HOW DO YOU EXPLAIN RISKS?
3 tips for telling bad news
By John Paling, PhD

When it comes to explaining the risks to patients and their families, our healthcare agencies, drug companies, and doctors tend to be out of step with all other professions.

Healthcare could learn a lot from the chemical, nuclear, and water industries that have been studying effective risk communication for years. They found out long ago that getting the facts across is not as easy as you might think. In particular, if you just deliver risk information without understanding how people actually “hear” it, you can cause excessive exaggerations, apparent flip-flops around the “truth,” and costly consequences — results that are not unknown in modern healthcare.

In that light, the contrast is striking. All the other professions that have to communicate risks to the public allow only a few people to do it, and each of these is carefully trained. However, when you compare that with healthcare, almost every physician speaks to patients about risks — and yet virtually none of them has any training for it!

To add to patients’ problems, healthcare agencies set the stage by reporting on risks in ways that are widely known to produce exaggerated perceptions for both risks and benefits. In the past, healthcare has been focused on so many other advances that establishing best practices for communicating risks to patients has not been a priority.

But now that the public gets so much of its information about health issues through the media and the Web, it is time to consider some changes:

1. Take into account how patients make risk decisions. Patients make their decisions about risks after applying an emotional filter to the data. If you don’t take that into account, you may see an excessive fear totally override any consideration of the facts about benefits.

If fear were not enough of a filter, in many instances patients “hear” news through a filter of optimism. Excessive optimism can also override any caution about the risks.

2. Use visual aids to explain the risk numbers. Part of understanding risks involves getting a feel for how likely the different outcomes may be.

Again, when journalists try to help the public understand numbers, they use visuals such as bar charts and pie charts. Yet when risks are communicated in healthcare, very few patients are shown the actual numbers. Instead, they are told the percentage changes.

Take the example of women considering taking hormone replacement therapy in order to reduce the embarrassing and sometimes painful symptoms of passing through menopause.

A few years ago, mature women were terrified to learn that (among other things) hormone therapy increased a woman’s risk of breast cancer by 29 percent. This is clearly an important issue, but when you show the actual numbers using graphics, the hard numbers tell a far less worrisome story.

It turns out that in any one year, three women out of 1,000 would be expected to get breast cancer even if they did not take hormone therapy; if they did, 3.8 women out of 1,000 would be predicted to get it (the basis of the “29 percent increase”).

In other words, the added risk from taking hormone therapy was really 0.8 out of 1,000 per year (or 4 per 1,000 women over a five-year period). This risk is obviously important to know.

But showing the actual numbers on a visual aid gives a very different impression to the public than presenting them in terms of percentage changes.

3. Tell the news in positive terms. The way patients hear about risks usually is from the negative perspective (such as, “You have a three in 100 chance of something bad happening.”)

However, patients are likely to make a different decision if they are told these facts from the positive perspective, such as, “You have a 97 percent chance of not being harmed while getting the benefits of this treatment.”

Don’t hide the bad news; merely emphasize the positive.

A picture is better than a thousand words. When it comes to explaining risk, a picture may be better than any number of words.

John Paling, PhD, author of Helping Patients Understand Risks: Seven Simple Strategies for Successful Communication, is research director and founder of the Risk Communication Institute in Gainesville, Fla., www.riskcomm.com. He can be reached at johnpaling@riskcomm.com.