Strengths and gaps in physicians’ risk communication: a scenario study of the influence of numeracy on cancer screening communication

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Title: Strengths and gaps in physicians’ risk communication: a scenario study of the influence of numeracy on cancer screening communication
Authors: Petrova, D
Kostopoulou, O
Delaney, BD
Cokely, ET
Garcia-Retamero, R
Item Type: Journal Article
Abstract: Objective. Many patients have low numeracy, which impedes their understanding of important information about health (e.g., benefits and harms of screening). We investigated whether physicians adapt their risk communication to accommodate the needs of patients with low numeracy, and how physicians’ own numeracy influences their understanding and communication of screening statistics. Methods. UK family physicians (N = 151) read a description of a patient seeking advice on cancer screening. We manipulated the level of numeracy of the patient (low v. high v. unspecified) and measured physicians’ risk communication, recommendation to the patient, understanding of screening statistics, and numeracy. Results. Consistent with best practices, family physicians generally preferred to use visual aids rather than numbers when communicating information to a patient with low (v. high) numeracy. A substantial proportion of physicians (44%) offered high quality (i.e., complete and meaningful) risk communication to the patient. This was more often the case for physicians with higher (v. lower) numeracy who were more likely to mention mortality rates, OR=1.43 [1.10, 1.86], and harms from overdiagnosis, OR=1.44 [1.05, 1.98]. Physicians with higher numeracy were also more likely to understand that increased detection or survival rates do not demonstrate screening effectiveness, OR=1.61 [1.26, 2.06]. Conclusions. Most physicians know how to appropriately tailor risk communication for patients with low numeracy (i.e., with visual aids). However, physicians who themselves have low numeracy are likely to misunderstand the risks and unintentionally mislead patients by communicating incomplete information. High-quality risk communication and shared decision making can depend critically on factors that improve the risk literacy of physicians.
Issue Date: 1-Apr-2018
Date of Acceptance: 1-Aug-2017
ISSN: 0272-989X
Publisher: SAGE
Start Page: 355
End Page: 365
Journal / Book Title: Medical Decision Making
Volume: 38
Issue: 3
Copyright Statement: © The Author(s) 2017. Published by Sage. The final, definitive version of this paper has been published inMedical Decision Making by Sage Publications Ltd. All rights reserved. It is available at:
Sponsor/Funder: Cancer Research UK
Funder's Grant Number: C33754/A12222
Keywords: cancer screening
risk communication
1117 Public Health And Health Services
1402 Applied Economics
Health Policy & Services
Publication Status: Published
Appears in Collections:Division of Surgery
Faculty of Medicine

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