Risk communication in the clinical consultation

Abstract

-Modern healthcare and modern societies are facing up to the need for greater engagement of patients in treatment decisions. Shared and informed decision-making is replacing traditional paternalistic approaches to decisions; health policy both reflects and drives these changes. A critical contribution to better informed decisions by patients is the effective communication of risk in the clinical consultation. This is not straightforward, but there is a growing evidence base to improve performance in this area to the benefit of both patients and clinicians. The purpose of this review is to provide an accessible and practical guide to better communication of risk by clinicians. KEY WORDS: communication skills, decisionmaking, risk communication, uncertaintyRisk communication is the open two-way exchange of information and opinion about risk, leading in the context of healthcare to better understanding and more informed decisions about clinical management. 1 However, this straightforward definition belies the difficulty of doing this effectively. 2 There are many reasons why discussing risk with patients in the clinical consultation is increasingly important. The policy agenda in healthcare in the NHS is rapidly changing. There is a major emphasis on choice; 3 together with that comes the need to give information that helps patients make more informed decisions. Hitherto, choice has been rather narrowly restricted to issues such as where to be treated. Arguably, choice is more important in making decisions on treatment options where there may be more than one treatment to consider, often with different risk and benefit profiles and long-lasting consequences for the patient.Thus, there has recently been considerable emphasis on shared and informed decision-making, in contrast to doctor-led paternalistic approaches that have dominated in the past. 4 In part, this reflects a wider societal change towards a more consumerist society, aligned with increasing expectations of healthcare. However, it also reflects a moral and ethical imperative better to engage patients in decisions that materially affect their health, especially when it is increasingly acknowledged that patients' values and preferences vary widely and that doctors are poor at predicting these in individual patients. 5 Furthermore, there is increasing evidence that patients who are better informed and more engaged in decisions about their own care are more likely to be knowledgeable, more likely to adhere to their chosen treatment and may have better outcomes. 6,7 There has been an explosion of decision aids to help patients participate in decision making and to make informed choices consistent with their values by presenting the clinical evidence and the likely effects of alternative treatments. A key element of such decision aids is the presentation of risks and benefits; it is within this field of endeavour that much of what we now know about good communication of risk arises. Whether or not they use decision aids, though, clinicians have a majo...

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