Gesundheitsrisiken verstehen: ein Bildungsproblem; Überlegungen zum risikokompetenten Bürger

Statistisches Denken ist eine Kernkompetenz des mündigen Bürgers, der fähig ist, informiert über seine Gesundheit zu entscheiden. Zugleich unterminieren die mangelnde Fähigkeit im Umgang mit Statistiken sowie die intransparente Kommunikation von Risiken das Ideal des aufgeklärten Bürgers. Bildungsprogramme müssen daher grundlegende Konzepte im statistischen Denken vermitteln und den Bürger direkt sowie via Mediatoren mit jenen Werkzeugen ausstatten, die informierte Entscheidungen ermöglichen

Priorities for Emergency Department Syncope Research

Study objectives There is limited evidence to guide the emergency department (ED) evaluation and management of syncope. The First International Workshop on Syncope Risk Stratification in the Emergency Department identified key research questions and methodological standards essential to advancing the science of ED-based syncope research. Methods We recruited a multinational panel of syncope experts. A preconference survey identified research priorities, which were refined during and after the conference through an iterative review process. Results There were 31 participants from 7 countries who represented 10 clinical and methodological specialties. High-priority research recommendations were organized around a conceptual model of ED decisionmaking for syncope, and they address definition, cohort selection, risk stratification, and management. Conclusion We convened a multispecialty group of syncope experts to identify the most pressing knowledge gaps and defined a high-priority research agenda to improve the care of patients with syncope in the ED

Transparency in information about health

Diese Dissertation umfasst vier Manuskripte zum Thema Risikokommunikation und medizinischen Entscheidungen. Das erste Manuskript diskutiert Unterschiede, Gemeinsamkeiten und die Anwendbarkeit von drei zentralen Ansätzen, die helfen sollen, bessere Entscheidungen zu treffen (Nudging, Social Marketing, Empowerment). Das zweite Manuskript präsentiert Ergebnisse einer Medienanalyse zur Evaluation von Zeitungs- und Internetberichten in Deutschland und Spanien über die HPV-Impfung. Basierend auf vordefinierten Standards für transparente, vollständige und korrekte Risikokommunikation, deckt die Medienanalyse Schwächen in der Berichterstattung auf. Das dritte Manuskript untersucht wie Laien relative Risikoreduktionen bzw. –erhöhungen, ein Standardformt in der Medizin, verstehen. Beide Formate führen Laien und Experten in die Irre und führen zur Überschätzung der tatsächlichen Effekte. Ein diskutierter Ausweg ist die zusätzliche Kommunikation der Basisrate. Die Ergebnisse zeigen, dass das Verständnis von relativen Risikoreduktionen (-erhöhungen) mit Basisrate von dem Präsentationsformat (Prozent- vs. Häufigkeitsformat) und der individuellen Fähigkeit im Zahlenverständnis abhängt. Teilnehmer mit geringem Zahlenverständnis profitierten von der Darstellung in Häufigkeiten; Teilnehmer mit hohem Zahlenverständnis zeigen ein besseres Verständnis unabhängig des Formats. Dennoch—selbst mit Basisrate—missverstehen viele Teilnehmer die Risikoinformation. Das vierte Manuskript untersucht wie Teilnehmer Behandlungen unter Unsicherheit auswählen. Ein Einwand gegen die Kommunikation von Unsicherheit ist die Behauptung, dass Menschen Unsicherheit in Gewinnsituationen vermeiden, in Verlustsituationen dagegen suchen. Die Ergebnisse dieser Studie in Bezug auf die Auswahl von medizinischen Behandlungen konnten diese Annahmen nicht bestätigen. Darüber hinaus wählte die Mehrheit der Teilnehmer die gleiche Behandlung, wenngleich sich die zugrundeliegende Auswahlstrategie unterschied.This dissertation comprises four manuscripts focusing on health risk communication and medical decision making. The first manuscript discusses differences, commonalities, and the applicability of three major approaches to help patients make better decisions: nudging, social marketing, and empowerment. The second manuscript presents results of an evaluation of media coverage about the HPV vaccine of newspaper and Internet reports in Germany and Spain. Based on predefined standards for transparent, complete, and correct risk communication, the analysis revealed substantial shortcomings in how the media informed the public. The third manuscript centers on a standard format to communicate treatment benefits and harms: relative risk reductions and increases. Such formats have been found to misinform and mislead patients and health professionals. One suggestion is to always include information about baseline risk to reduce misunderstandings. Results show that even when baseline risk was communicated, it depended on the presentation format (percentage vs. frequency) and people’s numeracy skills whether they correctly interpreted the risk reduction (or increase). Low numerates benefited from a frequency format, whereas high numerates performed better independent of the format. Yet, a substantial proportion of participants still misunderstood the meaning of a relative risk reduction (or increase). The fourth manuscript investigated how laypeople choose between medical treatments when ambiguity is present. One objection against communicating ambiguity is the claim that laypeople are ambiguity averse in the domain of gains and ambiguity seeking in the domain of losses. Results did not find supporting evidence for this claim in medical treatment choice. Moreover, most participants selected the same treatment option, independent of numeracy. However, the underlying choice strategies varied between individuals

Risk Communication in Health

Policy makers, health professionals, and patients have to understand health statistics to make informed medical decisions. However, health messages often follow a persuasive rather than an informative approach and undermine the idea of informed decision making. The current practice of health risk communication is often biased: Risks are communicated one sided and in nontransparent formats. Thereby, patients are misinformed and misled. Despite the fact that the public is often described as lacking basic statistical literacy skills, statistics can be presented in a way that facilitates understanding. In this chapter, we discuss how transparent risk communication can contribute to informed patients and how transparency can be achieved. Transparency requires formats that are easy to understand and present the facts objectively. For instance, using statistical evidence instead of narrative evidence helps patients to better assess and evaluate risks. Similarly, verbal probability estimates (e.g., “probable,” “rare”) usually result in incorrect interpretations of the underlying risk in contrast to numerical probability estimates (e.g., “20%,” “0.1”). Furthermore, we will explain and discuss four formats – relative risks, conditional probabilities, 5-year survival rates, and single-event probabilities – that often confuse people, and propose alternative formats – absolute risks, natural frequencies, annual mortality rates, and frequency statements – that increase transparency. Although research about graphs is still in its infancy, we discuss graphical visualizations as a promising tool to overcome low statistical literacy. A further challenge in risk communication is the communication of uncertainty. Evidence about medical treatments is often limited and conflicting, and the question arises how health professionals and laypeople deal with uncertainty. Finally, we propose further research to implement the concepts of transparency in risk communication

Impact of continuous and dread risk event on cumulative population size.

<p>Development of the population size when no risky event is present (baseline), and when a continuous risk (1 individual killed from <i>t</i>₁ to <i>t</i>₅) or a dread risk (5 individuals killed at <i>t</i>₁) event occurs. A dread risk leads to a more immediate impact on cumulative population size that lasts longer compared with the continuous risk.</p

Log difference in people years lost after continuous and dread risk event (US population).

<p>Log difference in people-years lost because of continuous and dread risk, based on the US population. The dread risk killed 20% of a specific age group at once; the continuous risk killed the same total number of people over a period of 10 years. Results show that the dread risk leads to a larger loss in people-years over time across all age groups. The loss was largest when children and young adults were affected.</p

Log difference in people years lost after continuous and dread risk event (population size: 160).

<p>Log difference in people-years lost because of continuous and dread risk, by age group hit by the risk, separately for A. constant, B. increasing and C. decreasing populations. The dread risk killed 50% of a specific age group at once; the continuous risk the same total number of people over a period of ten years. A negative value of the difference indicates that the loss in people-years is larger for the dread risk; a positive value that the loss is larger for the continuous risk. Results show that dread risks lead to larger losses in people-years across time compared with continuous risks, in particular when children and young adults are affected.</p