Benefits, Harms and Alternatives

#Compare the relevant options rather than a treatment in isolation

NICE recommends discussing the aims, risks, benefits and consequences of each option, including no treatment or no change to the current plan. NIA advises asking about different treatment choices, side effects, duration and effects on everyday life. Alternatives need a clinical explanation of what each would mean in the particular situation.

Ask which options are relevant and what may happen with each. Including no change in a discussion is not advice to stop or delay treatment. The NICE guideline excludes unexpected emergencies needing immediate life-saving care, and this page does not decide which options are safe for an individual.

Evidence: NICE NG197: shared decision making / National Institute on Aging: discussing health decisions

#Ask for numbers with a clear baseline and time period

NICE's risk-communication guidance recommends absolute risk rather than relative risk, natural frequencies, the same denominator when comparing risks and a defined period when relevant. It also recommends explaining how information applies to the person and the uncertainty attached to it. A statement that a risk rises or falls is incomplete without knowing the starting risk and what was measured.

When numbers are available, ask how many people out of the same-sized group experience the outcome with each option, over what time and in which population. Ask whether the estimate fits your situation. Research averages are not personal guarantees; this page supplies no personal probability or calculator.

Evidence: NICE NG197: shared decision making

#Consider consequences and unresolved questions together

NIA recommends considering treatment effects on regular activities and practical matters such as cost. NICE says people may value the balance of benefits, risks and consequences differently from their clinicians. Oxford's patient guidance also asks about goals, worries and quality of life.

Tell the clinician which consequences matter most and ask what evidence is missing or uncertain. If the explanation is hard to follow, ask for a clearer format or a relevant decision aid. Comparing benefits and harms is part of a clinical conversation, not a score that this page can use to select a treatment for you.

Evidence: National Institute on Aging: discussing health decisions / NICE NG197: shared decision making / Oxford University Hospitals: shared decision making

Source note

The sections above were checked against the linked sources. No clinical review has been performed. This is general research education, not a clinical guideline.