WEEK9: Communicating Risk Flashcards
What does the GMC state about communicating to patients?
- must work with patients
- share all information they need to make decisions about their care
discuss: - their condition
- progression
- treatment options
- risk of treatment
- respect the patients decisions about their treatment and care
- listen to the patient
- respect patient views
- maximise patient opportunity
- Tailor discussions with patients according to their needs, wishes, priorities, level of understanding (condition, prognosis), nature of condition, complexity of treatment, level of risk.
- Never make assumptions: on the type of info a patient wants to hear, what’s important for them and what isn’t, and about their level of knowledge.
When obtaining consent, what does the doctor ask themselves?
- Does the patient know about the material risks of the treatment I am proposing?
- What sort of risks would a reasonable person in the patient’s circumstances want to know?
- What sorts of risks would this particular patient want to know?
- Does the patient know about reasonable alternatives to this treatment?
- Have I taken reasonable care to ensure that the patient actually knows all this?
How should risk communication be done in different situation?
• Timing: Acute illness versus less acute e.g. heavy bleeding in pregnancy
o E.g. if someone has been admitted to A&E with an acute MI, you probably will not have extensive discussions with the pros & cons etc.
• Seriousness of situation: minor illness OR screening (OR cancer treatment
• Complexity of situation
• Consequences of intervention, i.e. size of beneficial consequences vs. risk of harmful consequences
• Availability of evidence – elements of uncertainty that you may need to discuss with patients
What does high quality decision making consist of?
- Correct assessment of clinical situation by health professional and quality of evidence assessed of any solutions.
- Correct information therapy to communicate situation
- Patient made aware of consequences of no treatment and treatment
- Relevant information is required (provide info in format preferred by patient)
- Give information in form that is understood (check understanding), accurate and unbiased
- Numeric risks are communicated (in complex information)
- Patient makes decision based on accurate information and their values (ask patient if the benefits outweigh the risks)
- Explore ICE
- Defer if necessary (refer to more info, use of motivational interviewing or acquiring deliberation skills)
What should a doctor not make assumptions about?
- patient values
- the infor a patient wants
- patients knowledge
- patients understanding level
- why they have come in- doesnt always need to be about health
What do you tailor the patients needs to?
- their values, needs, wishes and priorities
- their level of knowledge about, and understanding of, their condition, prognosis and the treatment options
- the nature of their condition
- the complexity of the treatment, and
- the nature and level of risk associated with the investigation or treatment
How do you communicate risks effectively?
- explain diff between screening and diagnostic test
- don’t use descriptive terms
- signpost you will be using numerical data
- check they understand what they are being told
- use absolute risk (ACTUAL NUMBERS) rather than relative risk (PERCENTAGES)
- provide a reference group e.g. ‘this data has been studied on a group of people like you’
- invite questions
How do you facilitiate high quality decision making?
- Set the agenda: define the problem from patient’s & your perspective
- Explore existing knowledge / understanding
- Patient needs to be aware of consequences of treatment & of ‘no treatment’
- Explain situation to patient - what format does patient prefer; do they like numbers or letters? Information needs to be in a form that is understood by patient
- Information needs to be accurate & unbiased
- Complex numeric information will require more time
- Patient needs to make decision according to their own values
- The doctor assists the patient in this decision
- Discuss ‘what happens next’
