1. How Patients Discuss Their Risk: Words and Numbers
Jessica Ancker, MPH, PhD,1 Rita Kukafka, DrPH, 2 Elke Weber, PhD3
Weill Cornell Medical College, Center for Healthcare Informatics and Policy, New York, NY; (2) Columbia University Department of Biomedical Informatics New York, NY;
(3) Columbia University, Department of Psychology, New York, NY
Background
Conclusions
Results
Although patients anchored their numeric risk estimates on the number that had been presented by their hypothetical doctor, their verbal interpretations varied widely
These verbal interpretations were strongly correlated with behavioral intention to take protective action, and thus appear to reflect their understanding of the meaning of the risk
Healthcare providers should recognize this variability in the words patients use to describe a single risk number
Risk communication research often focuses on the best ways to describe risks to patients. Understanding how patients themselves use risk language can be equally valuable.
almost certain
very large
large
moderate
small
very small
almost zero
Story 1 described a risk of 29%
Participants described their own risk numerically as (median) 29% and verbally as (mode) “moderate”
However, 29% was described as anything from “almost zero” to “very large”
“Moderate” risk associated with numeric values from 10% to 90%
Objective
To examine the relationship between patients' qualitative and quantitative descriptions of perceived risk
Methods
Patients from hospital waiting rooms (n = 65) or online lab (n = 100)
Completed web questionnaire about health risks and decisions
Read short stories about personal risk of:
(Story 1) a flulike disease with a 29% chance of occurring in the short term, and
(Story 2) a cardiac condition with a 6% chance of developing over time
Were asked to estimate their own risk on:
7-item verbal scale ranging from “almost zero” to “almost certain,” and
Continuous numeric scale from 0% to 100%
References
almost certain
very large
large
moderate
small
very small
almost zero
Story 6 described a risk of 6%
Participants described their risk numerically as (median) 6% and verbally as (mode) “very small”
Risk of 6% was described as anything from “almost zero” to “moderate”
Ancker JS, Weber EU, Kukafka R. Effects of interactive graphics on risk perceptions and decisions. Medical Decision Making 2011; 31(1): • Ancker JS, Weber EU, Kukafka R. Effect of arrangement of stick figures on estimates of proportion in risk graphics. Medical Decision Making 2011; 31(1): • Ancker JS, Chan C, Kukafka R. Interactive graphics to demonstrate health risks: formative development and qualitative evaluation. Journal of Health Communication 2009; 14:
Ancker JS, Senathirajah Y et al. Design features of graphs in health risk communication: A systematic review. JAMIA 2006; 13(6):
Numeracy effects:
Verbal and numeric risk estimates were both higher among patients with low numeracy
Correlation between verbal and numeric risk estimates was not affected by numeracy (rho’s from 0.5 to 0.6)
Acknowledgments
This project was supported by National Library Medicine predoctoral fellowship LM and AHRQ R03-HS