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Evidence-based Communication Tips

Evidence-based Communication Tips. How to not be a Spock when talking to your patients Scott Hippe , MD May 18,2019. I have no financial disclosures or conflicts of interest. Warm-up activity: take turns demonstrating the best and worst physician-patient communication you can imagine.

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Evidence-based Communication Tips

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  1. Evidence-based Communication Tips How to not be a Spock when talking to your patients Scott Hippe, MD May 18,2019

  2. I have no financial disclosures or conflicts of interest

  3. Warm-up activity: take turns demonstrating the best and worst physician-patient communication you can imagine

  4. What features of communication do your patients appreciate the most?

  5. Mazzi (2015)

  6. Mazzi (2015)

  7. Does patient-centered communication matter?

  8. Saha (2011)

  9. Saha (2011)

  10. Next warm-up activity:Communicate a 20% ASCVD risk and make a therapeutic recommendation, or make a recommendation for colon cancer screening

  11. Where are the gaps in understanding and communicating risk?

  12. Low risk patients overestimate riskHigh risk patients underestimate risk

  13. Van derWeijden (2007)

  14. Van derWeijden (2007)

  15. Describing risk qualitatively leads patients to a higher perceived risk Describing risk quantitativelyleads patients to a lower perceived risk

  16. Berry (2002)

  17. Note: probability of side effects as “very common” vs “15%” Berry (2002)

  18. Patients’ threshold level of risk at which they consider an intervention justified is higher than that of physicians Patients also expect a greater decrease in risk to make an intervention worthwhile

  19. Douglas (2012)

  20. Douglas (2012)

  21. How can the accuracy of risk communication be improved?

  22. First… a refresher on some terminology

  23. Lipkin(2014)

  24. Absolute risk reduction (ARR) is more accurate than relative risk reduction (RRR) Lipkin(2014)

  25. RRR increases risk perception compared to ARR Lipkin(2014)

  26. Including baseline risk with ARR or RRR improves accuracy and satisfaction Lipkin(2014)

  27. Number needed to treat (NNT) is less helpful when talking to patients Lipkin(2014)

  28. Qualitative risk descriptors showed lower accuracy and satisfaction as well as higher risk perception Lipkin(2014)

  29. Positive framing decreases perceived risk and increases acceptance of harmful procedures Lipkin(2014)

  30. Using denominator of 1000 led to greater comprehension than numerator of 1 or denominator of 100 Lipkin(2014)

  31. Decision Aids: tying together evidence-based risk communication

  32. https://statindecisionaid.mayoclinic.org/index.php/statin/indexhttps://statindecisionaid.mayoclinic.org/index.php/statin/index

  33. https://patientdecisionaid.org/wp-content/uploads/2016/06/CRC-Infographic-V-7-11-20-15.pdfhttps://patientdecisionaid.org/wp-content/uploads/2016/06/CRC-Infographic-V-7-11-20-15.pdf

  34. Cochrane on decision aids: “people exposed to decision aids feel more knowledgeable, better informed, and clearer about their values, and they probably have a more active role in decision making and more accurate risk perceptions” Stacey (2017)

  35. Try to make your own icon array! • http://www.nntonline.net/visualrx/ • http://www.iconarray.com/

  36. How did you do with your risk communication?

  37. Shared Decision-making

  38. What is Shared Decision-making?

  39. Do patients want shared decision-making?

  40. It depends on what type of decision

  41. Chewning (2012)

  42. It also might depend on the age of your patient

  43. Chewning (2012)

  44. Conclusions Patient-centered communication makes a difference Be cognizant of how patients perceive risk Evidence-based communication improves understanding and helps patients make decisions in line with their values

  45. Questions?

  46. References …First, a shout out to the Best Science Medicine podcast…

  47. References • Mazzi, M et al. What do people appreciate in physicians’ communication? An international study with focus groups using videotaped medical consultations. Health Expectations (2015) 18(5):1215-1226. • Saha, S et al. The impact of patient-centered communication on patients’ decision making and evaluations of physicians: a randomized study using video vignettes. Patient EducCouns(2011) 84(3):386-392. • Van derWeijden, T et al. Primary prevention of cardiovascular diseases in general practice: mismatch between cardiovascular risk and patients’ risk perceptions. Medical Decision Making (2007) 27(6):754-61. • Berry, DC et al. Provision of information about drug side-effects to patients. Lancet (2002) 359:853-4. • Douglas, F et al. Differing perceptions of intervention thresholds for fracture risk: a survey of patients and doctors. Osteoporosis International (2012) 23(8):2135-2140 • Lipkin, D et al. Evidence-based risk communication: a systematic review. Annals of Internal Medicine (2014) 161:270-80. • Stacey, D et al. Decision aids for people facing health treatment or screening decisions. Cochrane Systematic Review (2017). • Chewning, B et al. Patient preferences for shared decisions: a systematic review. Patient Education and Counseling (2012) 86(1):9-18.

  48. Thank you

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