Communicating a patient's individual risk
Risk communication is defined as, "the open, two way exchange of information and opinion about risk, leading to better decisions about clinical management".4
NICE advises that patients should be presented their risk in a numerical format. Diagrams, graphical images and decision aids can all be used to explain the risk factor to the patient.
Where a numerical risk factor is explained it is important to remember that a patient may have a different level of numerical understanding and that sufficient time is available to explain the principle fully. For example a patient with a risk factor of 30% should be advised that this means that in the next ten years they have a 30% risk of suffering a cardiovascular event. This could be explained as considering 100 patients of the same age and sex with the same lifestyle risk factors i.e. weight, smoking status, blood pressure and cholesterol levels where in the next 10 years 30 of them would suffer a stroke or heart problems, but 70 of them will have no cardiovascular health problems.
The table below demonstrates how this 30% risk could be communicated to a patient, the boxes coloured red represent the patients who within the next ten years will suffer a stroke or other heart problem whilst those in green will have no cardiovascular health problem.
When communicating risk to a patient it is important that any advice provided is targeted and individualised. Individualised action plans will help patients to focus on one or two modifiable risk factors. This will ensure that patients can identify what they can do to address their own risk factors rather than a generic conversation on how to reduce the risk of cardiovascular disease.
It is well recognised that patients who are informed and involved in making decisions about their health are more knowledgeable and consequently more likely to adhere to treatment or lifestyle changes.
Advice provided should be jargon free and in a language style that the patient will easily understand. When providing advice it is important to remember that every patient will have different views and preconceptions of their health risk. These views will be influenced by their knowledge, beliefs and understanding. Exploring an individual's thought processes will enable pharmacists to understand their reasoning and their perspective and to adopt appropriate counselling techniques.
Signposting patients to local services, such as stop smoking, weight loss or alcohol intervention services that will help them with the lifestyle changes they need to make will ensure that they are fully supported in their efforts to reduce their cardiovascular risk. These services could be within the community pharmacy or provided by another primary care healthcare professional.