An important part of shared decision making conversations is discussing what are commonly referred to as the “risks and benefits” of treatment options. However, this prevalent framing of “risks vs benefits” may give physicians and patients the wrong message, write Dr. Daniel J. Morgan, Dr. Laura D. Scherer, and Dr. Deborah Korenstein in a recent JAMA editorial.
The authors argue that using the language of “risks vs benefits” gives the impression that treatment options have the potential to cause harm (risk) but that the benefits are guaranteed:
"Presenting treatment decisions as a comparison of risks vs benefits creates an inherent imbalance in which benefits simply exist, whereas harms are uncertain. This imbalance is widespread and is present in how physicians have discussions with patients, how physicians likely approach decisions, and even how studies are reported in the medical literature."
Research shows that the language we use has a strong effect on clinicians’ and patients’ perceptions of their health care options. For example, when family members of patients with advanced disease are told that their loved one “wanted everything done,” they were much less likely to recommend withdrawing life-sustaining treatment, even for patients with a poor survival prognosis. Using a different phrase to elicit patients’ goals of care would give family members a clearer picture of the treatments patients would be willing to undergo.
Morgan et al. suggest that instead of saying “risks vs benefits” we should use the language of “harms vs benefits,” to properly emphasize the potential harm of medical treatments.