Supporting people to live at home in line with community care policies requires increasing attention to assessing, communicating and managing risks. There is a challenge in supporting client choices that include risk-taking whilst demonstrating professional accountability. Risk communication becomes increasingly important with the need to engage clients and families in meaningful shared decision making. This presents particular challenges in dementia services. This survey of risk communication in dementia care was administered to all health and social care professionals in community dementia services in Northern Ireland: June - September 2016. Of 270 professionals, 70 questionnaires were fully completed, with 55 partial completions. Scores on the Berlin Numeracy Test plus Schwartz items was low-moderate (mean 2.79 out of 7). This study did not find a significant association between numeracy and accurate perceptions of risk likelihoods in practice-based scenarios. Although 86% reported using numeric information in practice (mostly from assessment tools), respondents rarely communicated themselves using numbers. As in other domains, participants’ responses were widely variable on numeric estimates of verbal terms for likelihood. In relation to medication side effects, few participants provided responses that were concordant with those in the guidance of the European Union. The risks most commonly encountered in practice were (in rank order): falls, depression, poor personal hygiene, medicines mismanagement, leaving home unsupervised, financial mismanagement, malnutrition, swallowing difficulties, abuse from others, risks to others, home appliance accidents and refusing equipment. Respondents generally over-estimated the likelihood of serious harmful events by approximately ten-fold (having a missing person’s report filed with the police; having a fall resulting in hospitalisation) and by approximately double (being involved in a car accident; causing a home fire), and with wide variation between respondents. There is potential in icon arrays for communicating risks. Risk literacy among dementia care practitioners needs to be developed.What is known about this topic:• Supporting people with dementia to live at home is raising increasing concerns about risk.• Shared decision making requires increased attention to communicating risk.• Research is inconclusive about the merits of verbal, numeric and visual risk communication.What this paper adds:• Health and social care professionals make extensive use of numeric information although they more often communicate risk information using words.• Professionals frequently overestimate how often risks with severe outcomes occur.• Verbal descriptors for numeric likelihoods of possible harm are widely interpreted.
- shared decision making.
Taylor, B., Stevenson, M., & McDowell, M. (2018). Communicating risk in dementia care: survey of health and social care professionals. Health and Social Care in the Community, 26(2), e291-e303. https://doi.org/10.1111/hsc.12519