Beyond Instructions for Use: Communicating the Benefits and Risks of Medicines
"Talk About Prescriptions" Month
October 1990
Do your patients leave the office or pharmacy believing that the medicines they've been prescribed will help them and understanding how? Are they sufficiently aware of medication risks to avoid contraindicated behaviors, watch for signs of toxicity, and obtain early treatment of serious side effects?
If your counseling covers only instructions for use, your patients may not have all the information they need to take their medicines properly. By providing background about the benefits and risks of medicines, you create an educational context for "how-to" directions.
Presenting benefit and risk information is important for FOUR reasons:
- Appreciating the benefits of therapy may be critical to treatment adherence. For example, from 14 to 21 percent of patients never obtain their prescribed medicines. A significant percentage are concerned about drug dependence and society's being "overly prescribed." Patients with attitudes such as these may need to be convinced of the positive value of a medicine before they'll take your instructions seriously.
- The patient education movement has created a need for greater risk communication. Patients must understand medication risks to participate actively in treatment decisions and to take responsibility for monitoring their treatment. The need for risk information is likely to become even more important as the population ages, drug discoveries continue to increase, and cost controls favor home care over extended hospitalization.
- Providers may protect themselves from liability by disclosing potential adverse effects. Such information has become essential to fulfilling a patient's legal right to know.
- Patients may be more satisfied with the interaction when providers offer complete information. As medicine and pharmacy become more competitive and consumer driven, health professionals increasingly see thorough patient counseling as a practice management plus.
How Can You Communicate Effectively About Benefits and Risks?
- Put information about risk in the context of expected benefit. Use the reasons for taking medicine and the contributions it can make to your health as a backdrop for discussing potential harm. The National Council on Patient Information and Education (NCPIE) has developed five points that providers should tell patients about every new prescription. These points can provide a solid, non-threatening framework for a discussion of risk:
- The name of the medicine and what it is supposed to do.
- When and how often to take it, and for how long.
- What foods, beverages, or other medications to avoid while taking medicine.
- Possible side effects and what to do if they occur.
- What written materials are available with more information about the medicine.
- Discuss the specific expected benefits of each medicine a patient receives. Explain what would happen without the medicine. To reinforce benefits, ask patients to tell you in their own words how they expect treatment to help them.
- Time your counseling messages to the patient's need to know. For example, when a patient first becomes ill, understanding and adjusting to the diagnosis are the prime concerns. Risk information is most meaningful at later stages in the patient's progress: eg, during decisions about treatment and at the post-decision phase when the patient becomes responsible for carrying out the regimen.
- Target information to the patient's desire for and ability to understand medication information. Studies show that most patients want more information about risks. However, patients who leave decisions about treatment completely to the physician may want and need fewer details about risk. Most patients do not develop side effects because of the power of suggestion; but a provider may want to be more cautious with patients whom he or she believes have done so in the past.
- Present information in a supportive way. In talking about serious side effects, explain how you will cope with them if they occur. Balance a discussion of annoying side effects by emphasizing what the patient has to gain from tolerating minor problems.
- Encourage questions. When patients take an active part in communication, they can help providers better understand their information needs. Many providers use the patient's questions to help gauge desire for more detailed information about risks.
- Provide written material to supplement your discussion. When patients read about common side effects, they are more likely to attribute problems they experience to the medicine. If they make this connection, they can ask the physician to adjust the treatment. Written materials will also reinforce other precautions you suggest.
- Use innovative techniques to enhance communication. One pharmacy, for example, offered a toll-free telephone hot line for questions or concerns about medicines. The medication's label advertised the service, which most callers used within two days of their pharmacy visit. Another program used a videotape to show model patient communication behaviors in discussing the benefits and risks of medicine use.
In a study about public perceptions of risks, people were most uncomfortable with situations that were both "unknown" and "dreaded." Respondents saw the hazards of medicines as unknown but not as dreaded. With better communication, health professionals can help patients take positive, information-based action to use their prescription medicines safely and effectively.
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