Improving Effectiveness in Communicating Risk to Patients

Objective: To review approaches and tools that pharmacists may use in communicating evidence of risk to older patients and their caregivers.

Data Sources: Relevant publications related to tools to communicate evidence to patients were identified through a systematic MEDLINE and Internet search engines using key words: evidence-based medicine/practice, patient, and risk communication. Additional articles were identified through use of the PubMed “related articles” feature and a review of citations of previously identified articles.

Study Selection and Data Extraction: Relevant English language publications were reviewed, with particular focus on articles about older adults.

Data Synthesis: Communicating evidence from clinical trials to patients remains a challenge because of patient- and clinician-related barriers. Communicating with older adults faces additional challenges: perceptions of patient involvement in care and uncertainty of drug benefit-to-risk ratio because of the potential increase in adverse events. This is especially true in this population because of their multiple medical conditions. To actively involve patients in health care decisions, an ordered approach to teaching risks and benefits can be valuable. Evidence presented as a general risk estimate should be reinforced with specific numbers to depict patient-specific risk. Understanding may be strengthened with visual aids such as risk ladders or perspective scales. Each step in the process serves as a framework and should consider patients' individual values and beliefs.

Conclusions: For patients to fully understand medications' risks and benefits, clinicians must use a systematic approach to present data from clinical trials and reinforce patients' comprehension using visual aids. Ultimately, these approaches and tools aim to support patient involvement in health care decisions.

Abbreviations: EBP = Evidence-based practice, FDA = Food and Drug Administration, HRT = Hormone-replacement therapy, NNH = Number needed to harm, NNT = Number needed to treat, WHI = Women's Health Initiative.

Consult Pharm 2008;23:37-43.