Communicating Therapeutic Risks

ISBN-13: 9780387971926 / Angielski / Miękka / 1989 / 186 str.

Louis A. Morris

Opis

I guess everyone has a cousin Ernest. He is the fellow of whom your mother asks . . . "Why can't you be more like your cousin Ernest?" Cousin Ernest went to the high school for genius children and got all A's, even in French. As the years went by, I lost contact with Cousin Ernest. Then last year, at a family gathering, I met him again. Sure enough, he had gone to Harvard and become a doctor, a radiologist. We began discussing his practice and he mentioned that he performs some fairly risky diagnostic tests. While legally he was compelled to tell patients about the risks they were undertaking, he said that risk disclosure was a useless exercise. "No one has ever refused to undergo the procedure," he said. It was difficult to argue with his observation that no patient ever refused to undergo his tests. I understood that the lack of refusals did not necessarily mean that risk disclosure was a useless exercise, but his underlying argument was quite compelling.

Spis treści

1. Introduction.- 2. Learning About Therapy.- Why Communicate Risks? — The Health Professional Perspective.- Barriers to risk dissemination.- Why Communicate Risks? — The Patient Perspective.- Patient preferences.- Motivation to Seek Risk Information.- Medical decision making.- Coping with threats.- Avoiding risk Information.- The Content of Risk Communication.- Risk communication stages.- Sources of Risk Information.- Patient preferences.- Sources utilized.- Segmentation pattern.- Risk seeking passivity.- Stimulating Risk Disclosure.- Question-asking studies.- Increasing patient involvement.- Implications.- 3. Physician’s Risk Disclosure.- Normative Studies of Doctor-Patient Communication.- Observational analyses.- Patient interviews.- Information Exchange Standards.- Risk Disclosure Factors.- Physician’s script.- Moderating Factors — The Physician.- Individual differences.- Role and attitude.- Moderating Factors — The Prescribing Environment.- Disease and treatment.- Patient perception.- Situational factors.- Implications.- 4. Patient Information Processing.- Attention to Risk Information.- Priming effects.- Comprehension.- Context-availability model.- Integration in Memory.- Schema.- Categorical schema.- Ad hoc schema.- Scripts.- Elaboration.- Processing Risk Communications.- Information Retrieval.- Retrieving evaluations.- Implications.- 5. Patients’ Medical Judgments.- The Patient as a Decision Maker.- Decision Making Processes.- Editing stage.- Evaluation stage.- Biases in Decision Making.- Framing effects.- Interpretation bias.- Recall biases.- Weighing and evaluation bias.- Motivation to make decisions.- Patient Consent and Risk Acceptance.- Patients’ role.- Optimal decision making.- Physician and patient perspective.- Assessing probabilities.- Risk perception.- Risk Communication and Compliance.- Reasons underlying noncompliance.- Limiting treatment.- Implications.- 6. Effects of Risk Communication.- The Initial Doctor Visit.- Expectations and outcomes.- Emotional reactions.- Need fulfillment.- Initial therapy evaluation.- Product Use.- Suggestion induced side effects.- Product misuse.- Treatment Evaluation.- Product liability.- Medical malpractice.- Maintaining Treatment.- Implications.- 7. Mass Media Risk Communication.- Historical Development of PPIs.- Phase one — the flirtation.- Phase two — infatuation.- Phase three — the “break-up”.- Phase four — the maturing relationship.- Assessment of PPI Effects.- Regimen adherence.- Doctor-patient relationship.- Returned prescriptions.- Conclusion.- Direct Advertising of Prescription Drugs.- Manufacturer rationale.- Risk disclosure requirements.- Political environment.- Survey data.- Sales experience.- Risk Disclosure in Television and Magazines.- Purpose of risk disclosure.- FDA study.- Knowledge results.- Attitude results.- Conclusion.- Implications.- Endnote.- References.