Risk communication can be considered effective when the risk becomes meaningful to the audience, namely when it can be evaluated. The formats used to convey risk (i.e. probabilities, verbal labels or graphic devices) are not neutral, because some may have the effect of increasing the perceived probability connected with the risk while others lower this perception.

 

Effective risk communication

• the risk of having a child affected by a chromosomal anomaly (e.g. Down Syndrome, Turner Syndrome) increases with age. Women are usually advised of their risk as a “1 in X” possibility.
• the risk of transmitting either parent’s genetic disease (e.g. Cystic Fibrosis) to the foetus should be communicated (e.g. there is a “1 in 4 risk that your child is a CF carrier”)
• the increase in the risk is also communicated when patients have to choose whether to carry out invasive prenatal diagnosis (e.g. for amniocentesis, the risk of miscarriage as a result of the procedure is 1 in 100).
• risk is also communicated when a chromosomal anomaly is detected in the form of a mosaic (e.g. in 6 cases out of 20).
• all tests entail a certain risk of false positive and negative results (e.g. in 0.2% of cases the test detects an anomaly when no anomaly is actually present).

A new tutorial providing information about effective ways of communicating probability to patients in order to allow them to “attach meaning to numbers” has been realised, partially with the financial support of a 5 year grant from the European Commission (“Special Advances in Foetal and neo-natal Evaluation network”- SAFE- Project N°: LSHB-CT-2004-503243).

The tutorial is directed at:

• doctors;
• health service staff;
• all institutions in charge of clinical education.

The web tutorial includes 4 interactive units, each one dedicated to a specific type of communication technique:

1. Numerical Techniques
2. Verbal Labels and Comparison Scenario Techniques
3. Mental Imagery Techniques and the framing effect
4. Graphic Techniques

The different units have been realised on the basis of the existing psychological literature on risk communication and decision-making.

The content is illustrated using visually striking cartoons and audio effects. Practical examples of the application of such techniques to specific cases of communication in clinical practice are included, as well as multiple-choice questions to help users to evaluate the learning process.

The work has been carried out by four EU research groups:

• University of Trento, Italy: L. Savadori,  E. Barilli, S. Pighin.
• University of Zurich, Switzerland: M. Siegrist, C. Keller, P. Orlow
• Leon Kozminski Academy of Entrepreneurship and Management, Poland: T. Tyszka
• École Pratique des Hautes Etudes, France: E.Mullet

The training tool will be tested for face validity and for efficacy. The face validity test implies some expert physicians and a sample of parents of children with disabilities completing the tutorial in order to give their suggestions, especially regarding the plausibility of the situations described and the applicability to daily practice. A more standard test will also be conducted on tutorial efficacy. The degree of competence obtained in communicating risk by medical students asked to follow the tutorial will be compared with that of a control group that will not be asked to follow the tutorial.