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- Use risk descriptors cautiously (such as high chance, low chance, etc.).
When using risk descriptors, include qualifiers regarding your “own percep-
tions of context and severity, and acknowledgement that this may be mark-
edly different from that of [the] client,” and always provide numeric
probability as well. - Resist conflation of concepts—Be aware that “when we are providing numbers
in the context of risk communication...we are providing information only about
the numeric probability of an event—not about the broader concept of ‘risk,’
which would include severity, context, and potentially other factors too...we
have a responsibility to make the conceptual distinction...between risk and prob-
ability explicit for both ourselves and our clients, by being careful about the
language we use relating to the numbers (i.e. not referring to them as risks, but
probabilities or chances)....” - Know that risk perception is not just about the numbers. Help patients make
emotionally inclusive decisions—risk perception involves more than rational
and logical processing of numeric probabilities. “Perhaps, rather than encourag-
ing clients to make logical decisions based on accurate estimation of numeric
probability, we should be ensuring that our clients make the best possible— emo-
tionally inclusive—decisions that they can, based on thorough, conscious aware-
ness of their perceptions of context and nature of outcome.”
7.2.2 Factors that May Influence Patient Decision-Making
A number of patient factors may affect how patients and family members perceive
their risk.
- Cognitive functioning: for example, the extent to which the patient thinks
abstractly and mathematically, abilities that are related to intelligence and
education. - Emotional impact: Etchegary and Perrier ( 2007 ) cite evidence that “...people do
not always process information, particularly threatening health information, in a
deliberate, systematic way. For example, we are frequently motivated to process
threatening health information in a self serving manner that allows us to down-
play or deny our risk of disease...[One reason is that] messages that contain
threatening health information appear to evoke defensive cognitive processing.
We may respond by downgrading the seriousness of the illness or the validity of
the diagnostic test...scrutinize more carefully the threatening information or
generate counterarguments and alternative explanations to discredit it...we may
also selectively generate information about ourselves and others in ways that
allow us to believe we are at low relative risk for illness...” (pp. 420–421). - Temperament and personality: for example, pessimists may inflate risk figures,
while optimists underestimate their risks; achievement-oriented individuals may
believe they can beat the odds, while failure-threatened individuals believe there
is little to no chance of winning.
7 Providing Information and Facilitating Patient Decision-Making