“there’s a time bomb inside your..................., which could go off if you...

ldquoTherersquos a time bomb inside your which could go off

if you donrsquothelliphelliphelliphelliphelliphelliphelliphelliphellip

bull have this procedurerdquo

bull take this medicationrdquo

bull have this testrdquo

lsquomaking decisions about tests and treatmentsrsquo National Health and Medical Research Council 2006

principles for better communication between healthcare consumers and

healthcare professionals

context

bull knowledge translation multiple steps between research and uptake

bull healthcare consumerprofessional interface complex communication processes

bull for consumers facing tests or treatments awareness understanding decision

Aware Accepted Applicable Able Acted on Agreed Adhered to

Studies(primary research studies)

Systems

Synopses

Guidelines

Systematic Reviews

quality improvement (eg health services

governments)

clinicians Evidence Based Practicebull asking questionsbull other EBP steps

consumersbull awarenessbull understandingbull decision

research

myths feelings and

opinions

adapted from Glasziou P Haynes B ACP J Club 2005 Mar-Apr142(2)A8-10

ACP J Club 2005 Mar-Apr142(2)A8-10

better communication between healthcare consumers and healthcare professionals

potential benefits

bull for consumers more informed decisions greater satisfaction with healthcare

bull for professionals greater professional satisfaction fewer complaints less litigation

bull for communities more lsquoappropriatersquo care doing what should be done not doing what should not be done

background NHMRC HAC resolved to develop a lsquotoolkitrsquo in 2004

bull on communicating with healthcare consumers about the risks benefits and outcomes of elective therapeutic and diagnostic interventions

bull to extend advice in previous publications General guidelines for medical practitioners on providing information to patients NHMRC 1993 10 tips for safer health care ( for consumers) ACSQHC 2003 Communicating with patients advice for medical practitioners AHECNHMRC 2004

bull for consumers (and carers and families) and clinicians

development process

bull systematic literature review to define principles

bull draft lsquotoolkitrsquo to address options for consumerclinician interactions barriers eg functional health literacy lsquoframingrsquo of data modes of communication sources of more information

bull modification after 75 responses to public consultation

bull publication and dissemination

systematic literature reviewissues

bull channels of communication (including oral print media multimedia decision aids and models but excluding nonverbal communication)

bull barriers to exchange and utilisation of information including the importance of cultural socioeconomic language and linguistic considerations for effective communication

bull efficacy and effectiveness of different communication channels content and styles for communicating the risks benefits and outcomes of elective therapeutic and diagnostic interventions between consumers and clinicians in achieving outcomes including better knowledge and satisfaction

systematic literature reviewdatabases

bull MEDLINE

bull PsycINFO

bull Cochrane Database of Systematic Reviews and Consumers and Communication Review Group

bull National Health and Medical Research Council

bull Health Technology Assessment Database

bull Centre for Reviews and Dissemination


bull IntroductionSummary scope uses structure development

bull Part 1 5 principles

bull Part 2 3 case studies (1 diagnostic and 2 therapeutic) examples of 3 interventions to illustrate each of the 5 principles

bull Part 3

further information Australian and international organisations

websites and other resources bibliography composite bibliography for Parts 1 and 2

appendicies 1) development process 2) publication dissemination and implementation strategies 3) working committee members 4) list of individuals and organisations making submissions

principles for effective communication Principle 1

good communication between healthcare consumers and healthcare professionals has many benefits

Principle 2 healthcare consumers vary in how much participation in decision-making they desire

Principle 3 good communication depends on recognising and meeting the needs of healthcare consumers

Principle 4 perceptions of risks and benefits are complex and healthcare consumers and healthcare professionals may have different priorities

Principle 5 information on risks and benefits needs to be comprehensive and accessible

5 lsquoPrinciplersquo chapters structure

bull backgroundbull what this means for healthcare consumersbull what this means for healthcare professionalsbull examplesbull putting this principle into practice

tools for healthcare consumers tools for healthcare professionals exercises based on clinical scenarios

bull find out more

clinical scenario from Principle 3 good communication depends on recognising and meeting the needs of

healthcare consumers

bull Anna is a 50year old Aboriginal woman who visits a nurse practitioner after being recalled for a check up for her non-insulin-dependent diabetes mellitus Anna is obese and has mild hypertension and a blood test shows that her blood glucose levels are poorly controlled She is on the highest doses of oral anti‑diabetic medications and most of the time she takes the medication as recommended The nurse practitioner explains to Anna that she will need to

start insulin injections to properly control her diabetes but Anna is reluctant to do so

questions for healthcare consumers

bull do I have particular cultural issues that are relevant in this consultation

bull are those issues affecting my feelings about the suggested options for treatment

bull what could I do to let the healthcare professional know about those issues

questions for healthcare professionals

bull how could I explore the source of this personrsquos anxiety

bull is there anything in what the person has told me that has cultural origins

bull if so how can I best meet the personrsquos needs

case studies of interventions

bull diagnosis prostate specific antigen (PSA) testing

bull therapy procedural coronary angioplasty pharmacological glucocorticoids

3 lsquocase studyrsquo chapters structure

bull introduction background to the case study current status of communicating this intervention

bull applying each of the 5 principles to this case study

bull hypothetical examples from consumer or professional perspectives

bull resources

bull references

dissemination

bull healthcare consumer groupsindividuals

bull healthcare professional groupsindividuals

bull educational and training groupsinstitutions

dissemination educational and training groupsinstitutions

ndash healthcare consumer groups carer organisations support groups

ndash healthcare professionals eg nurses medical practitioners dentists physiotherapists etc at undergraduate and postgraduate levels and their teachers and teaching and training institutions

ndash overseas-trained healthcare professionals eg certification boards

ndash professional development eg professional societies group practices area health services general practice divisions

ndash staff within health services

ndash medical defence organisations

ndash senior school and college students eg as part of a module about health

toolkit strengths

bull one document for consumers and professionalsbull the lsquoprinciplesrsquo focus on key issuesbull data on health literacybull lsquoframingrsquo of data

eg absoluterelative benefits of treatments

bull adaptable clinical scenarios

What do we mean by literacy and health literacy

Literacy

Health literacy


Literacy is the ability to read and write A person who has only basic literacy can do very simple things such as sign their name whereas someone who has functional literacy can recognise words and phrases in specific contexts

Health literacy is a form of functional literacy It refers to a personrsquos capacity to obtain process and understand information needed to make appropriate health decisions that is their ability to understand and act on health informationhelliphelliphellip

Being health literate means more than simply being able to read and use numbers someone who is health literate is likely to understand and use health information so that they can make the best decisions for their situation Even some well-educated people can have problems with health literacyhelliphelliphelliphelliphelliphellip Health literacy also has a cultural dimension in that some cultures do not believe lsquoacceptedrsquo medical explanations (rather than not understanding them)

toolkit strengths




changing perceptions and comprehension by lsquoframingrsquo information

understanding the difference between relative and absolute risk

what is the lsquoNNTrsquo

bull your patient is a healthy 62 years old woman who asks about preventing osteoporotic fractures As her clinician you explain to her that there 2 drugs which are known to prevent fractures

bull A will reduce her fracture risk by 50 over 3 years

bull B 1 in every 100 ( ie 1 ) women like her will have a fracture prevented if treated for 3 years

bull what is the lsquoNNTrsquo ie the lsquoNumber Needed to Treatrsquo for I person to benefit

which drug is she likely to choose




bull which drug will she probably choose A or B


bull in this case the relative data ( A 50 ) appear much more impressive than the absolute data ( B 1 ) so she is likely to choose A

bull the treatments could be identical if the risk of fracture with no treatment over 3 years is 2

bull studies show that consumers non-clinical and clinical health professionals tend to choose data with big numbers for benefits from interventions

bull relative data however cannot be interpreted without a numerator or denominator so always provide absolute data at least with relative data when necessary

advertisements often use relative data with bigger numbers

changing perceptions by lsquoframingrsquo information

Emphasising one aspect of a health decision while leaving out another may change how people understand and perceive risks and benefits This effect is called lsquoframingrsquo of information For example health information can be framed as

negative or positivefor example giving the chances of an operation failing (negative framing) versus the chances of it succeeding (positive framing) loss or gain for example emphasising the risks or disadvantages of not having a particular screening procedure (loss) versus emphasising the benefits or advantages of having the procedure (gain)


Another factor that affects how people perceive risks and benefits is whether they are presented with absolute or relative riskshelliphelliphelliphelliphelliphelliphellip

relative risk the drug reduces the chance of a heart attack by 50 absolute risk the drug reduces the chance of a heart attack from 005 (1 in 2000) to 0025 (1 in 4000) Although the drug reduces the chance of a heart attack by 50 when compared to not using the drug in real terms the risk for the individual patient is reduced from 1 in 2000 if the drug is not taken to 1 in 4000 if it is

bull you are discussing the pros and cons of having a mammogram with a 49 year old woman

bull you know that breast cancer occurs in about 11000 women of 45-50 years

bull you also know that a mammogram has a sensitivity of ~95 ( ie 5 of women with breast cancer have

a negative test) and a specificity of 95 ( ie 5 of women who donrsquot have breast cancer have a positive test)

bull what is the chance that a woman has breast cancer if the mammogram is positive (assume you know nothing else about this woman)

bull what is the correct answer 01 1 2 50 95 99 995

Limitations 1) the lsquotoolkitrsquo does not address

bull non-verbal communication during consultations

bull the specific communication needs of particular subgroups of people such as

infants children elderly

people from lower socio-economic groups

people from non-English speaking backgrounds

people from different cultures

boriginal and Torres Strait Islander people

people with low health literacy

people with mental health problem

people with intellectual disabilities

bull the complicated processes of communication when many different professionals are involved like hospitals

Limitations 2) the lsquotoolkitrsquo has 160 pages


bull each lsquoprinciplersquo section is self contained

bull the introductionsummary (~ 4 pages) will be posted separately on the NHMRC website soon


benefits bull for consumers

more informed decisions greater satisfaction with healthcare


bull for communities more lsquoappropriatersquo care doing what should be done not doing what should not be done see Trevena LJ et al A systematic review on

communicating with patients about evidence J Eval Clin Pract 2006 12 13-23

further reading

bull Making decisions about tests and treatments Principles for better communication between healthcare consumers and healthcare professionals NHMRC 2006 whole document nhmrcgovau

summary (not yet posted on website) nhmrcgovau

bull Trevena LJ et al A systematic review on communicating with patients about evidence J Eval Clin Pract 2006 12 13-23

bull Greenberg PB Walker C Buchbinder R Optimising communication between consumers and clinicians Med J Aus 2006 (in press)

bull Health Literacy see J Gen Intern Med Aug 2006

bull Cochrane consumers and communication review group

acknowledgments

bull 1) Working Committee

bull 2) NHMRC Health Advisory Committee

bull 3) Technical writers

bull 4) Systematic reviewers

acknowledgments

bull 1) Working Committeebull Dr Rosemary Aldrich

HAC public health physician journalism

bull AProfessor Rachelle Buchbinder rheumatology clinical epidemiology

bull Ms Rosemary Clerehan linguistics

bull Dr Peter Greenberg HAC general physician

bull Dr Peter Joseph HAC general practice

bull Professor Judy Lumby nursing

bull Dr Christine Walker sociology chronic disease alliance

bull Ms Ros Wood consumer

received attendance fees and travel support from NHMRC

bull 2) NHMRC Health Advisory Committee HAC members Ms Stephanie Gates Mr P Callan Ms A Peristeri Ms C Clutton

bull 3) Technical writers lsquoBIOTEXTrsquo Pty Ltd Canberra Hilary Cadman and Janet Salisbury

bull 4) Systematic reviewers National Cancer Control Initiative Dr B McEvoy and Dr F Howes La Trobe University Dr C Peterson AProf G

Murphy




ldquoTherersquos a time bomb inside your which could go off if you donrsquothelliphelliphelliphelliphelliphelliphelliphelliphellip

PowerPoint Presentation


context

Slide 5

better communication between healthcare consumers and healthcare professionals potential benefits


development process

systematic literature review issues

systematic literature review databases

Slide 11

principles for effective communication


clinical scenario from Principle 3 good communication depends on recognising and meeting the needs of healthcare consumers





dissemination


toolkit strengths

Slide 22

Slide 23

Slide 24

Slide 25



Slide 28

Slide 29

Slide 30



Slide 33

better communication between healthcare consumers and healthcare professionals benefits

Slide 35

further reading

Slide 37

acknowledgments

Slide 39

Slide 40




context






Systems

Synopses

Guidelines

Systematic Reviews


governments)



research

myths feelings and

opinions




potential benefits








development process










bull MEDLINE

bull PsycINFO









bull Part 3













bull find out more




















bull resources

bull references

dissemination












toolkit strengths





Literacy

Health literacy





toolkit strengths
























































further reading







acknowledgments





acknowledgments














Murphy







context

Slide 5



development process



Slide 11








dissemination


toolkit strengths

Slide 22

Slide 23

Slide 24

Slide 25



Slide 28

Slide 29

Slide 30



Slide 33


Slide 35

further reading

Slide 37

acknowledgments

Slide 39

Slide 40



Systems

Synopses

Guidelines

Systematic Reviews


governments)



research

myths feelings and

opinions




potential benefits








development process










bull MEDLINE

bull PsycINFO









bull Part 3













bull find out more




















bull resources

bull references

dissemination












toolkit strengths





Literacy

Health literacy





toolkit strengths
























































further reading







acknowledgments





acknowledgments














Murphy







context

Slide 5



development process



Slide 11








dissemination


toolkit strengths

Slide 22

Slide 23

Slide 24

Slide 25



Slide 28

Slide 29

Slide 30



Slide 33


Slide 35

further reading

Slide 37

acknowledgments

Slide 39

Slide 40


potential benefits








development process










bull MEDLINE

bull PsycINFO









bull Part 3













bull find out more




















bull resources

bull references

dissemination












toolkit strengths





Literacy

Health literacy





toolkit strengths
























































further reading







acknowledgments





acknowledgments














Murphy







context

Slide 5



development process



Slide 11








dissemination


toolkit strengths

Slide 22

Slide 23

Slide 24

Slide 25



Slide 28

Slide 29

Slide 30



Slide 33


Slide 35

further reading

Slide 37

acknowledgments

Slide 39

Slide 40





development process










bull MEDLINE

bull PsycINFO









bull Part 3













bull find out more




















bull resources

bull references

dissemination












toolkit strengths





Literacy

Health literacy





toolkit strengths
























































further reading







acknowledgments





acknowledgments














Murphy







context

Slide 5



development process



Slide 11








dissemination


toolkit strengths

Slide 22

Slide 23

Slide 24

Slide 25



Slide 28

Slide 29

Slide 30



Slide 33


Slide 35

further reading

Slide 37

acknowledgments

Slide 39

Slide 40






bull MEDLINE

bull PsycINFO









bull Part 3













bull find out more




















bull resources

bull references

dissemination












toolkit strengths





Literacy

Health literacy





toolkit strengths
























































further reading







acknowledgments





acknowledgments














Murphy







context

Slide 5



development process



Slide 11








dissemination


toolkit strengths

Slide 22

Slide 23

Slide 24

Slide 25



Slide 28

Slide 29

Slide 30



Slide 33


Slide 35

further reading

Slide 37

acknowledgments

Slide 39

Slide 40





bull Part 3













bull find out more




















bull resources

bull references

dissemination












toolkit strengths





Literacy

Health literacy





toolkit strengths
























































further reading







acknowledgments





acknowledgments














Murphy







context

Slide 5



development process



Slide 11








dissemination


toolkit strengths

Slide 22

Slide 23

Slide 24

Slide 25



Slide 28

Slide 29

Slide 30



Slide 33


Slide 35

further reading

Slide 37

acknowledgments

Slide 39

Slide 40










bull find out more




















bull resources

bull references

dissemination












toolkit strengths





Literacy

Health literacy





toolkit strengths
























































further reading







acknowledgments





acknowledgments














Murphy







context

Slide 5



development process



Slide 11








dissemination


toolkit strengths

Slide 22

Slide 23

Slide 24

Slide 25



Slide 28

Slide 29

Slide 30



Slide 33


Slide 35

further reading

Slide 37

acknowledgments

Slide 39

Slide 40




















bull resources

bull references

dissemination












toolkit strengths





Literacy

Health literacy





toolkit strengths
























































further reading







acknowledgments





acknowledgments














Murphy







context

Slide 5



development process



Slide 11








dissemination


toolkit strengths

Slide 22

Slide 23

Slide 24

Slide 25



Slide 28

Slide 29

Slide 30



Slide 33


Slide 35

further reading

Slide 37

acknowledgments

Slide 39

Slide 40

dissemination












toolkit strengths





Literacy

Health literacy





toolkit strengths
























































further reading







acknowledgments





acknowledgments














Murphy







context

Slide 5



development process



Slide 11








dissemination


toolkit strengths

Slide 22

Slide 23

Slide 24

Slide 25



Slide 28

Slide 29

Slide 30



Slide 33


Slide 35

further reading

Slide 37

acknowledgments

Slide 39

Slide 40









toolkit strengths





Literacy

Health literacy





toolkit strengths
























































further reading







acknowledgments





acknowledgments














Murphy







context

Slide 5



development process



Slide 11








dissemination


toolkit strengths

Slide 22

Slide 23

Slide 24

Slide 25



Slide 28

Slide 29

Slide 30



Slide 33


Slide 35

further reading

Slide 37

acknowledgments

Slide 39

Slide 40


Literacy

Health literacy





toolkit strengths
























































further reading







acknowledgments





acknowledgments














Murphy







context

Slide 5



development process



Slide 11








dissemination


toolkit strengths

Slide 22

Slide 23

Slide 24

Slide 25



Slide 28

Slide 29

Slide 30



Slide 33


Slide 35

further reading

Slide 37

acknowledgments

Slide 39

Slide 40





toolkit strengths
























































further reading







acknowledgments





acknowledgments














Murphy







context

Slide 5



development process



Slide 11








dissemination


toolkit strengths

Slide 22

Slide 23

Slide 24

Slide 25



Slide 28

Slide 29

Slide 30



Slide 33


Slide 35

further reading

Slide 37

acknowledgments

Slide 39

Slide 40





















































further reading







acknowledgments





acknowledgments














Murphy







context

Slide 5



development process



Slide 11








dissemination


toolkit strengths

Slide 22

Slide 23

Slide 24

Slide 25



Slide 28

Slide 29

Slide 30



Slide 33


Slide 35

further reading

Slide 37

acknowledgments

Slide 39

Slide 40

acknowledgments





acknowledgments














Murphy







context

Slide 5



development process



Slide 11








dissemination


toolkit strengths

Slide 22

Slide 23

Slide 24

Slide 25



Slide 28

Slide 29

Slide 30



Slide 33


Slide 35

further reading

Slide 37

acknowledgments

Slide 39

Slide 40

acknowledgments














Murphy







context

Slide 5



development process



Slide 11








dissemination


toolkit strengths

Slide 22

Slide 23

Slide 24

Slide 25



Slide 28

Slide 29

Slide 30



Slide 33


Slide 35

further reading

Slide 37

acknowledgments

Slide 39

Slide 40







context

Slide 5



development process



Slide 11








dissemination


toolkit strengths

Slide 22

Slide 23

Slide 24

Slide 25



Slide 28

Slide 29

Slide 30



Slide 33


Slide 35

further reading

Slide 37

acknowledgments

Slide 39

Slide 40

“there’s a time bomb inside your..................., which could go off if you...

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