Case 16- communication Flashcards
Risk
The exposure to the possibility of loss, injury or other adverse or unwelcome circumstances. The chance or situation involving such possibilities
The challenges in communicating risk
- Data = can be hard to find right sources + depends on how the data is presented
- Perception of risk
- Understanding terms- people have different understanding of basic terms
- Statistics- using frequencies rather than percentages is best when communicating risk. Instead of 1% of women will get breast cancer, think of 100 women 1 will have breast cancer.
- Cognitive biases
What influences your perception of risk
- Doctors influence- culture, own personality, previous experience, assumptions
- Patients perspective- culture, personality, personal experiences, social networks, media reporting, fear of a particular disease, false trust in technology, avoidance of regret (test freely available so don’t want to miss the opportunity).
Problems with communicating about risk- understanding terms
Clinicians can use qualitive expressions of possibility like ‘common’ and ‘rare’ quite loosely, best to change them into figures
Cognitive bias
- Anchoring effect- people may anchor onto the first bit of information they hear when making decisions.
- Availability bias- people judge the event as more likely or probable if its easily bought to mind
- Optimism bias- it wont happen to me
Talking about risk- mico skills of an explanation
Important to use the micro-skills of giving an explanation when talking about risk:
• Assess patient’s starting point – what do they know already about possible bad outcomes and the probability something will occur.
• Signpost to discussing risk further
• Chunk and check
• Give information with permission – how much does the patient want to know
• Avoid jargon
• Use visual methods to convey information
• Check understanding at end
Talking about risk- the effect of framing
Positive framing would be saying how many people are likely to survive, negative framing would be saying how many people are likely to die. Interventions tend too be more persuasive with positive framing i.e. 92 out of 100 patients having this procedure had a good recovery. Screening messages tend to be more effective with a loss message i.e. not having a mammogram increases your risk of dying from cancer
Communicating about risk- use of geographical presentations
Palin chart- display a picture of 100 people, colour in the one who will get the disease. Good for showing statistics, it ditches the illusion of certainty
Communicating about risk- use of patient decision aids
Can take up a lot of paper and be quite expensive if you print them out. Aids the patient in shared decision making
Making it personal to the patient- i.e. using the QRISK calculator to measure hance of heart attack or stroke.
The key techniques in communicating risk
- Use natural frequencies rather than percentages (e.g. 3 out of 10 rather than 30%)
- Frame information appropriately
- Use absolute risk rather than relative risk
- Use decision aids
- Make it personal to the patient
Importance of undersatnding risk
1) Helps with shared descision making and identifying patient preference
2) Patients choosing surgery who are at high risk of dying (predicted 30 day mortality >1%) should be identified by age, type of surgery and additional medical conditions.
3) Important to not just talk about the risk but discuss what the risk means to the individual in front of them.
The core shared descision making skills
- Choice talk- introduce the idea of choice, patients often don’t realise they have a choice. Explore, ‘what is important to you.’
- Options talk- detailed risk and benefit of each option, check understanding. Introduce support/decision aids if it helps
- Preference / Decision talk- summarise and check preferred next step, move to making a decision.
Benefits of having a patient who is better informed/engaged
They are: • More knowledgeable • More likely to adhere to treatment • Have reduced decision conflict • Have better outcomes
The role of health practitioner teams in notifiable disease monitoring and control
Local Health Protection Teams lead public health England’s response to all health related incidents.
- They provide specialist support to prevent and reduce the impact of:
- Infectious diseases
- Chemical and radiation hazards
- Major emergencies - HPTs can help with:
- Local disease surveillance
- Maintaining alert systems
- Investigating and managing health protection incidents and outbreaks
- Implementing and monitoring national action plans for infectious diseases at local level
Notifiable disease
A disease that must be reported to public health authorities at the time it is diagnosed because it is potentially dangerous to human or animal health
Examples of UK notifiable diseases
Cholera, Diptheria, Plague, Mumps, Rubella, Whooping cough, Rabies etc (32 in total)
There is also a lot of notifiable organisms
The process of reporting notifiable infectious diseases
1) Complete a notification form immediately on diagnosis
2) Pass the notification to PHE within 3 days of a case being notified or 24 hours for urgent cases
When should you report a notifiable disease
When there is a suspected case of a notifiable disease. You don’t need to wait for a laboratory confirmation
Why it is important to record notifiable diseases
- It initiates a response by Public health England
- Tracing of the source of the disease and the prevention of spread to others
- Disease monitoring so that outbreaks can be detected early and acted upon
- Incidence of disease can be monitored to assess its abundance and to assess the effect of public health interventions, such as vaccination programmes
