These days, a routine trip to the doctor’s office can easily morph into a complicated calculation of risks and benefits. With the advent of pharmaceutical advertising and the plethora of medical information on the Internet, patients have more choices and responsibility to make decisions than ever before.
Enter Cornell professor Valerie Reyna, a faculty member in human development and expert in judgment and decision-making.
Her ground-breaking research has shown that medical information is difficult to understand for people of all education levels. In laboratory studies and analyses of real-world data, Reyna has found that adults tends to make all decisions – including medical decisions – based on the overall meaning or gist of situation, instead of using statistics and details. So there is a disconnect between the way medical information is presented and the way people make decisions.
For example, the risk of dying on the table during carotid endarterectomy (a vascular surgery procedure that removes plaque from the lining of your carotid artery) is 2 percent. In one of Reyna’s studies, some patients undergoing the surgery estimated their chance of dying as 10 percent, while others estimated as little 0 percent or no risk at all. Even though zero is numerically closer to two than ten is, someone who estimates 10 percent has made a more informed choice because that person grasps the important bottom-line: the surgery involves some risk.
But Reyna has found that gists are only as good as a person’s level of knowledge or understanding. For instance, the gist that “condoms block the exchange of bodily fluids” leads people to overestimate condoms’ effectiveness against sexually transmitted diseases, because it does not take into account infections that are transmitted by skin-to-skin contact, such as human papilloma virus. In this case, the bottom line is that some infections are transmitted skin to skin, not via exchange of fluids.
Reyna wants to help bridge this disconnect and make sure patients have the kind of information they need to make solid, informed choices. She has created a web page that explains how her basic research can help patients and their physicians map our health care choices.
She also offers some tips:
- Health providers should explain options qualitatively. Instead of relying solely on numbers, it’s helpful to explain probabilities verbally, stressing the bottom-line meaning of information.
- Display information visually. Simple bar graphs and pie charts help patients extract important information without getting hung up on memorizing the details.
- Tailor the format to trigger the appropriate gist. Frame messages and choose the most suitable visual formats to convey the bottom line.
while I can understand the type of statistics referred to above, a patient is a singular individual and without more information about what the factors are that determine the statistics, the patient has no way to see how he/she connects to the statistics. While there is obviously a large difference between a 2% chance of dying from a procedure and a 10% chance, it means that there is a 90 or 98% chance of surviving…which is a very good chance, If I were told that the relative statistics were 40% for a 40 year old surviving and only a l0% chance for someone my age, 79, i would decide not to have the procedure. A friend afflicted with lung cancer had radiation therapy which was very difficult for him…and died anyway…I was told he was given the treatment because there was a l0% chance he would survive…I don’t know if he had been told about the side affects and the small chance of survival whether he would have elected to have the treatment. Statistics alone are not the answer to helping patients to make decisions…they also need to have information on side effects.