When patients are facing a cancer diagnosis, they often need help understanding their treatment options as well as the risks and benefits of each choice. Treatment decisions can become fraught with emotion and cognitive difficulties. In addition, many Americans have low numeracy and health literacy skills. To assist clinicians, here are some strategies that can improve patients’ understanding of the information they’re given:
Use plain language. When using written and verbal materials, plain language will be more understandable for patients. Present information in a jargon-free yet respectful way to ensure trust and make messages less ambiguous.
Use absolute risks. For example, instead of saying a particular drug will cut their risk in half, say a drug will lower their risk of cancer from 4% to 2%. This information puts the data you’re sharing in better perspective. Inform patients of the exact benefit that may be obtained from using the drug.
Use visual aids. Presenting information in pictographs can help people understand the meaning behind the numbers. People learn by different methods. Visualization may make a greater impact than statistics alone.
Use frequencies. Presenting risks in frequencies rather than percentages may increase patients’ understanding of their risks. Instead of saying 60% of men who have a certain treatment will have a specific side effect, have them imagine 60 of 100 men in a room having this side effect.
Highlight additional risks. Provide patients with additional or incremental risks of treatment from preexisting baseline levels. Ensure that the risk number you’re presenting is the risk due to the treatment and not a risk they would face regardless.
Order matters. Preliminary research suggests that the last thing patients hear is most likely to stick with them when they leave your presence. Have patients consider all of the information and statistics you’ve shared with them before they leave so that their risk perceptions are accurate.
Summarize options. In many cases, patients will be presented with several treatment options. Write up a summary of the risks and benefits of the treatments you’ve discussed. Another option is to help patients take notes or put together this information.
Individualize risks. Clinicians should recognize that comparative risk information, such as what an average person’s risk may be, can be more persuasive than informative. It’s important to provide information that applies specifically to the patient you’re working with, if at all possible.
Present only what’s needed. Providing too much information can overwhelm patients. Focus on the information and treatment options that are relevant to decision making for each individual patient.
Pay attention to risk–time intervals. It’s important to remind patients that their risks may change over time. What may seem like a small risk over the next year or so to the patient may actually be much larger when it’s considered in the context of a lifetime.
It’s the responsibility of all providers who assist in decision making for cancer patients to be familiar with effective methods for presenting data so that patients can use it to make informed and preference-sensitive decisions (see also, Patients Becoming Better Healthcare Consumers). The better we present information to patients, the more likely they’ll be to make the best treatment decisions for themselves.
Readings & Resources (click to view)
Fagerlin, A. Zikmund-Fisher BJ, Ubel PA. Helping patients decide: ten steps to better risk communication. J Natl Cancer Inst. 2011 19 Sep [Epub ahead of print]. Available at: http://jnci.oxfordjournals.org/content/early/2011/09/19/jnci.djr318.abstract.
Heyn L, Finset A, Eide H, Ruland CM. Effects of an interactive tailored patient assessment on patient-clinician communication in cancer care. Psychooncology. 2011 Sep 15 [Epub ahead of print].
Song L, Hamilton JB, Moore AD. Patient-healthcare provider communication: perspectives of African American cancer patients. Health Psychol. 2011 Sep 5 [Epub ahead of print].
Zhang AY, Zyzanski SJ, Siminoff LA. Ethnic differences in the caregiver’s attitudes and preferences about the treatment and care of advanced lung cancer patients. Psychooncology. 2011 Aug 10 [Epub ahead of print].
Russell BJ, Ward AM. Deciding what information is necessary: do patients with advanced cancer want to know all the details? Cancer Manag Res. 2011;3:191-199.
Powazki RD. The family conference in oncology: benefits for the patient, family, and physician. Semin Oncol. 2011;38:407-412.