Risk communication in the prevention of human error

Risk communication is the concept of effectively educating patients about the risks inherent in their care. In their paper titled Communicating risk, Haroon Ahmed and colleagues defined risk communication as ‘the open two way exchange of information and opinion about harms and benefits‘. By improving the patient’s understanding of risk, they argued that risk communication facilitates greater involvement in informed decision making and shared management plans, and it promotes ‘better decisions about clinical management’.

Two children. Jean Louis Mazieres on Flickr. https://www.flickr.com/photos/mazanto/45382299291

According to Ahmed and colleagues, there are three key components of risk communication which are:

    • ‘The probability of the risk occurring’
    • ‘The importance of the adverse event being described’
    • ‘The effect of the event on the patient’

To effectively convey these risks, Ahmed and colleagues advised physicians to make use of natural frequencies rather than percentages or probabilities; they argued that this is because natural frequencies are easier to understand, and they are much better at conveying the understanding of risks and benefits‘. Furthermore, they stated that ‘decisions based on frequencies are more informed than those based on probabilities’. With regard to conveying the expected benefits of interventions, Ahmed and colleagues favoured the use of absolute risk reduction, discouraging the use of relative risk reduction which they said exaggerates the benefits and risks of interventions.

Ladies at the table. Pedro Ribeiro Simões on Flickr. https://www.flickr.com/photos/pedrosimoes7/32194955590

One situation in which risk communication plays a vital role is in the context of screening tests. In these situations, Gurudutt Naik and colleagues advised physicians to use both verbal and numerical expression of risks, stressing that relying only on verbal descriptors carries a high risk of misinterpretation. In their paper titled Communicating risk to patients and the public, they also advocated framing the risks of testing in terms of the potential loss (loss-framed message) of not screening, and not in terms of the potential gain (gain-framed message). Other techniques they recommended for improving patients’ understanding of risks are written, video, and computer-based tools.

In faithful discussion. Carsten ten Brink on Flickr. https://www.flickr.com/photos/carsten_tb/6014049155/

Beyond the statistical approaches to conveying risks, there are several non-statistical techniques which John Paling explored in his paper titled Strategies to help patients understand risks. He advocated the following rather simple measures particularly in situations where when time is limited:

    • Explaining that most treatments carry risks
    • Clarifying what the patient understands of the risk event
    • Sharing uncertainty with the patient when the best option is not clear
    • Using a consistent population denominator
    • Using appropriate visual aids
Dialogue. Chris Sloan on Flickr. https://www.flickr.com/photos/sloanpix/25253955837

Another simple non-statistical approach to improving risk communication is what Evan Wilhelms and Valeris Reyna referred to as ‘the gist’. In their paper titled Effective ways to communicate risk and benefit, they described the gist as the ‘vague, qualitative representations that capture the meaning‘ of the risk. Adding that the gist is an essential ingredient in communicating risk, Wilhelms and Reyna argue that it is better than ‘verbatim facts‘ in improving patients’ reasoning and decision making.

Talk. Aesthetics of crisis on Flickr. https://www.flickr.com/photos/aestheticsofcrisis/19099744220/

In the next post, we will look at the patient’s role in preventing human error.

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