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do ADR in monographs reflect what will happen in public?

not necessarily
- Trial participants are generally healthier than general pop (Younger, less conditions)
- Lack of comparisons b/w products or with no treatment
- Just have to show it’s better than placebo in Canada or US
- Don't have to compare best known treatment
-Info on risk can be implemented slowly (COVID changed this)


what are current risk attitudes>

Accept invisible high risks
● driving
Choose risky behaviour
● Rocking climbing, smoking, unprotected sex, cell
phone use while driving
Sensitive to low remote risks that are imposed by others
● Food additives, power lines, water bottle liners

Social amplification of risk comes from rumours about risk or harm
Over-estimation of dramatic or rare events, under-estimation of common killers or risks


define numeracy

- An element of health literacy
- Comprises basic math skills needed for health related activities such as timing, scheduling, dosing of meds a swell as numeric concepts needed to understand and act upon directions and recommendations given by HCPs


name 5 steps on how to communicate numbers

1. Simplify numbers
2.Avoid using descriptive words
3.Use standardized numeric definition
4.Use visual aids
5.Use more than one method

(extra: Chronic meds may often work for less than 50% of the population)


simplify numbers

how can you say take 30mg in the morning of 5mg prednisone tabs?
how can you say a 5% weight loss will help (275Ib)

- take 6 tabs every morning
- a 14Ib weight loss will improve health


Avoid using descriptive words

what 3 ways can be used to talk abt frequency?

HCPs interpret rare events as far less frequent than pts
fraction, percent, odds (better)


What fraction is
1. very common
2. common (freq)
3. uncommon (infreq)
4. rare

≥ 1/10
≥1/100 and <1/10
≥1/1 000 and <1/100
≥1/10 000 and <1/1 000


Use clear and consistent numbers

what is the best number format to use?

- Odds are more easily understood
- Simple percentages such as 10% are ok
- Use standard denominator

1 in 10 vs 3 in 100
10 in 100 vs 3 in 100 is better
Some pts see risk of 1 in 500 as greater than 1 in 80


what's wrong with saying that a pt will lower their risk by 30% by taking a statin?

sounds like she is at 100% risk of suffering a heart attack if she doesn't take the med
when in reality Susan has a risk of 1% for MI in 10 years

Susan’s risk after taking the med in the next 10 years = 0.67%


‘Studies show that taking DRUG X lowers people’s
risk of a heart attack by 25%, or about 1/4.

what type of risk is this?

relative risk


‘The studies showed that DRUG X lowered the total
number of people having heart attacks from 4 out of
100 to 3 out of 100.’ So DRUG X helped about 1 out
of every 100 people who took it.’

what type of risk is this?

absolute risk


absolute vs relative risk

10 of 100 get disease
After drug, 5 of 100 get the disease
5/100 = absolute risk
10 to 5 = 50% relative risk reduction

emphasize the absolute risk


Keep the direction the same
○ 10 out of 100 patients will develop cancer
○ 90 out of 100 will not develop cancer

what technique is shown?

Use a consistent frame


‘Medical experts estimate that about 10 out
of 100 people like you will develop colon
cancer during their lifetimes.’
○ ‘You can also look at this in another way: 90
out of 100 people like you [with your
characteristics] will stay free of colon cancer.’

what technique is shown?

Present both frames


‘One way to think about this is to imagine a
group of (100) people like you, who have the
following things in common: (sex, age,
family history of cancer ... etc). Of this group
of (100) similar people, 10 will develop colon
cancer in their lifetime.’

what technique is shown?

Explain the reference class


‘Even if the risk of a complication from
surgery is 10 out of 100, we don’t know
whether you will be one of the unlucky 10
who will suffer the complication, or the lucky
90 who will not.’

what technique is shown?

Acknowledge uncertainty


name the techniques for using clear and consistent numbers (5)

● Number format
● Frames
● Relative vs absolute risk
● Reference class
● Uncertainty


name 2 visual aids that can help

Perspective Scale: allows pts to compare medical risks with risks they are familiar with and to have some kind of conceptual context to reflect

Paling pallet or icon array: Simple to understand
- Have a common denominator
- Show even-handedly positive outcomes and risks
- Useful in consolidating relationships b/w HCP and pt

(see pics)


what obstacles are present to risk comm?

● Patients may be unable to take in info due to shock or distress
● Influenced by media and family
● Rare or low risk may be used differently between patients and HCP
● Cognitive function
● Numeracy/Literacy/Health Literacy


how did pts feel in the paper "It's for your benefit: exploring pts' opinions about inclusion of textual and numerical info"

- wondered what happens to people who won't be saved
- who is not going to be saved
- Participants were surprised that so few people would
- Some participants struggled to understand and interpret the NNT and others found it difficult to comprehend the magnitude of the benefit information, instead operating on initial and often crude assumptions of what the data meant.
- The provision of numerical benefit information appeared to shake participants’ faith in drug treatments.


what additional strategies can be used?

● Explore patient’s emotional state
● Identify and accept patients fears
● Relate risk to familiar everyday risks
● Ensure patient understanding of risk
● Provide time to make informed decisions

Use more than 1 method
Avoid using only descriptive words
Use standard vocab
Use standardized numeric definition
Avoid relative risk figures along
Frame risk positivity
Avoid complex forms (NNT, NNH), prevention or risk over time


define risk, hazard, harm

Risk means chance or probability of something bad happening
Hazard: inherent danger in something (tank of flammable liquid)
Harm: used to characterize nature of negative event, severity/duration