Andrew,
Another point is how patients do interpret the communication. Doctor (or
other health professional) may discuss certainty and uncertainty at the
same time. But it is important to know if it is capable of starting a
real communication which is understandable by the patient.
There is also a systematic review of risk communication interventions in
health care, that you may be aware of. Apart from the topic, they used a
meta-regression approach for data analysis which is interesting. This is
the citation:
Edwards A, Hood K, Matthews E, Russell D, Russell I, Barker J et al. The
effectiveness of one-to-one risk-communication interventions in health
care: a systematic review. Medical Decision Making 2000;20:290-7.
Regards
Arash
--
Arash Rashidian, MD
Health Services Research Scholar
Department of Health Sciences and Clinical Evaluation
Alcuin College, University of York
York, YO10 5DD, UK
Tel: +44 (0)1904 434498
Mobile: +44 (0)7786323559
Fax: +44 (0)1904 434517
http://www-users.york.ac.uk/~ar130/
Studying Adherence to Guidelines and Evidence (SAGE)
Andrew Jull wrote:
>
> Dear list
>
> Recently in NZ we have had a commission of inquiry into the misreading of
> cervical smear slides by a provinicial sole practice pathologist over a 10
> year period. I had hoped as a consequence that the public and media may have
> gained insight into the fact that diagnosis is probabilistic.
>
> More recently aggresive media response to misread prostate samples in an
> audit of histology slides at a metropolitan laboratory leads me to believe
> that no such learning took place. At recent dinner party were we got to
> discussing this, it was news indeed to the lay imbibers who all thought a
> diagnosis once given was a certainty.
>
> In musing on this, I began to wonder whether EBP had had an impact how
> diagnoses are communicated by practitioners. For instance, if a practitioner
> were to tell a patient that the chances of having a disorder is now 90%
> following a test (or that they are 90% certain the patient has the disorder
> - not sure this is the same thing though), s/he is communicating both
> certainty and uncertainty. However, my GP will usually start by saying "I
> think that ...", which seems to communicate certainty but not uncertainty.
>
> I would welcome any thoughts on this
>
> Andrew Jull
> Clinical Nurse Consultant
> Auckland Hospital
> NEW ZEALAND
>
> NB my email address has changed to [log in to unmask] Please update your
> address book.
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