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Effective risk communication to service users : a systematic review
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Antecedentes A comunicação do risco é uma necessidade no contexto clínico. A discussão dos prós e contras de um determinado procedimento e a percepção do risco por parte do doente constituem a pedra angular do processo de decisão partilhada. Por conseguinte, é necessário compreender quais são as melhores estratégias que permitem uma melhor compreensão do conceito de risco por parte do doente. Objectivos O objectivo deste estudo é compilar sistematicamente a melhor informação disponível publicada nos últimos cinco anos para avaliar quais são as melhores estratégias para comunicar risco aos doentes na prática clínica. Métodos As bases de dados Embase e MEDLINE foram pesquisadas em busca de ensaios clínicos aleatorizados, que comparassem dois ou mais métodos qualitativos ou quantitativos de comunicação de risco a doentes adultos ou outros utilizadores de serviços, bem como a familiares ou prestadores de cuidados. As intervenções foram classificadas como visuais, verbais, numéricas, ferramentas utilizadas ou intervenções mistas. As informações sobre os outcomes e os tipos de outcomes primários (conhecimento dos riscos/benefícios, alterações na saúde, decisões e opiniões e sentimentos) e os seus resultados foram sintetizados. Resultados Após o processo de selecção, foram incluídos 25 estudos. Destes, 10 (40%) estudos avaliaram métodos visuais, 5 (20%) técnicas verbais, 5 (20%) utilizaram ferramentas e 7 (28%) centraram-se em estratégias mistas. Conclusões Depois de resumirmos todos os dados, concluímos que os métodos numéricos estão sub-representados nos estudos com doentes. Os recursos visuais (particularmente pictogramas/conjuntos de ícones), panfletos, imagens representativas e intervenções mistas apresentaram resultados positivos significativos. No entanto, as intervenções interactivas em computador parecem ter resultados negativos quando comparadas com intervenções não digitais. Estes resultados pretendem fornecer uma melhor visão da área de comunicação de risco e estimular mais investigação, uma vez que existe possibilidade de melhoria.
Background Communication of risk is a necessity in the clinical setting. The discussion of the pros and cons of a given procedure and the perception of risk on the patient’s side constitutes a cornerstone of the shared decision-making process. Therefore, there is a need to understand which are the best strategies that allow for a better grasp of the concept of risk on the patient’s side. Objectives The objective of this study is to systematically compile the best available information of the last five years to assess which are the best strategies for communicating risk to patients in the clinical practice. Methods Embase and MEDLINE databases were searched for randomised controlled trials, comparing two or more qualitative or quantitative methods of communicating risk to adult patients or other service users, as well as relatives or caregivers. The interventions were categorised as visual, verbal, numerical, employed tools, or mixed interventions. Information on outcomes, and primary outcome types (risk/benefit knowledge, health changes, decision, and opinions and feelings) and results were summarised. Results After the screening process, we included 25 studies. Of these, 10 (40%) studies evaluated visual methods, 5 (20%) verbal techniques, 5 (20%) employed tools, and 7 (28%) focused on mixed strategies. Conclusions 3 After summarising all data, we concluded that numerical methods are underrepresented in studies with patients. Visual aids (particularly pictograms/icon arrays), pamphlets, representative pictures, and mixed interventions presented significant positive outcome results. However, computer based interactive interventions seem to have negative results when compared to non-digital interventions. These results intend to provide a better insight into the risk communication field and stimulate further research, as there is room for improvement.
Background Communication of risk is a necessity in the clinical setting. The discussion of the pros and cons of a given procedure and the perception of risk on the patient’s side constitutes a cornerstone of the shared decision-making process. Therefore, there is a need to understand which are the best strategies that allow for a better grasp of the concept of risk on the patient’s side. Objectives The objective of this study is to systematically compile the best available information of the last five years to assess which are the best strategies for communicating risk to patients in the clinical practice. Methods Embase and MEDLINE databases were searched for randomised controlled trials, comparing two or more qualitative or quantitative methods of communicating risk to adult patients or other service users, as well as relatives or caregivers. The interventions were categorised as visual, verbal, numerical, employed tools, or mixed interventions. Information on outcomes, and primary outcome types (risk/benefit knowledge, health changes, decision, and opinions and feelings) and results were summarised. Results After the screening process, we included 25 studies. Of these, 10 (40%) studies evaluated visual methods, 5 (20%) verbal techniques, 5 (20%) employed tools, and 7 (28%) focused on mixed strategies. Conclusions 3 After summarising all data, we concluded that numerical methods are underrepresented in studies with patients. Visual aids (particularly pictograms/icon arrays), pamphlets, representative pictures, and mixed interventions presented significant positive outcome results. However, computer based interactive interventions seem to have negative results when compared to non-digital interventions. These results intend to provide a better insight into the risk communication field and stimulate further research, as there is room for improvement.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Comunicação de risco Utilizadores de serviços Revisão sistemática