In a recent conversation about patient numeracy, and talking about numbers, a related question surfaced, and I thought it was worth exploring for its own episode: talking about randomness and randomization with patients.
Hi, everybody. This is 10 Minutes to Better Patient Communication from Health Communication Partners. Since 2017, we’ve been giving you inspiration and strategies to improve engagement, experience, and satisfaction. I’m Dr. Anne Marie Liebel, a researcher, consultant, and educator specializing in communication and education. This podcast makes space to dig into what it’s easy to take for granted about communication in our professional lives, especially in health care and public health, but increasingly across sectors, because communication touches everything. We’re here to learn, get inspired, and most importantly, make the difference we got into our jobs to make. Like what you’re hearing in these episodes, want to take it further? Work with me. Visit healthcommunicationpartners .com and click on contact.
So yeah, while working through the big theme of numeracy in my last monologue episode, I found myself continually thinking about a related question that I think deserves its own space: Randomization. It can be a big deal, especially in clinical trials. The concept of “randomization,” this specific kind of randomness, in clinical trials often refers to random assignment of patients to one intervention or another. I was talking to a team who often communicates about clinical trials. They had noticed that there were some ways of explaining them, specifically the common metaphor of the flip of a coin or toss of a coin. And patients, some patients, anyhow, that was not landing well with them. It might have suggested gambling, or evoked images of games of chance, and they wanted something different.
So I’m going to dig into numbers again. And I’ll use this example of communication and clinical trials and randomization, but I hope I’m going to deal with this concept in a way that can be helpful, no matter what your context is.
Now, the last monologue episode I did was called How to Talk About Numbers, because that was a question that I had gotten. And it’s a huge concept in healthcare and public health. So I’m just kind of touching the surface here, but I want to go back over a couple things that i said in that epised that have to do with numeracy and how we think about numbers. The way i see numeracy from the literacy field, it’s something we all do constantly, as part of everyday life. But you could think of us as having different kinds of numeracy or needing different kinds of numeracy in different situations.
We all have formal numeracy practices and informal numeracy practices. The formal ones being what you might think of a school-based numeracy. Anything that you had to learn in school, arithmetic and multiplication, all the way up to advanced modeling, all of the STEM fields, differential equations! So any formal way of working with math and mathematical reasoning, we could call formal numeracy practices.
We also have informal numeracy practices. So these are the numerous kinds of calculations, estimations, comparisons that we do as part of everyday life. These are also forms of mathematical reasoning, but we don’t necessarily reach for formal mathematical principles or tools while we’re doing them. Nonetheless, they reveal sophisticated kinds of reasoning about uncertainty, probability, proportion, and other mathematical concepts.
So in the last monologue, I had said, remembering that we all have informal numeracy practices can be really helpful when you’re trying to describe something that maybe requires formal numeracy practices. Because you want to refer to something people are already familiar with, when you’re trying to explain something new. So I also gave five examples of everyday domains where we all do these kinds of informal, but sophisticated, mathematical reasoning. So I’ll put links in the show notes for that episode if you want to go back over that.
But I’m telling you this because if you’re communicating about randomness or randomization, you want to be effective when you’re communicating and educating. Because you want patients to be able to make informed decisions and also have the best outcomes possible.
Because you have soemthing to communicate about involving numbers. we can think of numeracy as falling within shared decision making more broadly. As I just said, we all learn well when something new is built on something known. And that’s what I want to help you with here with randomization and randomness.
We could think of these as specific types of uncertainty. I found a great 2019 article about uncertainty in health care, and it opens with these words: “Uncertainty is an essential aspect of human life and an integral problem of medicine. It is the single common challenge faced by every patient who receives health care and every clinician who provides it….” So I’ll give you obviously a link to that article.
Now, those of you who are in the clinical research context, you’re communicating about uncertainty in multiple ways. Authors of a 2023 paper, Communicating complex numeric information in clinical research state: “In the clinical research context, appreciating the risks and benefits, the trade-offs, and importantly, the likelihood of those risks, benefits, and alternatives occurring, ground informed consent and enable autonomy.” The authors conclude that, “Understanding, and understanding numbers specifically, is especially important in the clinical research context.” The team who talked with me about randomization clearly knows this.
Again the concept of “randomization,” in case of clinical trials, we’re often referring to random assignment of patients.
Randomness is an important concept especially in public health and epidemiology. It shows up every day in many ways, like finding on street parking, or choosing the fastest checkout line, Maybe traffic lights, when you roll up to an intersection. How long are they going to stay that color? Or which elevator is going to show up first when you hit the button? Those are all examples of randomness.
Randomization, on the other hand, we run into more when we’re talking about a study. So I’m talking here about communicating with participants about randomization. Here, the uncertainty relates to their being assigned to one intervention or another.
You might be responsible for explaining randomization and the rationale behind it. As communicators, there’s a lot of responsibility and you have many choices to make. You are trying to share decicion making responsibility, and align your communication and recommendations with what matters to patients. This is not easy. So what I’m going to share, I hope will be helpful here.
I want to offer two options for where randomization shows up in everyday life. These would be the known, the familiar that you can use if you’re concerned on how to represent randomness in a clinical trial, which is, let’s say, the new or unfamiliar concept that you are trying to get across. Maybe one of these two will be appropriate in your situation. but maybe they’ll get you thinking of others.
And what i’m talking about here is obviously verbal communication. but please be multimodal! use this in conjuctntion w your graphs, icons, games, and other visual and kinetic explanations and decision aids.
2 examples of everyday randomization
1. Signing up for a class
If you’ve ever signed up for a class or if you’ve tried to get your kids into after school or summer program, usually students are often placed into a section of a class or program by a neutral system. It’s by random chance, it’s not by personal preference.What happens is you’re going to get different teachers, maybe slightly different schedules, different locations. And so the outcomes of your experience could be different. You could wind up having a very different course experience, depending on what section you got assigned to, but you’re still going to get a course.
2. Scheduling shifts at work
Another example is scheduling shifts at work. Some employers use randomization to assign shifts equitably, and that’s usually done by a computerized system, So you get scheduled for a shift. You look at your schedule. you know that what time slot you got, and who you get to work with, and if you get a break, when that break is scheduled also randomly, all this can really impact your experience at work. You’re still going to get a shift, but the outcome of that shift on your experience could be very different depending on what shift you got.
The point here isn’t to make a comparison to a treatment option, but to give you actual literal examples of randomization in everyday life that are familiar and also emotionally neutral. I want to remind us that uncertainty is part of life that we all deal with, using formal and informal numeracy, and offer you a couple everyday options you might use when you have to explain or teach about randomization.
If you’ve got a favorite or two that you’ve noticed that patients find helpful, I’d love to hear about it! Visit healthcommunicationpartners.com or message me on linked. Now, that last episode about talking about numbers, a listener responded, and said something I thought was really insightful: “We are all math people.” And I agree, even us word nerds.
Because as adults in our everyday lives, we don’t necessarily think in terms of formulas or percentages, but we regularly reason about quantity, chance, and uncertainty in meaningful ways. If you’d like more help with this, get in touch. Visit healthcommunication partners .com and click on contact. This has been 10 Minutes to Better Patient Communication from Health Communication Partners. Audio engineering and music from Joe Liebel, additional music from Alexis Rounds. Thanks for listening to 10 Minutes to Better Patient Communication from Health Communication Partners LLC. Find us at healthcommunicationpartners .com.