Crowson Cynthia S, Therneau Terry M, Matteson Eric L, Gabriel Sherine E
Department of Health Sciences Research, all at the Mayo Clinic, Rochester, MN 55905, USA.
Nat Clin Pract Rheumatol. 2007 Mar;3(3):181-7; quiz 1 p following 187. doi: 10.1038/ncprheum0397.
Assessments of risk are a critical part of the practice of evidence-based medicine. Comprehension of various risk measures, such as absolute risk, relative risk, attributable risk, odds ratio, and hazard ratio, is essential to understand the medical literature, and to communicate health risks effectively. Complex risk measures, including number needed to treat and survival estimates that are adjusted for competing risks, are often misunderstood. Communication of these concepts to patients can be a challenge. The patient's perception of risk stems not only from the way risks are stated, but also from family history, personal experiences, cultural norms, and beliefs. A multifaceted approach to risk communication that uses both qualitative and quantitative assessments of risk, and addresses the timing and permanence of risks, is necessary to ensure the patient understands the potential risks. Successful communication involves interaction with the patient to understand the patient's perspective and to aid in personalized decision-making. In the face of uncertainty, making a provisional decision with a plan to review it later can be a good strategy. Verifying the patient's comprehension can help ensure that the decisions reached are informed and acceptable.
风险评估是循证医学实践的关键部分。理解各种风险度量，如绝对风险、相对风险、归因风险、比值比和风险比，对于理解医学文献以及有效传达健康风险至关重要。复杂的风险度量，包括需治疗人数以及针对竞争风险进行调整的生存估计，常常被误解。向患者传达这些概念可能是一项挑战。患者对风险的认知不仅源于风险的表述方式，还源于家族病史、个人经历、文化规范和信仰。采用多方面的风险沟通方法，既使用风险的定性评估也使用定量评估，并解决风险的时间性和持续性问题，对于确保患者理解潜在风险是必要的。成功的沟通需要与患者互动，以了解患者的观点并协助进行个性化决策。面对不确定性时，做出临时决策并计划稍后进行审查可能是一个好策略。核实患者的理解有助于确保做出的决策是明智且可接受的。
