Risky communications

Clear and effective communication is vital to all human endeavour and interaction. 

But clear and effective communication in the public health sphere is particularly essential, as it can mean the difference between action and inaction, assurance and alarm, and even life and death.

Michelle Driedger is fascinated by the power of communication and knowledge translation and the effect that they have on public health policy and public trust. This fascination has informed her academic research as a health geographer, a U of M associate professor at the Rady Faculty of Health Sciences, and former Tier 2 Canada Research Chair (CRC) in Environment and Health Risk Communication in the department of community health sciences. Her CRC was funded by the Canadian Institutes of Health Research.

Driedger was raised in Winnipeg, but was recruited originally from the University of Ottawa, where she was an assistant professor in the department of geography.

During her tenure as a CRC, which began in 2006, was renewed in 2012 and ended in 2017, Driedger focused on the juxtaposition of environment and public health. She studied, and continues to study, how both real and potential health risks are communicated, how public health knowledge is translated and the ways in which communication and knowledge translation can be improved. She examines health policy decision-making and areas of potential controversy, and seeks to understand why public health communication and knowledge translation frequently inspire uncertainty rather than trust, and how that uncertainty can be eradicated.

Her research, she says, actually serves as a bridge between health risk communication and knowledge translation.
 
Health risk communication refers to communication about potential threats and safety recommendations between groups in an interactive fashion. Knowledge translation, on the other hand, implies a transfer of evidence to inform health practice or health policy decision-making.

“I specifically explore how scientific evidence is used, or not used, in policy decisions that affect our health, and what happens when these issues surface in public discourse,” Driedger explains.

“A central defining question that characterizes my research is how can the science and practice of risk communication and knowledge translation be advanced in a manner that engages civil society in effective dialogue when situations are characterized by uncertainty?”
 
That uncertainty, she elaborates, refers to times when, in spite of a lack of firm evidence, a health policy decision or recommendation must be made.
 
That kind of situation arose during the 2009 H1N1 pandemic and the 2014 Ebola outbreak, and regularly emerges in discussions of vaccine hesitancy and whether or not certain cancers and MS therapeutic treatments should be approved or made accessible to the public.

While much of Driedger’s qualitative research has taken place among the general population, several of her studies have specifically targeted the Indigenous community. In particular, her CRC support has enabled her to enjoy an extensive, enduring and productive partnership with the Manitoba Metis Federation (MMF).

In one of her MMF-supported projects, Driedger, who is Métis, is investigating if health-related messages that derive directly from Indigenous youth are more effective than messages delivered by government and health agencies. In a newer project, she is studying the way in which physicians communicate with patients about tests and procedures that they are, or are not, recommending, and whether or not that communication and those recommendations are affected by cultural biases.

The CRC program support also made it possible for Driedger to mentor students like Elizabeth Cooper, who recently completed a PhD focused on empowering health and safety-related decision-making in Indigenous women and girls. Like Driedger’s extensive body of research, Cooper’s thesis examined risk communication and environment, and ways of sharing study findings in an ethical and respectful way.

Driedger is an excellent role model who likes to push the boundaries, Cooper says of her mentor.

“She is able to explore decision-making, policy and health practices from multiple lenses, and she is able to explain complex topics in a way that is meaningful and relevant for all people.”

Driedger, in turn, insists that it was the multiyear support that she received from the CRC that nurtured her passion and curiosity and helped her develop into a leader in her field.

As a trailblazer, she has enhanced the public’s understanding about inherent risks and how and why certain health policy decisions are made. At the same time, she has enhanced policy makers’ and medical experts’ understanding about how and why their decisions sometimes breed uncertainty and distrust and how that scenario can be improved.

By consistently using clear and straightforward language in her questions, research and findings, Driedger has demonstrated the need for and the effectiveness of clear and straightforward communication whenever and wherever public health is at stake.

Changing the dialogue

Michelle Driedger is on a mission to improve communication between medical practitioners and their patients, especially their Métis and marginalized patients.

Her newest study—Changing the patient primary care provider dialogue: fostering trust through joint clinical decision making—aims to improve the way that clinicians explain to their patients their decision-making regarding follow up tests and treatments.

Do they clearly explain why they are not recommending specific tests? Are they concerned about taxing an already overburdened health care system? Do they respect their patients’ agency and culture? Do they ever withhold care? Do their patients ever think that they are withholding care?

Driedger developed an interest in this topic after learning about the global Choosing Wisely® movement. The movement, recently introduced in Canada, aims to eliminate unnecessary medical diagnostic tests.

“Choosing Wisely® is designed to provide health recommendations about what tests or procedures shouldn’t be undertaken for particular conditions when no red flags are present,” she explains.

While these recommendations are always based on an evaluation of the evidence, Driedger has some concerns about the process from a communication perspective.

“If there is no real engagement with the public around this, or if physicians don’t adopt this in a more culturally sensitive way,” she asks, “could patients be exiting an encounter with a physician thinking the doctor is withholding a particular test or treatment from them in order to save the health system money, or worse, because the doctor doesn’t feel that the life of an Indigenous person matters?”

Driedger is pursuing this study in partnership with the Manitoba Metis Federation Health and Wellness Department, as well as Shared Health (formerly Diagnostic Services Manitoba). Her ultimate aim, she explains, is to enhance physician- patient trust within the Métis community and improve health care communication for all Manitobans.

Story originally published in ResearchLIFE Summer 2018 Edition. Read the full magazine online.

SHARON CHISVIN