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About the Site:

This is the blog for the book Medical Decision Making: A Physician's Guide, by Alan Schwartz and George Bergus (Cambridge University Press, 2008). The book is now available from Cambridge University Press

About the Authors:

Alan Schwartz, Ph.D. is an Associate Professor of Medical Education and Pediatrics at the University of Illinois at Chicago College of Medicine, where he teaches and conducts research on physician and patient decision making.

George Bergus, M.D., M.A. is the Dr. William and Sondra Myers Family Professor of Family Medicine at the University of Iowa Carver College of Medicine, and Co-Director of the Family Practice/Psychiatry Residency program. He holds a Certificate of Additional Qualification in Geriatrics.

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MD NetGuide and risk communication

April 26th, 2009 by Alan Schwartz

The cover story in the March 2009 issue of MD NetGuide is “The Risk of Risk: Explaining Difficult Concepts to Patients“, by G. Stephen Nace, a physician at the University of Illinois College of Medicine at Peoria who I recently had the pleasure to meet. Making Medical Decisions is prominently cited in the piece.

The article does a fine job of reviewing and highlighting key research in patient risk communication. It offers clinically-relevant guidance for physicians seeking to educate their patients that is very much in the MDM:APG spirit. It also links to Dr. Chris Cates’s Visual Rx web site, which provides a form that can generate pictograms for representing number needed to treat or number needed to harm data (Dr. Cates, if you’re reading this, I’d love to see version that can combine both efficacy and adverse event data and produce a unified plot of NNT/NNH – something I’ve been meaning to do with my own (nonvisual) NNT/NNH calculator).

It’s great to see this kind of discussion appearing in publications like these that reach a large community of practice.

The study of risk communication is an active one. Determinants of whether or not lay people achieve adequate comprehension of risk information are multifaceted, and include how the risk communicator understands the risk information, his or her mental model of what the lay person knows, the format and context of the risk communication, the lay person’s own numeracy and health literacy, the human cognitive processes involved in judgment and decision making, and cultural expectations around the discussion of medical and environmental risk.

Due to the growing requirements to communicate numerical information to lay individuals, there has recently been a significant push to conduct research that can provide direct guidance regarding how to best present numerical information in order to increase the likelihood of informed decisions. Accuracy is one key goal; evaluability (the ability to make a meaningful interpretation of risk so that it can be used in judgments and decisions- cf. Hsee C, The Evaluability Hypothesis: An Explanation for Preference Reversals between Joint and Separate Evaluations of Alternatives. Organ Behav Hum Decis Process, 1996;67:3) is a conceptually distinct goal, and both are important. Look for a lot more research on these topics in the next few years.

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