Shared decision making to improve the quality of decisions and the communication of risk

Research has shown that too often decisions about individual’s healthcare are made in the face of avoidable ignorance:

“Doctors know far too little about what patients want, and patients know far too little about the treatment options, outcomes, and evidence for the condition they have.”

This inevitably affects the quality of the decisions made and the likelihood of the chosen treatment providing the best outcome for that particular patient.

A critical element of information that needs to be clearly communicated to patients is the risk associated with each available treatment.

Discussions about risk can be challenging.  They should cover:

  • how probable it is that an action will give rise to harm or an adverse event;
  • the importance or consequences of that adverse event; and
  • the impact that event will have on the patient.

However, the way a risk is explained (for example, whether the emphasis is on the advantages or the disadvantages of a treatment) is vitally important. It can affect how patients understand and perceive risks and, therefore, how they compare options.

The sentences below show how the same risk can be explained either negatively or positively:

Without treatment you have a 20% chance of having a heart attack in 10 years.

or

Without treatment you have an 80% chance of not having a heart attack in 10 years.

Many people struggle with health statistics and risk. Shared Decision Making encourages a different type of conversation about risk – in particular using simplified communication techniques to ensure that the conversation is as clear as possible. This means that people will have a much better understanding about the comparative risks inherent in different types of treatment.