Question (correct answer in bold) | n | n (%) correct | |
Questions asked before content covered in the course | |||
1. | Among groups of healthy adults, which group do you think is more likely to take up influenza vaccination?
| 298 | 258 (86.6) |
2. a | Which of the following statements about cancer screening would provide evidence that screening reduces deaths from cancer if true?
| 274 | 137 (50.0) |
3. | SDM is a continuum along which the extent a patient or a clinician takes responsibility for making decisions (True) | 256 | 198 (77.3) |
4. | SDM is simply informing patients of their options and letting them choose (False) | 256 | 216 (84.4) |
5. | SDM is a mechanism for applying evidence to an individual patient’s situation (True) | 256 | 226 (88.3) |
6. | SDM is a single step to be added into a consultation (False) | 256 | 225 (87.9) |
7. b | There is no need to document SDM as it is part of a routine exchange between patient and clinician (False) | 257 | 230 (89.5) |
8. | SDM and informed consent are essentially the same thing; both involve making patients aware of risks and signing a consent form (False) | 257 | 201 (78.2) |
9. b | SDM is documented by making a note in the patient’s medical record (True) | 257 | 228 (88.7) |
10. | Shared decision making may not be appropriate in which of the following situations? More than one answer may be correct.
| 257 | 121 (47.1) |
11. c | As both patients and clinicians can have difficulty with numbers, is it better to use terms like ‘high risk’, ‘unlikely’ or ‘possible’ to describe risk? (False) | 231 | 152 (65.8) |
12. | If you wake up in the morning and hear/read that there is a 20% chance of rain today, what does this mean?
| 231 | 124 (53.7) |
13. | Which of the following statements about relative risk is correct? More than one answer may be correct.
| 245 | 35 (14.3) |
14. | Absolute risk is the same as incidence (True) | 246 | 82 (33.3) |
15. d | Imagine that a new drug for osteoporosis has just been approved. In clinical trials, it was found to cut the risk of having a hip fracture in the next 3 years by 50%. The drug also seems to be well tolerated with no gastrointestinal or genitourinary side effects. You look up the evidence and find that 10% of the untreated people had a hip fracture at 3 years, compared with 5% of the people who took the osteoporosis drug every day for 3 years. Use the data provided to answer three questions about the study findings: | ||
i. Absolute risk reduction will be… A 5% B 10% C 20% D 30% E 40% F 50% | 245 | 145 (59.2) | |
ii. Relative risk reduction will be… A 5% B 10% C 20% D 30% E 40% F 50% [N.B. Answer is in the question] | 245 | 134 (54.7) | |
iii. Number needed to treat to benefit will be… A 5 B 10 C 20 D 30 E 40 F 50 | 245 | 112 (45.7) | |
16. e | When talking to (a patient) about the risk reduction associated with this treatment, what format would you use? (Absolute risk reduction or Relative Risk Reduction but with the caveat that RRR can be misleading in some circumstances, such as when absolute risks are very small) | 245 | 126 (51.4) |
17. | Does practising SDM routinely increase the length of consultations? (False) | 220 | 178 (80.9) |
Questions asked after content covered in the course | |||
1. | An online breast cancer Risk Assessment tool states: “Women (taking tamoxifen) had 49% fewer diagnoses of invasive breast cancer” and “The annual rate of uterine cancer in the tamoxifen arm was 30 per 10 000 compared with 8 per 10 000 in the placebo arm.” Which of these missing pieces of data would be most informative for weighing up the potential benefits against the potential harms of tamoxifen, when added to the information given above? i. Does this give all the information required for a patient to weigh up the benefits in terms of breast cancer against the risks in terms of uterine cancer? (No) | 220 | 193 (87.7) |
ii. In relation to the scenario above, which of these missing pieces of data would be most informative for weighing up the potential benefits against the potential harms of tamoxifen, when added to the information given above? a) The annual rate of breast cancer per 10 000 women with and without tamoxifen b) The percentage increase in uterine cancer for those taking tamoxifen c) The number needed to treat for one woman to get uterine cancer as a result of taking tamoxifen | 218 | 137 (62.8) | |
2. a | A website shows national statistics on cancer to allow comparison between different countries. Which statistic would you choose to compare the effectiveness of different healthcare programmes for those diagnosed with cancer?
| 217 | 86 (39.6) |
3. | SDM is a legal necessity as part of Informed Consent (False) | 217 | 117 (53.9) |
4. | Risk communication is a legal necessity as a part of Informed Consent (True) | 217 | 187 (86.2) |
5. b | SDM should be documented in the patient’s medical record (True) | 217 | 208 (95.9) |
6. | SDM is not appropriate where national guidelines for care are clear on what treatment is appropriate (False) | 217 | 196 (90.3) |
7. | Patients can choose to take part in SDM or not (True) | 217 | 206 (94.9) |
8. c | Since many people struggle with numbers, it is better to use verbal terms such as ‘rare’ and ‘common’ to communicate (False) | 217 | 191 (88.0) |
9. | When communicating risks to be compared, it is best to communicate in the format ‘one in x people are likely to experience…’ (eg, 1 in 10 compared with 1 in 250) rather than keeping the denominator the same (eg, 100 in 1000 compared with 4 in 1000)? (False) | 217 | 148 (68.2) |
10. | Appropriate visual aids such as pictographs or icon arrays can help see the risk numbers in context. (True) | 217 | 205 (94.5) |
11.d e | A treatment has a side-effect which increases the chances of a fatal pulmonary embolism from 1 in 10 000 to 5 in 10 000 | ||
i. What is the absolute risk increase (in percentage points)? A 0.04 B 5 C 40 D 500 E 2500 | 215 | 140 (65.1) | |
ii. What is the percentage relative risk increase? A 0.04 B 5 C 40 D 500 E 2500 | 215 | 55 (25.6) | |
iii. What is the number needed to treat to harm one person? A 0.04 B 5 C 40 D 500 E 2500 | 215 | 119 (55.3) | |
iv. Which would you use to communicate the risk to your patient? (Absolute risk increase) | 215 | 140 (65.1) | |
12.d | Looking at the treatment options for your patient, you see that one treatment is likely to decrease their risk of complications from 25% to 5% | ||
i. What is the absolute risk reduction in percentage points? A 4 B 5 C 20 D 60 E 80 | 214 | 152 (71.0) | |
ii. What is the percentage relative risk reduction? A 4 B 5 C 20 D 60 E 80 | 214 | 78 (36.4) | |
iii. What is the number needed to treat to benefit one person? A 4 B 5 C 20 D 60 E 80 | 214 | 101 (47.2) |
Superscript letters mark similar questions that were asked both pre-course and post-course
SDM, shared decision-making.