Communicating Radiation Risks and Benefits to Parents of Pediatric Patients
A new paper outlines strategies for physicians to better communicate the risks of medical imaging and radiation exposure
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While CT can effectively diagnose injury and illness in children, many parents have serious concerns about the negative health effects of radiation exposure. Even though children remain more sensitive to radiation than adults and require special considerations before imaging, the individual risk-benefit balance still favors the benefit when used appropriately.
Yet, according to a recent survey, only 21 percent of patients discussed the benefits and risks of their most recent imaging exams with physicians. This gap in communication can have dire consequences, such as patient dissatisfaction, medical errors, or litigation.
A new article from a team of researchers emphasizes the importance of effective risk communication between medical imaging providers and patients. They present 12 strategies that can help create an informed dialogue about the safety of CT scans for both adults and children. The article was published in the Journal of the American College of Radiology on March 16.
“So in my practice as a hospital-based medical physicist, I would sometimes get questions from concerned patients, parents of patients, patient advocacy and other representatives about the radiation risks of imaging,” said first author Nima Kasraie, a medical physicist at Children's Mercy Kansas City. “After a while, I started noticing trends in the types of questions that were being asked.”
In addition, Kasraie realized that the front line of risk communication occurs between the patient and either an attending physician, fellow, resident, or technologist -- all of whom may not be as knowledgeable about radiation risks as a medical physicist. He and his colleagues decided to use their expertise on the topic to create strategies for addressing patient concerns about radiation exposure during medical imaging.
These strategies include the following: discussing the clinical appropriateness of the scan with patients, families and referrers; describing the risks of CT scans in the context of clinical benefits; avoiding the use of jargon; comparing radiation exposure during medical imaging to more familiar situations, such as a commercial flight; and presenting graphics and visual aids.
“I would recommend focusing the patient or their parent's attention on the benefit-to-risk ratio. One must carefully consider: When does the risk become worth the benefit? What does your child get in return for that X-ray?” said Kasraie. “The radiologist or referring physician can then emphasize that the immediate medical benefit of appropriate imaging examinations far outweighs the low, future and theoretical risk of the radiation received.”
Both Jonathan Portelli at the University of Malta and Louise Rainford at the University College Dublin School of Medicine believe the paper covers effective radiation risk communication well from an American perspective. They agree that it is of utmost important for patients to be assured that any medical imaging procedure to be performed is justified and clinically indicated.
“Following from the explanation of benefits, a simple explanation of the associated radiation risks should be provided to patients and guardians, possibly also offering them some perspective by comparing such associated risks to an equivalent in background radiation or time spent on a trans-Atlantic flight,” said Rainford. “The use of lay language and addressing patients/guardians at the correct socio-educational level is important.”
Some of their current research has found that parents of pediatric patients appreciate this type of information provided by the medical team since they perceive it to be more trustworthy than information found online. They also note that the communication of radiation risk should not involve risk numbers -- for instance, a 1 in 2,000 risk of cancer -- since this can add to the patients' or parents' level of anxiety and concern.