Communicating risk and uncertainty to families — branching viva

Opening (candidate)

I would treat this as a structured risk-communication conversation, not a result handover. First I would assess what the family already understands, what they have read, and their numeracy and language needs, and arrange a trained interpreter. Then I would reframe the 50% figure with absolute numbers and a pictograph, present the rare harm in a balanced drug-facts box, confirm understanding with teach-back, and arrange follow-up. [1] [14]

Branch A — Definition and framing

Examiner: Why is "reduces harm by 50%" a communication problem? [1]

Candidate: It is a relative risk reduction quoted without its baseline, which inflates perceived benefit. I would state the absolute baseline and the absolute risk reduction so the family understands the true magnitude; halving a risk from 2 in 1000 to 1 in 1000 is a 50% relative reduction but a 0.1 percentage-point absolute reduction. [1] [10]

Branch B — Format and visual aid

Examiner: How would you present the numbers? [4]

Candidate: In natural frequencies with one consistent denominator, alongside a pictograph so the denominator is visible. For a medication with competing benefits and harms, I would use a drug-facts box pairing benefit and harm in absolute terms, or a validated decision aid for the preference-sensitive choice. [4] [6]

Branch C — Uncertainty

Examiner: How much uncertainty do you disclose, and how? [4]

Candidate: I would name epistemic uncertainty honestly and give a range rather than a single false-precise point estimate. Hidden uncertainty, offered as false precision, erodes trust when events diverge; an honest range preserves it. [4] [13]

Branch D — Language and numeracy

Examiner: The family speaks limited English. Your approach? [14]

Candidate: I would use a trained interpreter and never a child or family member, seek a culturally appropriate translated decision aid, and default to pictographs for low numeracy. I would gauge their preferred way of receiving information before presenting numbers. [14]

Branch E — Failure mode

Examiner: A colleague already told the parents the medication is 'completely safe'. [1]

Candidate: I would avoid openly contradicting my colleague in front of the family. I would acknowledge the reassurance, gently introduce the balanced benefit-harm picture with the absolute numbers, and align the team afterwards so the family hears one consistent message. [1] [14]

Close

Confirm understanding with teach-back, leave a written summary with the pictograph and drug-facts box, name the next contact, and document the numbers, format, understanding and decision. [13] [14]