{"id":2401,"date":"2020-10-16T13:20:23","date_gmt":"2020-10-16T20:20:23","guid":{"rendered":"https:\/\/phcprimarycare.org\/?p=2401"},"modified":"2020-10-16T13:20:23","modified_gmt":"2020-10-16T20:20:23","slug":"informed-consent-alternatives-to-weighing-risk-and-benefits","status":"publish","type":"post","link":"https:\/\/phcprimarycare.org\/?p=2401","title":{"rendered":"Informed Consent: Alternatives to “Weighing Risk and Benefits”"},"content":{"rendered":"

By Robert L. Moore, MD, MPH, MBA, Chief Medical Officer<\/strong><\/p>\n

“Beware of words – they are dangerous things. They change color like the chameleon, and they return like a boomerang.”<\/strong><\/p>\n

–Dr. William Osler<\/strong><\/p>\n

The words we choose to use in our interactions with patients convey underlying meaning. Sometimes this underlying meaning can affect patient decision-making in unintentional ways.<\/p>\n

In an editorial in the September 8, 2020 edition<\/a> of JAMA, entitled \u201cImproving Physician Communication About Treatment Decisions: Reconsideration of \u201cRisks vs Benefits,\u201d the authors argue that the commonly-used phrase \u201crisks vs benefits\u201d implies that harms from a procedure are possible, but the benefits are assured.\u00a0This asymmetry would be corrected by using the phrase, \u201cweighing the chance of harm and chance of benefit\u201d of a particular intervention.<\/p>\n

One physician responded to the editorial, noting that additionally, the \u201cchance of harm if nothing is done\u201d must also be accounted for, if a complete picture of the probabilities to be weighed is to be presented.<\/p>\n

This may be the most accurate presentation of everything a patient must consider, but humans have difficulty understanding what the probability<\/em> of an outcome really means. Experts in shared decision-making recommend using visual representations of probability, or comparing the probability to something more understandable, like the probability of a car accident while driving home.<\/p>\n

Such devices may still be too hard to grasp for patients seeking certainty<\/em> when making decisions.\u00a0Such a desire for certainly is a big driver of vaccine hesitancy, in which the absence of certainty of safety of an intervention is used to default to not taking action.<\/p>\n

Logically, a decision of whether to act or not should balance the chances of harm or benefit of the intervention, accounting for the chances of harm of no action. In reality human brains are generally wired to choose to not take action if they are not certain of what they want.\u00a0Psychologists call this omission bias<\/em>, the tendency to favor an act of omission (inaction) over one of commission (action).<\/p>\n

Of course, this is just one of many biases, which come into play in the clinical interaction between clinician and patient that may impact the patient\u2019s willingness to undergo an intervention.<\/p>\n

Nonetheless, changing our language from \u201cweighing risks vs benefits\u201d to \u201cconsidering the chance of\u00a0harm and the chance of benefit of the intervention with the chance of harm of doing nothing\u201d may help some patients weigh their options in making therapeutic decisions.<\/p>\n","protected":false},"excerpt":{"rendered":"

By Robert L. Moore, MD, MPH, MBA, Chief Medical Officer “Beware of words – they are dangerous things. They change color like the chameleon, and they return like a boomerang.” –Dr. William Osler The words we choose to use in … Continue reading →<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[1],"tags":[],"class_list":["post-2401","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"yoast_head":"\nInformed Consent: Alternatives to "Weighing Risk and Benefits" - PHC Primary Care Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/phcprimarycare.org\/?p=2401\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Informed Consent: Alternatives to "Weighing Risk and Benefits" - PHC Primary Care Blog\" \/>\n<meta property=\"og:description\" content=\"By Robert L. 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