RSNA: Best practices for communicating dose risks to patients
“As the public’s awareness of medical radiation has increased so has radiologists’ awareness of the importance and need for wholesome benefit and risk discussions. However, communicating this information in a comprehensive manner is challenging,” said Mahadevappa Mahesh, PhD, chief physicist at Johns Hopkins Hospital in Baltimore.
Mahesh identified a series of common communication missteps for radiologists to avoid when communicating with patients, including: too much jargon; too much information; and too complicated. “Instead,” he recommended, “keep the message short and simple, and placed in context.”
Co-presenter G. Donald Frey, PhD, of the Medical University of South Carolina in Charleston, S.C., shared another critical challenge. Neither radiologists nor the media are successfully communicating the benefits of radiation.
“We [as radiologists] need to do a lot more to explain the benefits of CT. Considering only risk is one-dimensional and not of any benefit; we really need to be talking about the benefits and risks of radiation exposure,” Frey said.
Inside the patient’s mind
Mahesh peered inside the patient’s mind to help radiologists better understand what patients think and hear about radiation exposure.
The risk of radiation-induced cancer, despite the long latency period, can weigh heavily on the patient. “Patients may be afraid of the smaller, long-term risk while forgetting about the benefits of the imaging exam in the short-term,” he said.
As radiologists and clinicians communicate about radiation exposure with patients, they should note that not performing the exam also may carry risk.
Mahesh shared a few other patient pointers, which included:
- Patients often lack familiarity with radiation risk;
- They may have difficulty processing information and “not hear what is being said;”
- Patients may distrust the physician;
- People often give greater weight to negative information than positive information; and
- Perception often becomes reality.
The framing effect, or how information is conveyed, carries tremendous impact. That is, a physician might state that an exam doubles a patient’s risk of radiation-induced cancer or that it slightly increases the patient’s very small risk. Each shares the same information, but the presentation and connotations are very different.
“Even highly educated patients find it difficult to understand basic probability concepts,” said Mahesh. “Give simple, clear messages at a sixth grade level. Avoid jargon, technical terms and acronyms. Repeat key points. Actively evaluate patient understanding.”
Finally, physicians need to allot sufficient time to explaining the relevance of the procedure along with radiation exposure and risk information. “An interactive dialogue allows patients and family to ask questions. The physician can explain the impact of not undergoing the exam,” said Mahesh.