians can make their own free visual aids by going to www.riskcomm.com.