The relationship between doctors and patients should be one of active partnership by both. The goal is shared or informed decision-making. Pivotal to this relationship is the understanding of the risks & benefits associated with different alternatives, and a condordance in knowledge of their outcomes.

Few consultations with doctors address the pros and cons of different alternatives and the uncertainties associated with them. But, there is a paucity of evidence of the most effective way for physicians to share clinical evidence with patients facing decisions.

A patient’s perceived personal risk is likely to be influenced by acceptability of risks, i.e. it is a consequence of a voluntary action.

In risk communication, it is about whether the risk assessment is applicable to a population group or it is about personal risk. For the postmenopausal woman, the tendency is to view population risk as something that might happen to other people, and not to themselves.

It is thus important to undertake personalized risk assessment for the patient as this would be more effective.

The dominating way is to discuss risks as “balanced risks” , i.e. benefits vs risks. Decision aids should be used, as this would be useful for transferring knowledge and enabling patients to participate in decision-making without increasing their anxiety.
 

Expanded cervical cancer vaccine use
Study finds that a quadri-valent vaccine is effective in women ages 24 through 45. ( FUTURE III study )

• it is a 4-year international multi-centre study
• involves 3800 women aged 24-45 years
• 31% of these women were Asians
• after 18 months of follow-up it showed that Gardasil
• prevented 91% of cases of persistent infection, low grade cervical, vaginal, & vulvar disease caused by HPV 6, 11, 16 & 18 in women up to 45 years old
• prevented 94% of abnormal Pap smear test results

 
Editor : previously, HPV vaccine, to prevent HPV infection & cervical cancer, is ecommended for the younger women, aged 10-28 years. Current studies indicate that older women may also benefit.