Risk Communication for Clinicians

Risk Communication for Clinicians

Presentation Overview Risk Communication What is it, and what is it for? How can it improve clinical care? Why does DoD care about it? Tools for DoD and VA clinicians.

What is Risk Communication? An interactive process of exchange of information and opinion among individuals, groups, and institutions. It involves multiple messages about the nature of risk and other messages, not strictly about risk, that express concern, opinions, or reactions to risk messages or to legal and institutions arrangements for risk managers. National Research Council, Committee on Risk Perception and Communication; 1989

What is Risk Communication? Building and maintaining relationships based on the effective exchange of technical and/or scientific information between concerned stakeholders about an actual or perceived risk. Risk Communication Team, USA CHPPM

What is Risk Communication? A science-based approach for communicating effectively in: High concern Low trust Sensitive or Controversial situations. Vincent Covello, Center for Risk Communication

Trust and Credibility Low trust and high concern situations Communication skills essential. Mistakes amplified. Negatives amplified. Risk communication helpful in all situations with high concern, even if trust is high.

Components of Trust Empathy -Caring Competence -Expertise Honesty -Openness Commitment -Dedication

Acceptability of risk is value laden

Seven Central ‘Rules’ of Risk Communication Rule 1. Accept and involve the recipient of information as a Legitimate Partner. Rule 2. Plan Carefully and Evaluate Communication Performance. Rule 3. Listen to Your Audience. Rule 4. Be Honest, Frank, and Open.

Seven Central ‘Rules’ of Risk Communication (Continued) Rule 5. Coordinate and Collaborate with other Credible Sources. Rule 6. Plan for Media Influence. Rule 7. Speak Clearly and with Compassion.

Military & Occupational Health Applications What Risks Concern Patients? Risk of Various Illnesses. Risk of Death. Risks associated with Medical Tests & Treatments. Risks & causes of medically unexplained symptoms Risk of workplace or other exposures.

Does Risk Communication Have Clinical Value? Risk communication takes time at the start. Pays off over the course of treatment. Lessens patient-provider tensions. Improves adherence to medical advice. Mitigates against “difficult” patients. Increases patient & provider satisfaction with care Enhances patient trust in the clinician and health care system.

DoD-VA CLINICAL PRACTICE GUIDELINE ON POST-DEPLOYMENT HEALTH EVALUATION & MANAGEMENT Defining “Best Clinical Risk Communication Practices” in the Military & Veteran Context and Providing Tools to Encourage Their Use.

The Stepped Risk Communication Strategy Prescribed in the CPG Chronic Unexplained Symptoms Unexplained Symptoms “Asymptomatic Concerned” Recently Deployed Routine rapport & trust-building Consult Deployment Health Clinical Center Consider Specialized Care Program Web-based education 30-minute follow-up visit Info on unexplained symptoms & self-care strategies Web-based education 30 minute follow-up visit

Other Guideline Clinical Risk Communication Tools DoD Deployment Health Clinical Center Specialized Care Program PDHealth.mil “Health-e VOICE” “Envite” Risk Communication Mnemonic Toll-Free Helpline for clinicians & patients

Deployment Health Clinical Center A resource for post-deployment care. Delivers consultation & referral services for post-deployment health issues. Fosters system-wide movement toward patient-centered post-deployment health care. Supports clinicians seeking to improve post-deployment services and related clinical skills.

The Specialized Care Program A Worldwide Referral Care Resource DoD DoDDeployment DeploymentHealth HealthClinical ClinicalCenter Center Walter WalterReed ReedArmy ArmyMedical MedicalCenter Center Building Building2,2,Room Room3G04 3G04 6900 6900Georgia GeorgiaAve, Ave,NW NW Washington, Washington,DC DC 20307-5001 20307-5001 866-559-1627 866-559-1627 202-782-6563 202-782-6563 DSN: DSN: 662 662 [email protected] [email protected]

PDHealth.mil World Wide Web Support for Post-Deployment Health Care Designed For Federal & Civilian Clinicians, Soldiers, & Their Families

http://www.PDHealth.mil For Clinicians For Veterans & Families About this Site Education and Training Related Sites/Links Glossary & Acronyms Guidelines Guideline Broadcast Help & FAQs Site Map Contact DHCC

Site Features Covers all deployments since 1990 Adheres to “two-minute rule” Structured PubMed (NLM Medline) searches Clinically relevant deployment-related scientific medical literature Covers various exposures of military concern

Navigable Practice Guidelines PDHealth Evaluation & Management Button for Practice Guideline View Guideline Algorithms

Site Features (Continued) “What your patients may be reading ” Unfiltered deployment-related media literature Helps anticipate patient concerns and questions Information to offer patients Announcements for military-relevant continuing education & training New section on “The War on Terrorism” Specific diseases and concerns

Who Needs Clinical Risk Communication Expertise? The Entire Practice Team Physicians Physician Assistants Nurses Paraprofessionals Unit Clerks Receptionists

“Health-e VOICE” A CDC-funded Project To Develop & Evaluate An Online Continuing Education Tool That Aims To Optimize Guideline-Directed Clinical Risk Communication

“ENVITE” – Mnemonic for Framing Risk Messages Empathy Non-confrontational Validate Inform Take action Enlist cooperation

Summary Risk communication involves low trust-high concern situations. Trust and credibility are the heart of relationships and risk communication. Value your patients views and beliefs. Use the tools developed to help you. Post-Deployment Health Clinical Practice Guideline offers a stepped approach to risk communication. Visit “PDHealth.mil” for clinically relevant risk communication information

Please Contact Us! DoD DoDDeployment DeploymentHealth HealthClinical ClinicalCenter Center Walter WalterReed ReedArmy ArmyMedical MedicalCenter Center Building Building2,2,Room Room3G04 3G04 6900 6900Georgia GeorgiaAve, Ave,NW NW Washington, Washington,DC DC 20307-5001 20307-5001 866-559-1627 866-559-1627 202-782-6563 202-782-6563 DSN: DSN: 662 662 [email protected] [email protected]