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Chapter 3 - Show Me the Data

Tips for Discussing Numerical Risk in Critical Care

Published online by Cambridge University Press:  27 May 2021

Matthew N. Jaffa
Affiliation:
Hartford Hospital, Connecticut
David Y. Hwang
Affiliation:
Yale University, Connecticut
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Summary

Shared decision-making involves using the best scientific evidence available to make a choice together with the patient or their surrogate, while weighing the options against the patient’s values, preferences, and goals. A lion’s share of the process, therefore, must be devoted to conveying the clinical information and the science surrounding the available options to the patient, or their surrogate, as is often the case in critical care. There are multiple pitfalls to be aware of when conveying numerical risk to patients and families that can impede their decision-making ability. First, numeracy -- an aspect of literacy that deals specifically with understanding numbers -- can be very poor, even among highly educated people, creating a barrier to comprehending clinical information. Second, the manner in which numerical data are presented can easily manipulate the cognitive biases of patients and their surrogates, limiting their autonomy. Third, clinicians may often present their interpretation of numerical risk rather than the actual data, corrupting the step in shared decision-making where we elicit values and preferences from the patient, imprinting their own values instead. In this Chapter, we explore these issues and discuss ways to optimize the presentation of numerical information.

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Publisher: Cambridge University Press
Print publication year: 2021

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