Omitting numbers in medical communications can mislead patients

Omitting numbers in medical communications can mislead patients

When a doctor says a procedure is “rarely risky,” what does that really mean? Although terms like "common" and "unlikely" may sound descriptive enough, medical decision-making experts suggest that omitting numbers can potentially be misleading for patients.

In a paper published April 29 in theJournal of General Internal Medicine,A team of researchers and clinicians explained that patients often overestimate risk estimates, such as possible side effects or illnesses, when only verbal descriptions are given. They encourage doctors not to be afraid to include numbers and offer a list of five science-backed tricks for making those numbers count.

One of the purposes of this paper is to help physicians figure out how to communicate numerical information about risks so that patients can understand and use it to make better decisions, take charge of their health, and be healthier in the long term. “

Ellen Peters, professor in the School of Journalism and Communication and Department of Psychology at the University of Oregon

Peters, also director of the Center for Science Communication Research at the UO, draws on two decades of research on how patients understand numbers and make decisions. She said it's a common problem that patients don't understand numerical information, with about a third of American adults having limited numerical skills.

But she has found that people often prefer to be given numbers. According to their previous studies, people rated messages more trustworthy and their messenger when they provided data.

Working with physicians Paul KJ Han at the National Cancer Institute and Clara N. Lee at the University of North Carolina, Peters hopes their recommended strategies will facilitate greater shared decision-making between patients and their health care providers.

"There are a whole range of strategies you can use, some of which are more appropriate in one situation over another," she said. "But by choosing one of them, you can help people use statistics more than they normally would. Otherwise, numbers are just abstract and meaningless."

1. Communicate with numbers, not just words

Doctors often oppose verbal terms because they know that a significant portion of American adults struggle with simple numerical concepts, Peters said. However, research shows that when the numbers are discussed along with verbal descriptions, people understand risks better and respond appropriately.

"When you present numerical evidence, such as the likelihood of side effects for a prescription drug, it helps correct people's initial expectations," Peters said. “They are much less likely to overestimate the risk and more likely to follow a doctor’s recommendations.”

Do: “Headaches are a common side effect, occurring in 7 percent of people.”

Not: “Headaches are a common side effect.”

1. Make numbers more manageable

When patients are overwhelmed by medical information, they may rely on mental problem-solving techniques such as gut feelings, pre-existing beliefs, and anecdotes they have heard from others. To avoid cognitive overload, Peters suggests limiting information to what is important. If a disease has three intervention options, but a patient has a condition that eliminates one as a viable option, she advises mentioning that option.

The authors also suggest that doctors do math for their patients. For example, they can calculate the risk of birth control based on the number of years the patient expects to use it instead of the annual risk.

DO: Highlight only the most important facts and tailor information to the patient's situation.

Don't: Provide information that is not relevant to a specific patient.

1. Provide context for statistics

The numbers alone can be meaningless, so Peters suggests using evaluative labels such as "A 6 percent risk is generally considered poor" or comparisons to indicate whether it represents high or low risk.

DO: “Ninety-three percent of patients survive with treatment A compared to 99 percent who survive with treatment B.”

Not: “Ninety-three percent of patients survive with treatment A.”

1. Acknowledge uncertainty

Risk information is an estimate. In some cases, it can help convey to patients how seriously they should take the uncertainty about whether a patient is part of the 40 percent side or the 60 percent side of a risk.

Do: "Estimates of the chance of something happening are just a best guess based on the scientific knowledge we have right now. We don't know your personal true risk because you've never been studied, and we don't understand it yet."

Don’t: Present numerical risk information as uncomfortably precise and correct.

1. Test your communication using teaching techniques

Experts tend to overestimate how much other people know and how clearly they have communicated. So doctors can use the teaching technique, Peters said, by asking their patient to repeat what they understood and found important. The doctor can then insert more information to either correct what is wrong or remind them of something.

Do: "This can be hard to understand. I want to make sure I've explained it clearly. Can you tell me how you understand the pros and cons of taking drug x?"

Not: “What questions do you have?”

Such strategies can also be used by patients to advocate for themselves, Peters said. When told about a possible side effect, they may wonder how statistical it is. Giving too many possible side effects or treatments can simplify information about the most important facts.

Peters plans to conduct a series of studies to test which of the five strategies are most effective. She is also interested in how storytelling and anecdotes impact patient decision making.

“Doctors have a very limited amount of time in an appointment and are often faced with a similar patient over and over again,” Peters said. “That means if you're trying to help them communicate better with patients, you need to provide things that are quick and written so everyone can make informed decisions about their care.”

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