When undergoing a surgical procedure, Dr. John Kim has an extensive conversation with his patients to ensure that there is a partnership when making choices about the type of procedure and to ensure that patient expectations can align with the realities of a procedure. In order to have these conversations, Dr. Kim will cite recent studies that will offer information about the risk of a given procedure, and explain these numbers in a way that will make it clear what is meant by these studies and translate these numbers into a tangible figure that can be used to make decisions about care. There has been an increase in research studies regarding the understanding and perception of risk. Dr. Kim feels it is important to fully inform patients of their risks and that patients should be active participants in their care. In order to improve patient satisfaction it is critical to ensure that there is a mutual understanding of the likelihood of a given outcome. A number of studies have explored this issue of patient expectations and this work has made suggestions to physicians about how to discuss these issues.
Studies in psychology have developed three approaches to understanding risk: heuristics and biases, cognitive psychology, and a psychometric paradigm [Nevid].
Heuristics are mental shortcuts that tend to focus on only one aspect of a problem and ignore the other issues [Nevid]. Heuristics and biases can have an effect on the way one understands risk. Heuristics are seen in decision making in many aspects of everyday life. For example, people may decide that a movie was good simply because a laudable actor was in the film, not because the movie was in fact exceptional. In the medical field heuristics can cause people to make decisions simply because someone they trust, the doctor, tells them this course of treatment is the best option. Marewski and colleagues wrote that patients often rely on a heuristic, trust your doctor, when it comes to making health related decisions even if it contradicts their own interests. For example, choosing to go on a physician recommended medication that may increase the likelihood that the patient will experience hot flashes, even though the patient has been battling miserable hot flashes for years with a treatment that they can no longer use with the new medication.
The cognitive psychology approach describes people’s tendency to express a much greater concern for problems that show an immediate effect on everyday life [Nevid]. The concern about the immediate is seen in the public response to environmental events. The Flint, Michigan water crises mobilized large numbers of people and politicians demanding clean water. The issue of global warming on the other hand is debated in the political sector and there is a lack of response to the impending catastrophic effects of climate change. The concern of the immediate versus taking action to prevent future problems is also seen in how risk is managed in medical decision-making. This phenomena explains why people are more concerned about acute health problems but are not as concerned about changing behavior today to prevent disease in the future. In a study by O’Brien and colleagues interviewing pre-diabetic patients about their perception of risk of developing diabetes, the authors found that patients had underestimated their risk of getting diabetes and underestimated how much time it would take to develop diabetes, which had an effect on their motivation to adopt treatment.
This approach focuses on how emotion and stigma will affect the way risk is perceived [Nevid]. For example there is a belief that genetically modified organisms (GMO) may have a threatening effect on human health including cancer or birth defects, even though there is no evidence that this is the case. The fear of genetic modification although baseless has caused some debate as to whether or not GMO foods should be labeled at the store; on one side saying that people should decide whether or not they want to consume GMOs, and others saying that by placing the label it may cause companies to lose revenue because of the stigma.
Through this approach there are three factors that determine how someone understands their risk: the degree to which the risk is understood, whether or not the risk leads to a feeling of dread, and finally the number of people exposed to this risk. In a recent study, Waters and colleagues found that patients would not pursue beneficial therapies because of the potential of the side effects associated with the treatment.
In determining how to talk about risk it is important to consider how these different psychological phenomena may affect the way risk is understood and good hinder autonomous decision making. Better understanding risk is a way to lead to better outcomes, when patients and physicians can discuss a treatment plan in concert then they will have the same expectations and be able to carry out the plan the patient desires.
Marewski, J. N., & Gigerenzer, G. (2012). Heuristic decision making in medicine. Dialogues in clinical neuroscience, 14(1), 77-89.
Nevid, Jeffrey S. (1 October 2008). Psychology: Concepts and Applications. Cengage Learning
Schwartz, P. H., & Meslin, E. M. (2008). The ethics of information: absolute risk reduction and patient understanding of screening. Journal of general internal medicine, 23(6), 867-870.
O’Brien, M. J., Moran, M. R., Tang, J. W., Vargas, M. C., Talen, M., Zimmermann, L. J., … & Kandula, N. R. (2016). Patient Perceptions About Prediabetes and Preferences for Diabetes Prevention. The Diabetes Educator, 42(6), 667-677.
Waters, E. A., Pachur, T., & Colditz, G. A. (2016). Side Effect Perceptions and Their Impact on Treatment Decisions in Women. Medical Decision Making, 0272989X16650664.