WesternU's Ray Symposium does the math on why numbers matter in health care

Many people in the U.S. aren’t good with numbers, but that shouldn’t stop health professionals from providing them to patients – along with some context – to help them lead healthier lives, according to the keynote speaker at Western University of Health Sciences’ 9th Annual Ray Symposium.

The symposium, held April 30, 2015 in Pomona, Calif., featured keynote speaker Ellen Peters, PhD, a professor in the Psychology Department and Director of the Behavioral Decision-Making Initiative at The Ohio State University.

In her research, Peters focuses on understanding the basic building blocks of human judgment and decision making. She is a recognized leader in risk perception, communication, and the psychology of health decision making, publishing papers on the effects of affect and emotion, numeracy and number processing, and aging.

Numeracy, or numeric literacy, is the ability to understand and use numerical concepts. Numeracy is important in health care because numbers instruct, inform and give meaning to information about health plans, medications and treatments, Peters said.

“The problem is, not everyone can understand and use numbers effectively,” she said. “Even people who are highly educated can be innumerate, or not very good with numbers.”

This variation in numeracy skill, combined with policy shifts at the national and local levels, may result in an increase in health disparities across the nation as people who are good with numbers can take advantage of our information-rich society, while people who don’t have as many skills get left farther behind, Peters said.

Americans have limited numeracy skills, and disparities exist. Those who are older, less educated or have a lower income tend to be less numerate. People without health insurance prior to implementation of the Affordable Care Act are less numerate than those insured before ACA went into effect.

“What that means is that health insurance companies and health care providers continue to be faced with a less numerate population of patients than what you’ve seen before,” Peters said.

Providing as much information as possible does not always produce the best results. People who are lower in numeracy are less likely to seek out numerical information, and even if the information is right in front of them, they are less likely to look at it, she said.

Those less numerate are more likely to have to go to hospitals and emergency rooms. They have a lower likelihood to quit smoking if they’re in a cessation program, and they have less ability to follow complex medication regimens.

Peters recommended giving patients the numbers they need to make good decisions. She conducted a study where half the subjects received basic information about a new medication and the other half received the same information, plus additional numeric information such as the frequency of certain side effects.

“People who don’t get the numbers are far more likely to overestimate the risks than the people who are given the numbers, and your numeric ability does not matter,” she said. “In addition to that, less-numerate individuals are more likely to take the drug if you give them the numbers.

“Providing numbers matters,” Peters said. “It’s about education. It’s about informing our patients and helping them take charge of their own health.”

Although you should provide numbers, you shouldn’t overwhelm patients with them, she added.

“We need to reduce how much cognitive effort we require from patients,” Peters said. “Less is more. Including less information – just the most important information – helped comprehension most in the less numerate.”

Peters also recommended providing patients context to better understand the meaning of numbers. For instance, a person deciding whether to eat a cookie may be told that the cookie has 220 calories. Or you could tell them that it would require 40 minutes of brisk walking to walk off those calories.

“Which one has the bigger impact?” she said.

Communicating with patients is not easy, she said. How do we figure out what they already know and what they want to know? If less is more, how do we draw the line in terms of what’s important and what’s not?

“Consumers are certainly not always adept at using the complex and often numeric information that’s important to good health decisions,” Peters said. “Patient communication should be done strategically, first by deciding what the goal of that communication is. You have to decide what is it you want them to get out of this encounter. Once you know what you want them to get out of this encounter, you can carefully choose — in an evidence-based manner — how to present that information, with the ultimate goal of healthier, happier patients.”

The Ray Symposium, presented by the College of Pharmacy and the Interprofessional Education program, honors Max D. Ray, MS, PharmD, Dean Emeritus of the College of Pharmacy.