Communicating risk to emergency department patients with chest pain.

BACKGROUND

The risks and benefits of thrombolytic therapy for acute myocardial infarction are usually discussed with patients before treatment. Numerous factors may make it difficult for a patient to understand these issues fully; one of these is the language doctors use to describe risk.

STUDY OBJECTIVE

To determine whether emergency department (ED) patients who experience chest pain have the same understanding of the frequency of side effects when expressed as percentages or in descriptive language (eg, "uncommon") as emergency medicine doctors.

SETTING

The chest pain area of an urban ED.

METHOD

A short questionnaire survey was administered to both patients and ED doctors.

RESULTS

Of the 50 patients recruited, 88% correctly understood data when presented as percentages. When patients were asked to identify the frequency of an "uncommon" and "rare" side effect only 22% and 18%, respectively, were able to do so. The corresponding results for the doctors were 70% (p<0.0001) and 54% (p = 0.0006). 39% of patients felt that there was no difference between these two verbal descriptors.

CONCLUSION

Patients understand side-effect frequencies when expressed as percentages. Patients have different understandings of the frequency of events to doctors when verbal descriptors are used. This lack of a shared understanding has implications for informed decision-making and we recommend that percentages are used to communicate risk in the ED.