Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, WA.
Decision Science Group, University of Washington, Seattle, WA.
Ann Surg. 2023 Apr 1;277(4):e766-e771. doi: 10.1097/SLA.0000000000005255. Epub 2021 Oct 25.
To assess whether different methods for communicating the probability of treatment complications for operative and nonoperative appendicitis treatments result in differences in risk perception.
Surgeons must communicate the probability of treatment complications to patients, and how risks are communicated may impact the accuracy and variability in patient risk perceptions and ultimately their decision making.
A series of online surveys of American adults communicated the probability of complications associated with surgical or antibiotic treatment of acute appendicitis. Probability was communicated with verbal descriptors (eg, "uncommon"), point estimates (eg, "3% risk"), or risk ranges (eg, "1% to 5%"). Respondents then estimated the probability of a complication for a "typical patient with appendicitis." The Fligner-Killeen test of homogeneity of variance was used to compare the variability in respondent risk estimates based on the method of probability communication.
Among 296 respondents, variance in probability estimates was significantly higher when verbal descriptions were used compared to point estimates ( P < 0.001) or risk ranges ( P < 0.001). Identical verbal descriptors produced meaningfully different risk estimates depending on the complication being described. For example, "common" was perceived as a 45.6% for surgical site infection but 61.7% for antibiotic-associated diarrhea.
Verbal probability descriptors are associated with widely varying and inaccurate perceptions about treatment risks. Surgeons should consider alternative ways to communicate probability during informed consent and shared decision-making discussions.
评估用于交流手术和非手术阑尾炎治疗并发症概率的不同方法是否会导致风险感知的差异。
外科医生必须向患者传达治疗并发症的概率，而风险沟通的方式可能会影响患者风险感知的准确性和可变性，并最终影响他们的决策。
对美国成年人进行了一系列在线调查，以了解与急性阑尾炎的手术或抗生素治疗相关的并发症的概率。概率通过口头描述（例如，“不常见”）、点估计（例如，“3%的风险”）或风险范围（例如，“1%至 5%”）来传达。然后，受访者估计“典型阑尾炎患者”发生并发症的概率。使用 Fligner-Killeen 方差同质性检验来比较基于概率沟通方法的受访者风险估计的变异性。
在 296 名受访者中，与点估计（P < 0.001）或风险范围（P < 0.001）相比，使用口头描述时概率估计的变异性显著更高。相同的口头描述根据所描述的并发症产生了有意义不同的风险估计。例如，“常见”被认为是手术部位感染的 45.6%，但抗生素相关腹泻的风险为 61.7%。
口头概率描述与对治疗风险的广泛变化和不准确的感知相关。外科医生在知情同意和共同决策讨论中应考虑替代方法来传达概率。
