Paeds · professional-practice-and-evidence
Communicating risk and uncertainty to families
Also known as Risk communication in paediatrics · Communicating numerical risk and uncertainty · Natural frequencies and pictographs · Shared risk and benefit-harm communication · Prognostic uncertainty communication
Fellowship guide to communicating risk and uncertainty to families in paediatrics: risk versus uncertainty, aleatory versus epistemic uncertainty, natural frequencies and pictographs, absolute versus relative risk, framing effects, numeracy and graph-literacy barriers, prognostic uncertainty and honest hope, decision aids, teach-back and documentation; with ANZ/UK/US/Canada guidance.
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Target exams
Red flags
- Quoting a relative risk reduction without the absolute baseline, so the family overestimates benefit
- Switching denominators mid-conversation (10 of 1000 then 5 per cent) so the family loses the comparison
- Offering a single precise prognosis where genuine uncertainty exists
- Assuming a parent understood a percentage because they nodded
- Framing only the upside of a treatment and omitting the harms
- Hiding uncertainty for fear of causing anxiety, which later breaks trust
Life stages
Care settings
Clinical exam formats
Board mappings
- General and Community Paediatrics
- Communication skills and professional practice
- Renewed curriculum — Learning goal 12: Communication with patients, families, and health professionals
- Evidence-based practice and shared decision making
- Professional practice and ethics
- Written assessment of professional practice and evidence communication
- Communication stations
- Long Cases involving shared decision making and risk discussion
- Structured discussion of communicating risk and uncertainty
- 2. Professional skills and knowledge: Communication
- Evidence-based practice and quality improvement themes
- Safeguarding and screening themes
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- Communication
- History taking and management
- Child development
- General Pediatrics Content Outline — communication, screening and shared decision making
- General Pediatrics EPA: Counselling families on risks, benefits and uncertainties
- Bioethics and professional conduct
- Interpersonal and Communication Skills
- Practice-based Learning and Improvement: evidence-based risk communication
- Professionalism
- Communicator
- Collaborator
- Scholar
- Health Advocate
- Pediatrics EPA — counselling families on risk and uncertainty
Two things that get mixed up
Risk
Uncertainty
Assess what they know and their numeracy · Frame with absolute numbers and the baseline · Icon array or pictograph alongside the words · Range or honest acknowledgement of uncertainty · Teach-back to confirm understanding. Remember it as A-F-I-R-T — assess, frame, icon, range, teach-back. [3] [7] [13]
Overview & Definition
A mother reads online that a treatment "reduces harm by 50%". In your clinic she asks whether her child should have it. Before you answer a single clinical question, you face a communication problem: that 50% is a relative reduction, and she has no idea what it is relative to. Whether she consents well or badly now depends on how you handle the number. [1] [10]
Risk communication is the work of conveying the probability and magnitude of potential benefits and harms in a form a family can use to make decisions. In paediatrics the family is the unit of decision, and the child or young person is included developmentally, so the numbers must reach not only a parent but the right people in the right language. [14]
Uncertainty sits beside risk in every such conversation. It has two flavours. Aleatory uncertainty is irreducible chance — the run of luck in who is affected. Epistemic uncertainty is the gap in what we know, which better evidence can narrow but rarely close. Prognosis in a relapsing illness, the meaning of an incidental finding, and the long-term effects of a new treatment all carry epistemic uncertainty that families deserve to hear named. [4] [13]
This page owns the process and skills of presenting numbers and uncertainty. Cross-link the dedicated leaves for shared decision-making and assent, breaking bad news, vaccine-hesitancy counselling, consent frameworks, health literacy, and working with interpreters — do not rebuild their content here. [14]
References14ShowHide
- [1]Gigerenzer G Helping Doctors and Patients Make Sense of Health Statistics. Psychological science in the public interest, 2007.PMID 26161749
- [2]Fagerlin A Making numbers matter: present and future research in risk communication. American journal of health behavior, 2007.PMID 17931136
- [3]Paling J Strategies to help patients understand risks. BMJ, 2003.PMID 14512489
- [4]Zipkin DA Evidence-based risk communication: a systematic review. Annals of internal medicine, 2014.PMID 25133362
- [5]Woloshin S Communicating data about the benefits and harms of treatment: a randomized trial. Annals of internal medicine, 2011.PMID 21768582
- [6]Schwartz LM Using a drug facts box to communicate drug benefits and harms: two randomized trials. Annals of internal medicine, 2009.PMID 19221371
- [7]Bonner C Current Best Practice for Presenting Probabilities in Patient Decision Aids: Fundamental Principles. Medical decision making, 2021.PMID 33660551
- [8]Hoffrage U Natural frequencies improve Bayesian reasoning in simple and complex inference tasks. Frontiers in psychology, 2015.PMID 26528197
- [9]Garcia-Retamero R Visual aids improve diagnostic inferences and metacognitive judgment calibration. Frontiers in psychology, 2015.PMID 26236247
- [10]Moxey A Describing treatment effects to patients. Journal of general internal medicine, 2003.PMID 14687282
- [11]Galesic M Graph literacy: a cross-cultural comparison. Medical decision making, 2011.PMID 20671213
- [12]Galesic M Statistical numeracy for health: a cross-cultural comparison with probabilistic national samples. Archives of internal medicine, 2010.PMID 20212183
- [13]Peters E Communicating Numeric Risk Information to Patients. Journal of general internal medicine, 2025.PMID 40301218
- [14]Levetown M Communicating with children and families: from everyday interactions to skill in conveying distressing information. Pediatrics, 2008.PMID 18450887