“An Appropriate Verbal Probability Lexicon for Communicating Surgical Risks Is unlikely to Exist”, 2022-07-28 ():
[cf. 2008] Ear, Nose and Throat (ENT) surgeons report most often communicating surgical risks with verbal probability expressions (VPEs, eg. “unlikely”; “likely”), but:
their interpretations of oft-used terms differ substantially from those of laypeople (Studies 1 & 2).
In Study 3, laypeople were unable to suggest VPEs to differentiate 10 numerical probabilities inferred (from surgeon’s data in Studies 1 & 2) to be relevant for surgical risk communication.
We propose that communicating low probability risks, as required in the surgical domain, is best done with numbers to enable appropriate differentiation between risk levels.
Effective risk communication about medical procedures is critical to ethical shared decision-making. Here, we explore the potential for development of an evidence-based lexicon for verbal communication of surgical risk.
We found that Ear, Nose and Throat (ENT) surgeons expressed a preference for communicating such risks using verbal probability expressions (VPEs; eg. “high risk”). However, there was considerable heterogeneity in the expressions they reported using (Study 1).
Study 2 compared ENT surgeons’ and laypeople’s (ie. potential patients) interpretations of the 10 most frequent VPEs listed in Study 1. While both groups displayed considerable variability in interpretations, lay participants demonstrated more, as well as providing systematically higher interpretations than those of surgeons.
Study 3 found that lay participants were typically unable to provide unique VPEs to differentiate between the ranges of (low) probabilities required.
Taken together, these results add to arguments that reliance on VPEs for surgical risk communication is ill-advised. Not only are there systematic interpretation differences between surgeons and potential patients, but the coarse granularity of VPEs raises severe challenges for developing an appropriate evidence-based lexicon for surgical risk communication. We caution against the use of VPEs in any risk context characterized by low, but very different, probabilities
[Keywords: ENT, informed consent, risk communication, verbal probability expressions, surgical risk]