When patients struggle to understand their condition or follow medical advice, the issue often reflects difficulty in interpreting numerical and statistical information rather than a lack of engagement. This limitation, which can also affect clinicians, shapes risk perception and informed decision-making.

Evidence from science communication research has shown that a clearer presentation of numerical data can strengthen the clinician-patient relationship, particularly when discussing risks, probabilities, and treatment outcomes.

In JAMA, Ellen Peters, PhD, director of the Center for Science Communication Research and professor in the School of Journalism and Communication at the University of Oregon in Eugene, Oregon, outlined practical strategies to improve how clinicians communicate numbers in routine care.

The issue extends beyond “health literacy.” Framing it this way can imply “illiteracy” among those who struggle to understand health information, which is misleading. Even highly educated individuals may find health communication difficult to navigate, given the complexity of healthcare systems and the widespread use of professional jargon, including acronyms, abbreviations, and implicit concepts that are familiar to clinicians but not to the public.

Numeracy Matters

Even more concerning than imperfect translation is the absence of translation altogether, which may suggest that a concept is not well established or widely recognized in a given culture. One example is the term “empowerment,” which refers to individuals’ ability to understand information, make informed choices, and act, helping to move away from persistent forms of medical paternalism. In this context, it is also notable that “numeracy” has no clear equivalent in some languages. Numeracy refers to the ability to understand and use numerical information, a vital part of health literacy and a fundamental skill for navigating daily life, both within and beyond healthcare.

In the health context, numeracy is associated with adherence to therapies, treatment outcomes, risk assessment, and the ability to make informed decisions. However, gaps in these skills remain in some populations. For example, a report on adult skills in Italy, based on data from the Survey of Adult Skills conducted by the National Institute for Public Policy Analysis as part of an international Organisation for Economic Co-operation and Development (OECD) program, highlighted these challenges.

Although many individuals downplay their comfort with mathematics, familiarity with numbers, percentages, and statistics is not limited to specific professions. It is a basic skill that is as essential as reading and understanding written language for making everyday decisions.

OECD data showed that Italy scored below the OECD average in numeracy, with a mean score of 244 compared with 263. Performance also varies by region, with lower scores reported in the southern areas.

Clinical Consequences

Data from the OECD show that in 2023, the average competence level of the population in Italy across literacy, numeracy, and problem-solving was below the OECD average. The mean score in Italy was 244, which is 19 points lower than the OECD average of 263. Only Chile (214), Poland (239), and Portugal (238) scored lower, while differences were not statistically significant compared with Israel (246), Lithuania (246), and the US (249). Regional disparities were also evident. Populations in the northeast perform at levels comparable to the OECD average numeracy score, while those in the south score closer to the lowest-ranking countries.

Communicating Numbers

These findings highlighted the need to improve how numerical information is communicated in clinical practice. Clinicians must work within this context, recognizing that interpreting proportions, percentages, risks, and probabilities can be challenging not only for patients but also, at times, for healthcare professionals.

The author emphasized that understanding improves when information is presented alongside relevant alternatives aligned with patient values and preferences. For example, when considering surgery, individuals should be informed not only of the risks and benefits of the procedure but also of those associated with medical or noninterventional options. The same principle applies when comparing a drug with a placebo or another treatment. Providing this context supports clearer decision-making. Similarly, when discussing the risk of developing a disease, it is helpful to include a reference point, such as the average risk among comparable individuals.

Evidence from experimental studies has shown that the way information is framed affects understanding. Describing a risk as “low” or “high,” or an outcome as “likely” or “unlikely,” can lead to variable interpretations because these terms are subjective and influenced by individual perception.

Clarity can be improved by using consistent denominators, preferably multiples of 10. In a US study involving 633 individuals from diverse backgrounds, more than 70% correctly found that 8.9/1000 was greater than 2.6/1000. In contrast, only slightly more than half answered correctly when the same risks were presented as 1 in 112 vs 1 in 384.6.

Absolute risk should also be communicated. The statement that treatment halves mortality has quite different implications depending on the baseline risk. Reducing mortality from 80% to 40% is interpreted differently from the reduction from 0.8% to 0.4%.

Visual aids may further support understanding, provided they include the denominator to provide a suitable context. For example, showing how many individuals out of 10 or 100 are affected can improve interpretation. Any reported value should also be placed in context so that its clinical relevance is clear. Some variations may have no clinical significance, while in other cases, even minor changes can be important.

More broadly, communication should be adapted to the clinical context. During emotionally challenging moments, such as diagnosis, individuals may struggle to process enormous amounts of information. Prioritizing essential information and presenting it clearly can improve understanding. Asking individuals to summarize key points at the end of the consultation can also help confirm comprehension and allow clarification of any misunderstanding.

This story was translated from Univadis Italy, part of the Medscape Professional Network.