Table 4 Strategies and approaches used by physicians in patient-physician risk communication
Strategies and approaches used in patient-physician risk communication | Description of strategies and approaches used | Mentioned in | Indicative quotations from articles |
|---|---|---|---|
CVDs | |||
Use of fear/scare tactics | A few clinicians mentioned using fear of stroke to persuade patients to make the right decision. ‘Scare tactic’ strategies were used when a GP’s perception of patient’s CVD risk was high, or where patients are unmotivated. Such strategies focus on how future risk may be at an even higher level that may possibly lead to a CVD event. For lifestyle change, strategies used include using strong language to evoke fear in patients about risky behaviour. Other risk communication approaches include appealing to fear by emphasising the worst possible consequences that may occur. | Bonner et al. (2014) [45] /Australia | “I like to…put a little fear into them…if they don’t ‘pull up your socks’ (sic) bad things can happen to them…if you don’t want that kind of scenario you do what I tell you.” (ID10, male, 40 years experience) |
Borg Xuereb et al. (2016) [46] /UK | “I mean generally, if you tell them it’s a stroke, they get worried about it and generally as you know, when people think of stroke, they think ‘oh my god, I’ll become bed bound, very disabled, I wouldn’t be able to do it’. So they start to take it very seriously that AF is not as benign as they expected.” (D10, General physician) | ||
Honey et al. (2015) [53]/UK | “Pt N: It’s very difficult when somebody stands in front of you and tells you that in another 12 months you could end up with a heart attack if you carry on the way you are going, it just jolts you.” (Male, 66 years) | ||
Rosal et al. (2004) [58]/USA | No specific quotations | ||
Presenting different CVD scenarios | If patients did not adhere to drug treatments, various CVD scenarios, including negative consequences of not adhering to medications, were conveyed to patients. | Barfoed et al. (2015) [43]/Denmark | “…GP: ‘Well, okay. You can then see the nurse, or you can see me once a year. Then we don’t need to...but you are welcome to come back, if you change your mind...and then we have to be a bit more intensive about your disease...For instance, if you had a stroke…” (Male 64 years, partnership practice) |
Use of metaphors and analogies | Diagrams and metaphors were used by physicians to convey risks of stroke and bleeding, and to explain what AF is. Metaphors were used together with analogies to describe bodily function (e.g. heart function as electrical wiring). | Borg Xuereb et al. (2016) [46] /UK | “I would explain to them that they have an irregular heart and their heart is going irregularly, and I usually sort of tap it out for them as to what is happening. I tell them that the electrical wiring of the heart is erm still there and fine but like any wiring in an old house. You know the insulation is just got a bit worn. So the currents tend to short-circuit and not connect up That is a sort of analogy for the patients. And erm… that erm in the short term they are not in any risk but we need to get it sorted out.” [D15, GP] |
Positive | GP’s used ‘positive’ strategies to communicate risk if they perceived a patient’s CVD risk to be low, and if they are aware that a patient is determined to manage one’s own condition. Approach involves reassuring and motivating patients, as well as focusing on change that is achievable. | Bonner et al. (2014) [45] /Australia | “I’m trying to convince them that they’re eating too much and not exercising enough and they’re trying to convince me that they are…but the ones that take it on board and make progress…they feel positive…encouraged…rewarded… motivated to keep going.” (ID36, male, 25 years experience) |
Indirect | ‘Indirect’ strategies were used by GPs for patients who may be of low CVD risk, who tend to be more resistant, where the conveyance of risk may not be helpful and may elicit a negative response from patients. | Bonner et al. (2014) [45] /Australia | “Cardiovascular risk just isn’t on their agenda, they are more worried about their day to day social issues or their mental health issues even though technically in the back of my mind they’re more likely to die from a heart attack (than) from suicide or violence.” (ID16, male, 9 years experience)” |
Downplaying risk | Patients described healthcare professionals as downplaying their high-risk scores, which in turn affects the significance a patient attribute one’s own risk. | Honey et al. (2015) [53]/UK | No specific quotations. |
Intervening at strategic timepoints | Physicians intervened during “teaching moments”. | Rosal et al. (2004) [58]/USA | No specific quotations. |
Emphasising gradual and continuous change | Emphasising continuous and gradual change include asking patients to adopt one change at a time. | Rosal et al. (2004) [58]/USA | No specific quotations. |
Diabetes | |||
Varying presentation style to tailor to different types of patients | Physicians use various strategies to present risk information to patients, using words such as ‘common’ or ‘rare’, and avoiding statistics. Physicians also varied presentation style by medication. | Ledford (2011) [66]/USA | ‘‘I have to see how sophisticated my patient is at understanding what those numbers mean.’’ |
Avoiding statistics | Ledford (2011) [66]/USA | ‘‘I don’t throw out numbers at people for the most part. I mean if there’s something that happens 5% of the time I may tell them that. If it’s 50% of the time I may tell them that about half the people I prescribe have this.’’ | |
Using words like ‘common’ or ‘rare’ to present risks | Ledford (2011) [66]/USA | ‘‘I mean I can’t say that I know the percentages for everything so I will tell them, ‘in my experience for your particular disorder, this is not very common.’’’ | |
Setting goals | There were instances where GPs set goals for patients, although patients may adhere less often than advised. Some patients mentioned their GPs using dramatic illustrations such as pictures of amputations to persuade them. Good communication from physicians involves positive body language, receiving prompt feedback and using straightforward language to convey information. | Yao et al. (2022) [70]/China | “The doctor told me the goal and self-monitoring at home, but I rarely did it.” (FG1 P3) |
Prompt provision of feedback | Yao et al. (2022) [70]/China | “Call him (the GP) when you don’t feel well in the evening and he’s always there to answer you” (FG1 P1) | |
Using of clear and frank words | Yao et al. (2022) [70]/China | “He (the GP) showed me a picture with a diabetes patient lose one leg. And he said if you did not control diabetes and you might be like that patient.” (FG2 P4) | |
Positive body language | Yao et al. (2022) [70]/China | “Once he took my hands and said you did not be afraid. That was really touching. I think he is a good doctor- better than my son.” (FG4 P3) | |
Using illustrations such as pictures of amputations | Yao et al. (2022) [70]/China | “He (the GP) showed me a picture with a diabetes patient lose one leg. And he said if you did not control diabetes and you might be like that patient.” (FG2 P4) | |