The way in which information about risks of treatments is communicated to patients can have a significant effect on their perceptions and decision making.
“Surgeons must frequently communicate the probability of various treatment outcomes, complications and chances of cure to their patients to help them make health care decisions,” said Joshua Eli Rosen, MD, of the Surgical Outcomes Research Center at the University of Washington, in Seattle. “Prior studies have shown that how probability information is communicated can impact its interpretation and ultimately decisions that are made with it.”
Yet, despite these concerns, no standard practice exists for how surgeons should communicate such information to their patients.
To further study the effect of different communication approaches, an online survey was conducted that queried respondents on a set of complications associated with surgical and antibiotic treatment of appendicitis.
Risk information was presented either verbally (i.e., “uncommon”), as quantitative point estimates (i.e., 3%), or via quantitative ranges (i.e., 1%-5%). Next, participants were asked to estimate the likelihood of a complication occurring for an average person with appendicitis. A total of 296 respondents completed the survey, with a mean age of 37 years.
Verbal risk communications were found to result in significantly higher ranges of risk estimates for each surveyed complication, and were found to consistently lead to overestimation of risk.
“There are many reasons why a surgeon may want to use a verbal descriptor of risk,” Dr. Rosen said. These may include convenience and fluidity of communication, lack of precise numerical estimates, or hesitation to communicate data with greater certainty than they feel is warranted by existing data.
“However,” Dr. Rosen added, “we must recognize that by addressing these concerns with verbal descriptors alone, we are simply passing that uncertainty and variability to the patient in an uncontrollable way that may result in suboptimal decision making.”
Although verbal descriptors of probability resulted in greatly variable and inaccurate interpretations of risk, participants were able to accurately interpret numerical point estimates and ranges.
“This is particularly notable given that many surgeons may be concerned that too much numerical risk information may overwhelm patients,” Dr. Rosen said. “These data may be used to inform how surgeons communicate probability of risks and benefits to their patients.”
This article is from the December 2021 print issue.
Please log in to post a comment
For the overwhelming majority of patients their priorities are are 1) Elimination of risk of death, 2) Relief of pain and 3) cure of disability. There are special important circumstances that are uniquely important to some patients. 1) would rather die in bed surrounded by loved ones rather than die in surgery, 3) they want two months of lucidity rather than two years of of tortured life and confusion 4) they want dignity, what ever that means to them, 5) they want not to be a burden to their family.
When I give advice to a patient to a patient my number one priority is to decrease the risk to life. My second priority is to give them comfort. After that, when it makes no differences to my priorities, I honor the patients wishes.
Advanced directives mean nothing to me and I tell patients this. They are free to pick a different surgeon. I always do what I think is right.
Patients are not doctors. I am. Many decisions they are told to make do not come from physicians. I feel it is my responsibility to guide them into the best decision. If I cannot do this I feel that I have failed my patient and am not worthy of being called a physician.
You have to treat each patient like you love them. Which I do.
Kevin C. Petersen, M.D.