Clinicians need to be ready and willing to help patients navigate their decisions by helping them to understand risk, benefits and what is important to them.
Writing in The New York Times, New York-Presbyterian Hospital’s Dr. Dhruv Khullar argued that a world of medical advances was leading to more uncertainties for patients to navigate at the very moment they were taking on more responsibility for their own health.
“Medicine’s decades-long march toward patient autonomy means patients are often now asked to make the hard decisions – to weigh trade-offs, to grapple with how their values suggest one path over another,” he wrote.
“Research suggests that physicians’ recommendations powerfully influence how patients weigh their choices, and that while almost all patients want to know their options, most want their doctor to make the final decision. The greater the uncertainty, the more support they want – but the less likely they are to receive it.”
Choosing your words
Addressing this disparity rests on a number of factors, including understanding the power of words during consultations.
He said: “Doctors could be more aware of how their language affects patients.
“It’s easier for patients to understand absolute risks than relative risks. Presenting choices sequentially instead of all at once seems to improve comprehension. And patients feel more confident in doctors who offer a rationale for uncertainty — describing the possible diagnoses even if the right one is unclear — than when they simply acknowledge it without explanation.”
It’s an area that was examined in detail during the recent Astellas Advocacy Breakfast, where Sarah Krug, CEO of CANCER101 spoke about the Words do Matter Project.
The group is working to redesign the healthcare lexicon after finding that many of the phrases used routinely in medical practice create a barrier to communication by meaning nothing to patients.
“The words we use have a major effect on our thoughts, perceptions, emotions and actions. We often underestimate the power of words,” said Sarah.
Tools for dealing with the uncertainties
Dr. Khullar, who is also a researcher at Weill Cornell Department of Healthcare Policy and Research, and Director of Policy Dissemination at the Physicians Foundation Center for Physician Practice and Leadership, said shared decision making (SDM) rested on coming to terms with two forms of uncertainty.
He wrote: “Uncertainty of evidence is an information problem. It’s like putting a quarter into a gumball machine and having no idea how many will come out. Maybe there aren’t good clinical trials; maybe there are trials but they don’t include patients like you.
“Uncertainty of outcome is a prediction problem. We know five gumballs are coming out, we just don’t know which ones. Let’s say five percent of patients like you will have a stroke this year. Are you the 5% or the 95%?”
As well as provide the necessary information in an appropriate format, clinicians can aid SDM by helping patients work out what is important to them. This allows them to frame the uncertainties in a way that relates to their own lives, he said.
This is something Tyler Ludlow, Founder and Chief Decision Scientist at the Decision Skills Institute, knows all about.
He recently spoke at an Astellas Advocacy Breakfast about SDM tools and tactics that can be used to bring patients more into their treatment decision making.
What is certain, Dr Khullar said, is that there will always be a level of uncertainty.
“When wading through medicine’s expansive gray zones, patients could use a guide,” he concluded.
We’re Bad at Evaluating Risk. How Doctors Can Help. (2018, April 17) Retrieved from https://www.nytimes.com/2018/04/17/upshot/were-bad-at-evaluating-risk-how-doctors-can-help.html