Spivey G H
Health Services Department, Epidemiology & Environmental Medicine, UNOCAL, Los Angeles, CA 90017.
J Clin Epidemiol. 1991;44 Suppl 1:63S-67S. doi: 10.1016/0895-4356(91)90177-b.
Health risk communication is discussed in respect to four principles of biomedical ethics: (1) autonomy, the need to protect confidentiality and provide decision-making information; (2) beneficence, an obligation to inform and to develop trust; (3) non-maleficence, not covering up study findings, not over- or underinterpreting data; and (4) justice, helping place risk in proper perspective. The epidemiologist's role in risk communication includes responsible interpretation of data, balanced and non-judgemental risk communication and careful attention to the biologic and population significance of study findings. Potential problem areas for epidemiologists which are discussed include deciding when risk is significant, working for an agency which does not want a communication to take place and the occasional need to violate confidentiality for overriding societal goals. The paper concludes with an example risk communication which illustrates some of the principles covered in the paper.
（1）自主性，即需要保护隐私并提供决策信息；（2）行善原则，有告知并建立信任的义务；（3）不伤害原则，不掩盖研究结果，不过度或错误解读数据；（4）公正原则，帮助正确看待风险。流行病学家在风险沟通中的作用包括对数据进行负责任的解读、进行平衡且不带偏见的风险沟通以及密切关注研究结果的生物学和人群意义。文中讨论了流行病学家可能面临的问题领域，包括确定何时风险显著、为不希望进行沟通的机构工作以及偶尔为了更重要的社会目标而需要违反保密规定。本文最后给出了一个风险沟通示例，阐释了文中涉及的一些原则。
