We propose that academic scholarship and clinical practice should conceptualize communication about risk as a dialogic and relational process. This conceptual paper addresses how clinical decisions about cancer treatment are impacted by different risk perceptions. Patients and health care providers base their risk perceptions on analytic or experiential reasoning processes. However, most risk communication research in the clinical context only examines the transmissive and persuasive communication of these different risk perceptions. This transmissive communication results in a monologic model that limits the opportunities for patients and clinicians to incorporate their perspectives into a shared understanding. The dialogic model of risk communication contributes to a quality cancer care decision because it creates open space to find connections between patient values and clinical evidence while allowing the parties to have a satisfactory level of involvement. The final section of the paper describes theory behind a dialogic perspective and offers guidelines for how to implement it in risk communication to improve clinical decision making.