Navigating Risk Communication Amidst Clinical Uncertainty: Physician Perspectives of Patient Interactions

Abstract

Objective: Communicating risk to patients can be a rather complex process given how subjective and variable its application can be by individual physicians. This is further complicated when the nature of the evidence characterizing the situation is conflicting, unknown, or evolving. This project explored how physicians conceptualize risk communication in the field of cancer care and how they attempt to effectively convey risks to their patients under situations of uncertainty. Materials and Methods: Family physicians (n=6) and oncologists (n=8) were interviewed using a series of qualitative semi-structured interviews guided by a process of convergent interviewing to facilitate the exploration of key concepts. Data were analyzed using NVivo9TM. Conclusions were generated based on an examination of areas where participants converged and diverged, and exploring the implications of these within the small sample. Results: Ideal risk communication included involving the patient in the decision making process, educating the patient, ensuring patient understanding, having the patient accept any uncertainty present and thus accepting the possible associated risks, and allowing the patient time to process the information. There was discordance regarding whether physicians should participate in shared decision making with their patients, or inform patients and then allow them to come to their own decision. Most physicians also expressed apprehensions about the process, largely in terms of whether or not patients could understand and interpret the information being presented competently enough to be truly informed about the decisions being made. Conclusions: Physicians utilized similar techniques when discussing clinical risks with their patients, yet there was a lack of standardized approaches and the process was highly individualized. In these high uncertainty situations, physicians expressed significant unease regarding the efficacy of these discussions.