Steven Woloshin, MD, MS; Lisa M. Schwartz, MD, MS
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-2880.
Woloshin S., Schwartz L.; Communicating Benefits and Harms of Treatment. Ann Intern Med. 2011;155:793. doi: 10.7326/0003-4819-155-11-201112060-00017
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Published: Ann Intern Med. 2011;155(11):793.
Dr. Nardone's suggestion on how to communicate risk is intended to help patients develop a sense of numbers using concrete images. For this technique to work, though, it would be important to use images that are familiar to the target audience. We doubt that most Americans know how many soldiers are in a battalion (we don't), the capacity of the field for the local AAA baseball team (we don't even know if we have an AAA team), or even the number of U.S. senators (we did know this one).
Even with familiar images, there may still be problems. Changing the denominators to accommodate chances of different magnitude may undermine communication. In our trial, people had the most trouble understanding the variable frequency format where denominators changed by orders of magnitude (for example, 100, 1000, or 10 000).
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