Patient Education and Shared Decision-Making
Domain 3: Patient Education and Shared Decision-Making
Expect items on teach-back, plain-language explanation, risk communication, decision aids, and the three-talk model of shared decision-making (team talk, option talk, decision talk).
Core rules
- Plain language: short sentences, common words, active voice. Replace "hypertension" with "high blood pressure", "ambulate" with "walk".
- Chunk and check: give two or three points, then confirm understanding before continuing.
- Teach-back: "I want to be sure I explained this clearly - can you tell me in your own words what you'll do if you miss a dose?" The clinician owns any misunderstanding.
- Communicate risk with absolute numbers and a consistent denominator: "Out of 100 people like you taking this for 10 years, 6 fewer will have a stroke." Relative risk alone ("halves your risk") misleads.
- Use icon arrays or natural frequencies for numeracy, and check understanding of the numbers, not just the words.
- Shared decision-making means: explain all options including doing nothing, discuss benefits and harms with their uncertainty, elicit what matters to the patient, decide together, and arrange review.
- For behaviour change use motivational interviewing (OARS: open questions, affirmations, reflections, summaries) and close with a specific brief action plan: what, how often, and confidence rated 0-10.
Worked example
A 68-year-old with atrial fibrillation asks about anticoagulation. Explain the 10-year stroke risk, the absolute reduction with treatment, the absolute increase in major bleeding, and the option of no treatment. Then ask: "What matters more to you - avoiding a stroke or avoiding a bleed?" She values independence after a stroke. Document the discussion and her choice.
Traps
- "Do you understand?" or "Any questions?" used as a substitute for teach-back.
- Quoting relative risk only, or changing denominators between options.
- Equating low literacy with low intelligence.
- Offering a decision aid without conversation, or nudging toward the clinician's preferred option.