Communicating risk and uncertainty to families — formative SAQs

SAQ 1 (10 marks)

A parent has read online that a daily preventive medication for their child's chronic illness "reduces harm by 50%". They are unsure whether to start it. [1]

1. Explain why quoting "a 50% reduction" alone is a communication failure, and describe how you would reframe the benefit accurately. (4) [1] [3]
2. Outline the presentation format and visual aid you would use to support this discussion. (3) [4] [6]
3. Describe how you would confirm the family understood the numbers and the options before a decision. (3) [13] [14]

Model answer

"50%" is a relative risk reduction quoted without its baseline, which inflates perceived benefit. Reframe by stating the absolute baseline risk and the absolute risk reduction, so the family understands the true magnitude; for example, halving a risk from 2 in 1000 to 1 in 1000 is a 50% relative reduction and a 0.1 percentage-point absolute reduction. [1] [3]

Present the numbers as natural frequencies with one consistent denominator, and add a pictograph (icon array) so the denominator is visible; for a medication, use a drug-facts box pairing benefit and harm side by side in absolute terms, or a validated patient decision aid for the preference-sensitive choice. [4] [6]

Confirm understanding with teach-back: ask the family to restate the chance and the options in their own words, elicit their values and preferred direction, name any uncertainty honestly, and provide a written summary and a named follow-up contact. [13] [14]

SAQ 2 (10 marks)

A newborn screen returns positive for a rare metabolic condition with a recognised false-positive rate. The family speaks limited English. [4]

1. How would you explain the result, including the residual uncertainty, in a way the family can use? (4) [4] [14]
2. Describe how you would adapt the communication for language and health-literacy needs. (3) [14]
3. Outline what you would document after the conversation. (3) [4] [13]

Model answer

State plainly that most positive screens are false positives, and present the residual chance that the child is actually affected using natural frequencies and a pictograph; give a clear confirmatory pathway and the next step, and acknowledge the uncertainty rather than offering a single precise probability. [4] [14]

Use a trained interpreter (never a child or family member), seek a culturally appropriate translated decision aid, default to pictographs for low numeracy, and assess the family's baseline understanding and preferred way of receiving information before presenting numbers. [14]

Document the numbers shared, the format used (frequencies, pictograph, decision aid), what the family understood on teach-back, the residual uncertainty discussed, the confirmatory plan, and the named follow-up contact. [4] [13]