Risk talk: Using evidence without increasing fear

Abstract

Objective: this paper explores unexpected findings about how to "do risk talk" which emerged during a broader research project on of the application and misapplication of evidence-based practice in Canada.

Design: the study used qualitative methods such as semi-structured interviews and thematic analysis of inter-professional maternity care conference presentations.

Setting: Canada

Participants: fifty Canadian midwives, doctors and nurses involved in maternity care were interviewed to uncover the "how and whys" of differing interpretations and uneven application of evidence.

Results: care providers described a "lean to technology" as an unexpected result of using evidence in their discussions with pregnant women. They perceived risk talk as undermining low intervention approaches and reassurance about the safety of birth. Across professional groups, interviewees described how they attempted to mitigate this unwanted effect. Their strategies to put risk in perspective include finding comparable everyday risks, using words and pictures to describe numbers and using absolute risk and numbers needed to treat rather than relative risk. They warned about the need to balance a culture of fear combined with maternal altruism. Time, reassurance, awareness and humility were seen as key tools.

Key conclusions and implications for practice: midwives and other maternity care providers can use a variety of techniques to put risk into perspective. It is important to discuss evidence and risk with an awareness that the process itself can exaggerate risk. Care providers in all professional groups were motivated to avoid contributing to a culture of fear about childbirth and increasing rates of intervention.

Keywords: Evidence-based practice; Evidence-informed practice; Informed choice; Informed consent; Risk; Risk communication.