What Data Should We Give Our Patients?

By | March 26, 2019

In healthcare,  we continue to increase our focus on preventing illness and disease. With prevention, we also must balance the polarity of whether the preventive treatment outweighs the risks involved. For instance, the association of vaccine usage with possible long-term impacts prevails in the minds of numerous people still, even though the research has staunchly supported their benefit over their risk, and there is no longer any question that the benefits far out way the possible risks.

Moreover, a recent study published by Zheng at al., in the Journal of the American Medical Association, addresses a similar analysis of the treatment of aspirin for primary prevention of cardiovascular events and the risk of major bleeding events. Their application of the number needed to benefit, and the amount required to harm forces us to compare the two. The systematic review and meta-analysis reveal that the number needed to treat for benefit (prevention of a cardiovascular event) is 265, and yet the amount required to harm with a resultant major bleed is 210. Consequently, from a ratio perspective, aspirin usage in these patients can be considered to cause harm more frequently than providing a benefit, as 1 out of 265 will receive benefit while 1 out of 210 will be harmed.

Sure, there are plenty of nuances to this finding, but how we begin to discuss these polarities is paramount. As we focus on shared decision making with those we serve, it is imperative to do so with understandable information. Since treatment is an individual decision, having informed information such as the likelihood of benefit versus likelihood of harm in the example mentioned earlier enhances the discussion between the physician and the patient.

Additionally, having this information in this manner assists the physician in understanding what the data reveals. Patients pose extremely crucial questions and encompassing such information to enhance our recommendations and conversations in a manner that involves both the risks and benefits is critical. The value of such evaluations of the literature is greater than the topic at hand. Focusing on numbers needed to treat and harm allows us to assimilate the information in a way that is consumable by those we serve.  It will also help us build trust, as we are being more transparent with our patients.

If we are to continue enhancing our relationships with those we serve, then embracing shared decision making with meaningful information allows us the ability to expand the value of our interactions and thus treatment. Let us adopt such a methodology of cooperation.