Strengths and Gaps in Physicians’ Risk Communication: A Scenario Study of the Influence of Numeracy on Cancer Screening Communication

Petrova, Dafina; Kostopoulou, Olga; Delaney, Brendan; Cokely, Edward T.; García‐Retamero, Rocío

doi:10.1177/0272989x17729359

Cited by 38 publications

(41 citation statements)

References 73 publications

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“…However many clinicians have been found to overestimate bene ts and underestimate harms, [60] lack ability to retrieve relevant evidence, [60] or have poor statistical numeracy and risk literacy. [66] This makes it di cult for clinicians to not only understand medical test statistics, but also to communicate this information to patients. A greater emphasis on interpretation of statistical information in medical school curricula could equip clinicians with these essential skills.…”

Section: Discussionmentioning

confidence: 99%

“…[38,68,[73][74][75] However, some studies demonstrated that the use of protocols resulted in inappropriate use of tests and overtesting. [28,29,66] Alber et al [43] and Bishop et al [51] found that doctors based their test ordering decisions on individual patient cases, using guidelines "as a guide rather than strict rules". [51] This resulted in variation in test ordering behaviour, with some more likely to test while others less likely.…”

Section: Guidelines Protocols and Policiesmentioning

confidence: 99%

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Why do clinicians overtest? A narrative review and workshop group discussion exploring influences on clinician overtesting as possible causes of overdiagnosis

Lam

Pickles

Stanaway

et al. 2020

Preprint

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Background: Screening and diagnostic tests provide important information to guide clinical management. Overtesting however may cause harm to patients and the healthcare system, including through overdiagnosis. Clinicians are ultimately responsible for test requests, and therefore are ideally positioned to prevent overtesting and overdiagnosis. Through this narrative literature review followed by group discussion at a conference workshop (Preventing Overdiagnosis Conference [PODC], Sydney, 2019), we aimed to identify and categorise factors that influence clinicians to request potentially unnecessary screening and diagnostic tests that could result in overdiagnosis.Methods: Articles exploring factors affecting clinician test ordering behaviour were identified through a systematic search of MedLine in April 2019, forward and backward citation searches and content experts. Two authors screened abstract titles and abstracts, and two authors screened full text for inclusion. Identified factors were categorised into a preliminary framework which was subsequently presented at the PODC for iterative development.Results: The MedLine search yielded 542 articles; 55 were included. Another 10 articles identified by forward-backward citation and content experts were included, resulting in 65 articles in total. Following small group discussion with workshop participants, a revised thematic framework of factors was developed: ● “Interpersonal” – pressure from colleagues and medical culture; pressure from patients and doctor-patient relationship● “Contextual” – clinician knowledge and understanding; cognitive biases and experiences; contemporary medical practice and new technology● “Environmental or workplace” – guidelines, protocols and policies; financial incentives; time constraints, physical vulnerabilities and language barriers; pre-emptive testing to facilitate subsequent care; availability, ownership and ease of access to tests● “Intrapersonal” – fear of malpractice and litigation; intolerance of uncertainty and risk aversion; sense of medical obligation Conclusion: Through this thematic framework, clinicians can become more aware of their test ordering behaviour and feel empowered to limit overtesting and overdiagnosis. This framework may also guide the development of a scale assessing clinician knowledge, attitudes and practices around overtesting and overdiagnosis, to facilitate measurement of the effects of clinician-targeted interventions to prevent overdiagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Guidelines Protocols and Policiesmentioning

confidence: 99%

Why do clinicians overtest? A narrative review and workshop group discussion exploring influences on clinician overtesting as possible causes of overdiagnosis

Lam

Pickles

Stanaway

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Numeracy influences not only the extent to which consumers understand different risk communication formats, but also their preference for receiving quantitative information [15][16][17]. This suggests that tailoring information on the individual or average population level can increase risk communication efficiency (see [18] for an example from the medical domain). There are several validated tools that can help to adapt risk communication to individual recipients or on average to the population level.…”

mentioning

confidence: 99%

“…Conclusions. High level of education does not guarantee comprehension of risk communications as even some highly educated, experienced professionals misunderstand important risk communications in their field of expertise [18,22]. Subtle differences in risk communication formats and misunderstanding of risk statistics can have significant effects on comprehension and subsequent decisions and behavior.…”

mentioning

confidence: 99%

How to effectively communicate risks to diverse consumers

Petrova¹,

García‐Retamero²

2018

Health Risk Analysis

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The article outlines how to efficiently communicate risks described in numerical values to consumers. The issue is vital and its relevance is related to communication that applies numeric values is an essential part of informing consumers about hazards and advantages of food products; however, a lot of consumers have difficulty perceiving digital information about risks due to various reasons. Consequently, such people assess risks inadequately and can't make well justified decisions based on quantitative information. The authors explain that to remove numerical information and to replace it with verbal description is not advisable as it doesn't allow to solve an issue of efficient risk communication. They also give examples that illustrate how wrong communication tactics can lead to risks aggravation or underestimation. The authors apply certain propositions to prove efficiency of tested risk communication formats, such as standard categories, visual aids, conventional symbols, etc. It was detected that visual aids, or graphic images of information on risks, can eliminate a lot of problems and result in much better understanding of risks and decisions among diverse people. Such means are quite efficient when it comes to people with limited abilities related to perception of linguistic and numerical information, elderly people, highly educated people and population in general. The authors also give some positive examples on how information was adapted for diverse consumers. They come to a conclusion that well-thought-out and transparent risk communication formats that incorporate natural cognitive strategies can make risk communications much easier. Better understanding, in its turn, often leads to conscious decision making by consumers and health-oriented decisions, intentions, and behavior.

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“…Это говорит о том, что адаптация информации на индивидуальном или популяционном уровне может повысить эффективность риск-коммуникации (см. [18], пример из медицинской области). Существует несколько проверенных инструментов, которые могут помочь адаптировать риск-коммуникации для отдельных получателей или в среднем на популяционном уровне.…”

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How to effectively communicate risks to diverse consumers

Petrova¹,

García‐Retamero²

2018

Health Risk Analysis

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Проанализированы эффективные средства информирования потребителей о рисках, выраженных числовыми значениями. Актуальность проблемы связана с тем, что коммуникация с использованием числовой информации является важной частью информирования потребителей об опасностях и достоинствах пищевой продукции, однако многие потребители в силу различных причин с трудом воспринимают цифровую информацию о риске. Как следствие, такие лица неадекватно оценивают риски и не могут принимать обоснованные решения на основе количественной информации. Показано, что устранение числовой информации и замена ее словесным описанием не являются целесообразным в решении проблемы информирования о рисках. Приведены примеры, как неверное применение тактики коммуникаций может привести к аггравации или недооценке рисков. Рядом положений авторы доказывают эффективность использования апробированных форматов риск-коммуникации: стандартных категорий, визуальных средств, условных обозначений и т.п. Установлено, что визуальные средстваграфические отображения информации о рискахмогут устранить многие из проблем и надежно улучшить понимание рисков и решений у разных людей. Такие средства являются эффективными для лиц с ограниченными способностями восприятия лингвистической и числовой информации, пожилых людей, высокообразованных специалистов и населения в целом. Приведен ряд положительных примеров адаптации информации для разных категорий потребителей. Делается вывод о том, что хорошо продуманные, прозрачные форматы риск-коммуникации, которые используют естественные когнитивные стратегии людей, могут облегчить риск-коммуникации. Улучшение понимания, в свою очередь, часто приводит к осознанному принятию решений потребителей и ориентированным на здоровье решениям, намерениям и поведению.

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Strengths and Gaps in Physicians’ Risk Communication: A Scenario Study of the Influence of Numeracy on Cancer Screening Communication

Cited by 38 publications

References 73 publications

Why do clinicians overtest? A narrative review and workshop group discussion exploring influences on clinician overtesting as possible causes of overdiagnosis

Why do clinicians overtest? A narrative review and workshop group discussion exploring influences on clinician overtesting as possible causes of overdiagnosis

How to effectively communicate risks to diverse consumers

How to effectively communicate risks to diverse consumers

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