A commentary published Sept. 19 in the Journal of the National Cancer Institute reveals that oncologists and their patients are more and more challenged with making difficult decisions regarding screening, prevention and treatments, as the majority of patients do not posses adequate knowledge nor the means of translating the information they do have in a qualitatively and quantitatively useful way.

To overcome these communication problems, Angela Fagerlin, Ph.D., of the Center for Bioethics and Social Sciences in Medicine at the University of Michigan and the VA Ann Arbor Center for Clinical Management Research and her team developed 10 important recommendations. The methods used have improved patients’ understanding of the information they received when asked to make important decisions.

To tackle the problems arising when physicians need to present complex medical information, the researchers first outline these problems and then translate the information into simple terms because most patients fail to comprehend health literacy and cannot understand what doctors convey to them. This in turn makes it difficult for patients to fully understand reading materials they receive from health providers. In addition, patients often tend to have insufficient numeric skills preventing them to properly evaluate useful statistics, such as risk and benefit statistics.

Researchers therefore recommend for doctors to use plain language in their written and verbal materials, to make the information easier to understand and to present patients only with information that is relevant to them. According to the researchers the order in which doctors present types of information is also important. They cite the “recency effect,” which proves that patients have a better memory of the most recent information presented to them.

Another recommended strategy is to present information in terms of absolute risks, i.e. the specific chances of developing the disease under different circumstances instead of informing patients of the relative risks, e.g., “50% greater risk”. According to research, presenting patients with relative risks leads patients to view the risk reduction as larger and treatments more favorably, which can inappropriately influence patients and physicians to choose treatments.

The authors make another vital point stressing that doctors must always emphasize the time-element to their patients, as patients may make different decisions based on the time period they have been presented with, e.g. presenting a patient’s lifetime risk instead of the risk within a ten-year interval can lead to different perception of the risk in a patient’s mind.

The authors conclude that their commentary does not represent a systematic review of the literature; instead they focus on some of the most commonly accepted recommendations for risk communication. They summarize:

“We believe it is the responsibility of all cancer educators, decision aid developers, and clinicians to be familiar with the growing body of rigorous research that has tested effective methods of presenting probabilistic information, so that patients can use it to make an informed decision.”

Written by Petra Rattue