Table 2

Percentage of correct responses to shared decision making and risk communication knowledge questions (in the course before content covered and at the end)

	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? Adults who think they are at high risk of influenza Adults who do not think they are at high risk of influenza	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? More cancers are detected in screened populations than unscreened populations Screen detected cancers have better 5 year survival rates than cancers detected because of symptoms Mortality rates are lower among screened populations than unscreened populations in randomised trials The screening test has a post-test positive value of approximately 30%, making it highly accurate at detecting aggressive cancers	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. In an emergency When it is not welcomed by the patient When it may lead to the patient making a decision that is against standard medical practice or your advice	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? It will rain 20% of the time today (5 hours) It will rain in 20% of the region today (so probably not in your area) It will rain on 20% of the days for which this prediction is made (therefore it probably won’t rain) Two in 10 meteorologists predict it will rain today None of the above	231	124 (53.7)
13.	Which of the following statements about relative risk is correct? More than one answer may be correct. Relative risk gives an idea of the risk of experiencing something over time Relative risk is a concept rather than something that can be measured Relative risk indicates whether a particular characteristic or exposure increases or decreases risk Relative risk compares two risks	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? 5 year survival rate for those diagnosed with cancer Detection rate of cancer in screening programmes Mortality rate of cancer in the population Incidence of cancer in the country	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.