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Communicating Risk

Communicating Risk. Dr Katherine Teare GP Educator Fellow. RISK. ‘The probability that a hazard will give rise to harm’. Risk Communication. Probability of risk occuring Importance of the adverse event Effect on the patient. Perception - how it varies. Awareness of risk in question

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Communicating Risk

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  1. Communicating Risk • Dr Katherine Teare • GP Educator Fellow

  2. RISK • ‘The probability that a hazard will give rise to harm’

  3. Risk Communication • Probability of risk occuring • Importance of the adverse event • Effect on the patient

  4. Perception - how it varies • Awareness of risk in question • Understanding of risk including statistics • Dependent upon information presented to patients • May be at odds with public health message - population level

  5. Problems with communicating risk • Patients, AND DOCTORS, struggle to understand numbers and statistics • Basic numeracy also an issue for some

  6. Methods: Framing • Attribute framing: ‘Positive’ vs ‘Negative’ e.g. 82% chance survival 5yrs post diagnosis breast cancer or 18% chance dying • Goal framing: describe consequences as gain vs loss e.g. screening will improve chance survival vs not participating will reduce survival

  7. Method: Presenting Risk Reduction • RRR: reduction of risk in intervention group relative to risk control group e.g. early detection breast cancer reduces risk dying from breast cancer by 15% • ARR: difference risk between two groups e.g. early detection with mammography reduces risk dying from breast cancer by 0.05% • NNT: number of patients who need to be treated (or screened) to prevent one additional adverse outcome e.g. 2000 women need to have regular mammograms for more than 10 years to prolong one life

  8. Method: Personalising risk information • Give population based risk estimate OR on basis individual risk factors • Personalised risk info in screening context leads to more accurate risk perception, improved knowlesge and increased uptake screening

  9. Method: Decision Aids • Clear evidence based information on choices available • Improve patient participation in decision making

  10. Case Study • Bridget Jones - just turned 50, fit and well, no reg meds. Menarche 14yrs, no FHx breast cancer, first child aged 26yrs. Sister told her mammogram will detect a cancer before she can feel a lump but she is concerned about false alarms and unnecessary treatment

  11. Case Study cont... • NHS National Prescribing Centre has a breast screening decision aid • Explains if 1000 women aged 50-70 attend regular mammograms for 10 years 970 will not have breast cancer but 130 of these will have had unnecessary investigations • 30 will have breast cancer, 4 would have been clinically inconsequential, for 23 the fact that detected during screening does not alter outcome but 3 women will live longer because found at screening

  12. Other cases to discuss • Concerned 63 year old man with 1 x nocturia re PSA testing • Cardiff Health Check: 31 year old woman, alleged sexual assault in teens but never in another sexual relationship re cervical screening • Newly diagnosed 57 year old hypertensive male patient with QRISK score 21% who has heard only bad things about statins

  13. References • Communicating risk. Ahmed H, Naik G, Willoughby H, Edwards A. BMJ 2012;344:e3996

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