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27-09-2011 | Legal medicine | Article

Patient, physician decision-making can be improved via information distribution


Free abstract

MedWire News: The way patients are given information about the risks and benefits associated with treatment of cancer can help them understand the complexity of that information, and enable them to make better decisions, say researchers.

The team, writing in a commentary published in the Journal of the National Cancer Institute, suggests 10 ways in which information can be best given to patients, including via plain language, pictographs, and absolute rather than relative risks.

"We believe that it is the responsibility of all cancer educators, decision aid developers, and clinicians to be familiar with the growing body of rigorous research that has tested effective methods of presenting probabilistic information, so that patients can use it to make an informed decision," Angela Fagerlin (Center for Clinical Management Research, Ann Arbor, Michigan, USA) and colleagues.

The team begins by highlighting three strategies for which strong evidence has already been shown: these are communicating using plain language, presentation of information using absolute rather than relative risk or numbers-needed-to-treat formats, and using pictographs.

Research has shown that people understand the content of plain language (no jargon, logical, and focused information) and that picographs are the most easily understood graphical representation of statistics, say Fagerlin et al.

"Part of the appeal of the pictographs is that they visually represent the risk as a frequency rather than a probability," writes the research team.

Statistical information is particularly challenging to present to patients; the researchers give the example of women deciding whether to take chemopreventive therapy against breast cancer. The relative risk is a 50% reduction, while the 5-year absolute risk reduction is from 4% to 2%.

Patients may believe that changes in risk are larger, and more favorable, when presented to them in a relative compared with an absolute format, say the researchers. This can lead patients to believe that a treatment is more effective than has actually been proven, remark Fagerlin and co-workers, who recommend only giving absolute risks.

The remaining seven strategies they discuss have shown only preliminary evidence of success.

The first indicates that presenting frequencies of events (60 out of 100 people) rather than percentages (60% of people) could help patients understand information better. One study cited showed that lower numeracy participants perceived medical choices as less risky when information is given as a percentage than as a frequency.

Highlighting the difference between baseline (eg, risks regardless of treatment) and incremental risks can help patients understand how much risk is actually related to the intervention, they remark.

Furthermore, the order that information is presented can affect their view of it, with a possible "recency effect" being triggered whereby patients best remember the last thing they were told, whether good or bad.

Comparative risk information could be helpful to relay statistics because "it allows relatively hard to evaluate personal risk statistics to be compared against a meaningful standard," ie, comparing the individuals' risk to the absolute risk faced by the "average person."

Finally, using "summary tables" to neatly review all the information given, withholding information if it is unnecessary or repetitive, and reinforcing the time interval over which a risk occurs all represent methods that could help patients understand their situation, the researchers conclude.

By Sarah Guy

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