From the Departments of Anesthesiology.
Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin.
Anesth Analg. 2020 Aug;131(2):579-585. doi: 10.1213/ANE.0000000000004816.
Helping patients to understand relative risks is challenging. In discussions with patients, physicians often use numbers to describe hazards, make comparisons, and establish relevance. Patients with a poor understanding of numbers-poor "health numeracy"-also have difficulty making decisions and coping with chronic conditions. Although the importance of "health literacy" in perioperative populations is recognized, health numeracy has not been well studied. Our aim was to compare understanding of numbers, risk, and risk modification between a patient population awaiting surgery under general anesthesia and attending physicians at the same center.
We performed a single-center cross-sectional survey study to compare patients' and physicians' health numeracy. The study instrument was based on the Schwartz-Lipkus survey and included 3 simple health numeracy questions and 2 risk reduction questions in the anesthesiology domain. The survey was mailed to patients over the age of 18 scheduled for elective surgery under general anesthesia between June and September 2019, as well as attending physicians at the study center.
Two hundred thirteen of 502 (42%) patient surveys sent and 268 of 506 (53%) physician surveys sent were returned. Median patient score was 4 of 5, but 32% had a score of ≤3. Patients significantly overestimated their total scores by an average of 0.5 points (estimated [mean ± standard deviation (SD)] = 4.3 ± 1.2 vs actual 3.8 ± 1.3; P < .001). Health numeracy was significantly associated with higher educational level (gamma = 0.351; P < .001) and higher-income level (gamma = 0.397; P < .001). Physicians' health numeracy was significantly higher than the patients' (median [interquartile range {IQR}] = 5 [4-5] vs 4 [3-5]; P < .001). There was no significant difference between physicians' self-estimated and actual total numeracy score (mean ± SD = 4.8 ± 0.6 vs 4.7 ± 0.6; P = .372). Simple health numeracy (questions 1-3) was predictive of correct risk reduction responses (questions 4, 5) for both patients (gamma = 0.586; P < .001) and physicians (gamma = 0.558; P = .006).
Patients had poor health numeracy compared to physicians and tended to overrate their abilities. A small proportion of physicians also had poor numeracy. Poor health numeracy was associated with incomprehension of risk modification, suggesting that some patients may not understand treatment efficacy. These disparities suggest a need for further inquiry into how to improve patient comprehension of risk modification.
帮助患者理解相对风险具有挑战性。在与患者的讨论中，医生通常使用数字来描述危害、进行比较并建立相关性。理解数字能力差的患者（“健康算数能力差”）也难以做出决策和应对慢性疾病。尽管围手术期人群的“健康素养”很重要，但健康算数能力尚未得到充分研究。我们的目的是比较接受全身麻醉手术的患者人群和同一中心的主治医生对数字、风险和风险修正的理解。
我们进行了一项单中心横断面调查研究，比较了患者和医生的健康算数能力。研究工具基于 Schwartz-Lipkus 调查，包括 3 个简单的健康算数问题和 2 个麻醉学领域的风险降低问题。该调查于 2019 年 6 月至 9 月期间邮寄给接受全身麻醉择期手术的 18 岁以上患者以及研究中心的主治医生。
寄出的 502 份患者调查中有 213 份（42%）和寄出的 506 份医生调查中有 268 份（53%）被退回。患者的中位数得分为 5 分（满分 5 分），但 32%的患者得分≤3 分。患者的平均总得分高估了 0.5 分（估计[均值±标准差（SD）]=4.3±1.2 与实际 3.8±1.3；P<.001）。健康算数能力与较高的教育水平（γ=0.351；P<.001）和较高的收入水平（γ=0.397；P<.001）显著相关。医生的健康算数能力明显高于患者（中位数[四分位距（IQR）]=5[4-5]与 4[3-5]；P<.001）。医生自我评估的总算数能力得分与实际得分没有显著差异（均值±SD=4.8±0.6 与 4.7±0.6；P=.372）。简单的健康算数（问题 1-3）可以预测患者（γ=0.586；P<.001）和医生（γ=0.558；P=.006）对正确风险降低的反应。
与医生相比，患者的健康算数能力较差，且往往高估自己的能力。一小部分医生的算数能力也较差。健康算数能力差与风险修正的理解能力差有关，这表明一些患者可能不理解治疗效果。这些差异表明，需要进一步研究如何提高患者对风险修正的理解。
