Health Risk Communication

• Risk Communication in the Healthcare Setting
• Risk Communication in the Community Setting
• Related Links

One of the more commonly addressed issues of patient-clinician interaction is the skill with which physicians communicate bad news to patients. Probably more common for most physicians, however, is the need to effectively convey reassuring information when the available medical evaluation suggests the absence of a catastrophic or rapidly progressive problem. This process is known as risk communication. It is the science of communicating information about risk under circumstances involving some combination of low trust, high concern, perceived crisis, or differential interpersonal power.

Nearly all clinicians regularly encounter patients under conditions of high concern, low trust, perceived crisis or differential interpersonal power. Clinicians can learn to improve their capacity for effective doctor-patient communication about risk, disease, and prognosis from the burgeoning literature on risk communication.

We've gathered some training material that we hope will help you learn how to effectively communicate deployment-related health concerns to patients.

• Videos
  • Clinical Risk Communication Presentation (Deployment Health Clinical Training Series, Jan 04). This briefing covers the use of risk communication principles in a clinical setting to improve communication between health care providers and patients, especially in situations involving patients with high levels of concern and low trust. The briefing defines risk communication, explains how it can improve clinical care and offers tools to help clinicians communicate more effectively. It includes a written script, slide presentation, and a video.
  
  
  
  • Clinical Health Risk Communication: A Tool to Improve Health Care Communication. This is a 44 minute videotape presentation of a lecture on clinical risk communication that was presented on 6 June 2003 as part of the Deployment Health Guest Lecturer Program at Walter Reed Army Medical Center. It covers the definition and principles of risk communication and includes 3 video vignettes followed by discussion regarding use of risk communication in a clinical setting.
  
  
  
  • Health Risk Communication - Talking with Patients About Environmental Concerns. Two-hour videotape of live 2003 broadcast jointly developed by VA and DoD to help improve communication between healthcare providers and their patients. The principles of health risk communication are shown in video vignettes, each of which is followed by a panel discussion of the key points.
  
  
  
  • Think Cultural Health (Sponsored by Department of Health and Human Services (DHHS) Office of Minority Health. Provides the opportunity for a wide variety of groups (e.g., physicians, nurses, social workers) to earn free continuing education credits in the field of cultural competency.)
  
  
  
• Articles
  • Preparing to Work with Veterans A section on the Addiction Technology Transfer Center (ATTC) Network Web site that focuses on steps that the civilian clinician can take to work with veterans in ways that respect the individual, the military culture, and the veteran’s experience in the theater of war.
  
  
  
  • American Medical Associations, Health Literacy and Patient Safety: Help Patients Understand, Manual for Clinicians, 2nd edition, 2007 Communication is essential for the effective delivery of health care, and is one of the most powerful tools in a clinician's arsenal. Unfortunately, clinician's level of communication and a patient's level of comprehension. Tthis manual reviews the problem of health literacy, its consequences for the health care system, and the likelihood that a clinician's practice includes patients with limited literacy. The manual then provides practical tips for clinicians to use in making their office practices more "user friendly" to patients with limited literacy, and gives suggestions for improving interpersonal communication between clinicians and patients.
  
  
  
  • Communicating the Uncertainty of Harms and Benefits of Medical Interventions. There is growing interest in shared medical decision making among patients, physicians, and policy makers. Little is known about the optimal approaches to or outcomes of communicating uncertainty about the risks and benefits of treatments. The authors reviewed the literature on various issues related to uncertainty in decision making and current practices and recommendations by expert groups on communicating uncertainty. Med Decis Making 2007; 27; 681 originally published online Sep 14, 2007.
    
    
  • Risk Communication in the Clinical Consultation. A critical contribution to better informed decisions by patients is the effective communication of risk in the clinical consultation. This is not straightforward, but there is a growing evidence base to improve performance in this area to the benefit of both patients and clinicians. The purpose of this review is to provide an accessible and practical guide to better communication of risk by clinicians. Clinical Medicine Vol 5 No 5 September/October 2005.
    
    
  • Adherence: Addressing a Range of Patient Health Behaviors. This fact sheet was developed by the Uniformed Services University for the Health Sciences (USUHS) to assist providers identify "teachable moments" when they can educate patients about this important health behavior and its implications for individual, family, and community health
    
    
  • Patient-Physician Communication: Why and How. This article briefly reviewis current data on the benefits of effective communication in the clinical context of physicians caring for patients. The authors then offer specific guidance on how to achieve effective communication in the patient-physician relationship.  Journal of the American Osteopatic Association (JAOA) Vol 105  No 1 January 2005.
    
    
  • Providers Plan Better Health Risk Communication. This article in U.S.Medicine October 2002 describes a conference regarding ways to mprove communication between providers and patients about health risks. The conference was co-sponsored by the DoD Deployment Health Clinical Center and the Department of Energy.
    
    
  • Treating People With Information: an Analysis and Review of Approaches to Communicating Health Risk Information.   The communication of risk information is a fundamental aspect of nearly all health promotion interventions. However,no consensus exists regarding the most effective way to provide people with risk information. This article reviews and evaluates the relative merits of two approaches to risk communication. Journal of the National Cancer Institute Monographs No. 25, 1999.
    
    
  • Clinical Risk Communication: Explaining Causality to Gulf War Veterans with Chronic Multisymptom Illnesses. LTC (Dr.) Charles Engel of the Department of Defense's Deployment Health Clinical Center introduces the topic of clinical risk communication. He uses a basic illustrative model that borrows from signal theory. The approach should help clinicians develop an increased sensitivity to the ways that patients decide about risk.
    
    
  • Tips When Caring for Soldiers with Deployment-Related Health Concerns. Using a role-playing approach, this paper explores the first and second line considerations for a clinician when a patient thinks he may have a deployment-related condition.
    
    
  • When the Doctor and Patient Don't See Eye to Eye. Learn how to handle the struggle that develops between the patient and the clinician when the patient is feeling uncertain and anxious.

• A Primer on Health Risk Communication Principles and Practices. This Primer was written by the Agency for Toxic Substances and Disease Registry (ATSDR) to provide a framework of principles and approaches for the communications of health risk information to diverse audiences. It is intended for public health professionals who must respond to public concerns about exposure to hazardous substances in the environment.
• Risk Communication: A Lecture by Dr. John H. Marburger. Dr. Marburger, Science Advisor to the President, discusses his implementation of a comprehensive risk communication strategy used to rehabilitate the relationship of the Brookhaven National Laboratory to the neighboring community following its designation as a EPA Superfund Site.
  Link to /downloads/RCLecture.doc
• Centers for Disease Control and Prevention (CDC)
  • Emergency and Risk Communication (Provides training curricula and tools on crisis and emergency risk communication for healthcare providers).
  • Communicating in the First Hours: Initial Communication With the Public During a Potential Terrorism Event (The Office of Public Affairs of the U.S. Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC) have developed messages and other resources for federal, state, local, and tribal public health officials to use during a response to an emergency.)
• Navy and Marine Corps Public Health Center (NMCPHC)
  • Introduction to Risk Communication for Medical Treatment Facility Support Personnel. This power point presentation was developed by NEHC for a crisis communication class which was piloted for Medical Treatment Facilities. Although not a subsitute for the classroom experience, it is fairly self explanatory and provides additional guidelines for successfully working in these situations.
  • Risk Communication Primer – A Guide for Conveying Controversial or Sentitve Environmental, Health, and Safety Information to a Concerned Audience. NEHC developed this primer as a quick reference guide to provide a framework of risk communication principles and associated tools for use when explaining environmental, health, or safety risks to the public.
  
  
  
  • Communicating Risk About Emerging Chemicals.  This Power Point Presentation was presented at the Navy and Marine Corps Public Health Center Conference, 19 Mar 08. It defines emerging chemicals and reviews the related risk communication issues.
  
  
• World Health Organization Field Guide, Effective Media Communication during Public Health Emergencies, Jul 05 Effective media communication is a key responsibility of public health professionals and information officers, especially during emergencies. This field guide summarizes the practical steps that can be taken to strengthen and enhance efforts made in this area. The guide can act as a rapid primer document as it highlights aspects of media communication activities that are crucial during a public health emergency. The target audiences for this field guide are WHO office and field personnel who are unfamiliar with media interactions or who wish to sharpen their skills in this area. It is also intended to help public health officials in other organizations and networks to deal with the media communication aspects of public health emergencies.



• Risk Communication: Principles, Tools, and Techniques Technical Brief, 5 Feb 08

• US Army Center for Health Promotion and Preventive Medicine (USACHPPM) Health Risk Communication Program (Provides risk communication workshops, consultation and assistance with strategic risk communication planning, and risk communication resources and sample tools.
• Navy and Marine Corps Public Health Center (NMCPHC) Risk Communication Program (Provides risk communication policies, information, tools, resources, and an interactive site where individuals can ask and answer risk communication-related questions).
• Center for Risk Communication (Brings proven techniques based on decades of university-level behavioral-science research and practice to meet public and organizational communication challenges posed by public perceptions and misperceptions of risks and benefits).
• Society for Risk Analysis (A multidisciplinary, interdisciplinary, scholarly, international society that provides an open forum for all those who are interested in risk analysis. Risk analysis is broadly defined to include risk assessment, risk characterization, risk communication, risk management, and policy relating to risk, in the context of risks of concern to individuals, to public and private sector organizations, and to society at a local, regional, national, or global level).
• Center for Health and Risk Communication (The CHRC at George Mason University provides an important organizational framework for stimulating innovative health and risk communication research collaborations, health promotion intervention projects, and community interventions.)