Healthy Skepticism Library item: 12881

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: Journal Article

Moore RA, Derry S, McQuay HJ, Paling J.
What do we know about communicating risk? A brief review and suggestion for contextualising serious, but rare, risk, and the example of cox-2 selective and non-selective NSAIDs.
Arthritis Res Ther 2008 Feb 7; 10:(1):R20
http://arthritis-research.com/content/10/1/R20

Abstract:

ABSTRACT: BACKGROUND: Communicating risk is difficult. While different methods have been proposed, using numbers, words, pictures, or combinations, none has been extensively tested. We reviewed evidence concerning risk perception and presentation, using electronic and bibliographic searches. People tend to under-estimate common risk and over-estimate rare risk; they respond to risks primarily on the basis of emotion rather than facts, appear to be risk averse when faced with medical interventions, and want information on even the rarest of adverse events. METHODS: We identified observational studies (primarily in the form of meta-analyses) with information on individual non steroidal anti-inflammatory drug (NSAID) or selective cyclooxygenase-2 inhibitor (coxib) use and relative risk of gastrointestinal bleed or cardiovascular event, the background rate of events in the absence of NSAID or coxib, and the likelihood of death from an event. Using this information we present the outcome of additional risk of death from gastrointestinal bleed and cardiovascular event for individual NSAIDs and coxibs alongside information about death from other causes in a series of perspective scales. RESULTS: The literature on communicating risk to patients is limited. There are problems with literacy, numeracy, and the human tendency to overestimate rare risk and underestimate common risk. There is inconsistency in how people translate between numbers and words. We present a method of communicating information about serious risks using the common outcome of death, using pictures, numbers, and words, and contextualising the information. Using this method for gastrointestinal and cardiovascular harm with NSAIDs and coxibs shows differences between individual NSAIDs and coxibs. CONCLUSIONS: While contextualised risk information can be provided on two possible adverse events, many other possible adverse events with potential serious consequences were omitted. Patients and professionals want much information about risks of medical interventions but we do not know how best to meet expectations. The impact of contextualised information remains to be tested.