© 1999 by Oxford University Press
Journal of the National Cancer Institute Monographs, No. 25, 124-133,
1999
© 1999 Oxford University Press
Risk Communication in Clinical Practice: Putting Cancer in Context
Affiliations of authors: Department of Veterans Affairs Medical Center, White River Junction, VT; Center for Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, NH; Norris Cotton Cancer Center, Lebanon, NH.
Correspondence to: Lisa M. Schwartz, M.D., M.S., and Steven Woloshin, M.D., M.S., VA Outcomes Group (111B), VA Medical & Regional Office Center, 215 N. Main St., White River Junction, VT 05009.
CONTEXT: Clinicians are increasingly urged—even mandated—to help patients make informed medical decisions by paying more attention to risk counseling. For many, the role of risk counseling is new and unfamiliar. This effort is made more difficult given the practical constraints created by 15-minute visits and competing demands (e.g., patient's chief complaint and institutional needs). OBJECTIVE: We detail a three-part approach for improving risk communication, acknowledging the role of clinicians, patients, and other communicators (i.e., media or public health agencies). PROPOSED APPROACH: Office-based tools to help clinicians do more. We suggest two ways to help make up-to-date estimates of disease risk and treatment benefit easily available during office visits. We propose the development of a comprehensive population database about disease risk and treatment benefit to be created and maintained by the federal government. Educating patients. We propose "Understanding Numbers in Health" a tutorial that reviews basic concepts of probability and their application to medical studies to help people become better critical readers of health information. Guidance for communicators. Finally, we propose a writer's guide to risk communication: a set of principles to help health communicators present data to the public clearly and objectively. CONCLUSION: In addition to tools to help clinicians better communicate risk information, serious efforts to improve risk communication must go beyond the clinic. Efforts that help the public to better interpret health risk information and guide communicators to better present such information are a place to start.
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