"You'll be Fine. Probably." Communicating Risk in Clinical Medicine

Communicating risk is fundamental to informed consent and shared medical decision-making, yet it presents challenges in clinical practice. This review examines the major barriers to effective risk communication between clinicians and patients, including linguistic ambiguities, numeracy challenges, the influence of emotion, and cognitive biases. Without addressing these barriers, patients may misinterpret risk information, leading to decisions that do not align with their values and goals. Descriptive risk terms (such as "likely," "rare," or "common") are ambiguous, with wide variations in interpretation and, notably, between patients and clinicians. Medical professionals consistently assign lower numerical probabilities to risk terms than patients do, creating potential misalignment. Numerical expressions of risk - while seemingly more precise - assume patient numeracy; yet approximately 30% of U.S. adults lack basic numeracy skills needed to understand percentages and probabilities. Visual aids such as pictographs improve comprehension and accuracy of risk perception for most patients. Pre-existing biases, personal experiences, and emotional factors significantly influence how patients interpret risk information, regardless of how it is presented. Effective risk communication requires a multilayered individualized approach tailored to patients' understanding, experiences, and values. When important risk discussions are occurring, clinicians should consider using a combination of descriptive terms, numerical expressions, and visual representations, while remaining attentive to emotional factors and patient values that influence risk perception. To support more effective risk discussions, we introduce the RISKS framework (Recognize risk communication, Identify patient understanding and priorities, Self-assess for clinician biases, Key in on appropriate communication strategies, Solicit patient comprehension).