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[ MDster Editorial Team ](https://mdster.com/about) · Oct 09, 2026 · 6 min read · 37 [ Reviewed by Dr. Ali Ragab, MBBCH, MSc, MCAI ](https://mdster.com/medical-reviewers/dr-ali-ragab) [Editorial Policy](https://mdster.com/editorial-policy) | [Corrections Policy](https://mdster.com/corrections) [ Family Medicine ](https://mdster.com/blog?tag=family-medicine) [ Evidence-Based Medicine ](https://mdster.com/blog?tag=evidence-based-medicine) [ Primary Care ](https://mdster.com/blog?tag=primary-care) [ Shared Decision-Making ](https://mdster.com/blog?tag=shared-decision-making) [ Risk Communication ](https://mdster.com/blog?tag=risk-communication) ![Shared Decision-Making Using Evidence in Family Medicine](https://mdster.com/storage/blog/images/shared-decision-making-using-evidence-in-family-medicine.png) Share this article Share this post On this page 1. [ Start With the Decision, Not the Recommendation ](#start-with-the-decision-not-the-recommendation) 2. [ Identify where preferences can change the answer ](#identify-where-preferences-can-change-the-answer) 3. [ Translate Relative Effects Into Absolute Outcomes ](#translate-relative-effects-into-absolute-outcomes) 4. [ Ask: how many events change for this patient? ](#ask-how-many-events-change-for-this-patient) 5. [ Make Baseline Risk Clinically Credible ](#make-baseline-risk-clinically-credible) 6. [ Check the population before running the calculator ](#check-the-population-before-running-the-calculator) 7. [ Find Out What a Good Decision Means to the Patient ](#find-out-what-a-good-decision-means-to-the-patient) 8. [ Compare options, then elicit the trade-off ](#compare-options-then-elicit-the-trade-off) 9. [ Key Takeaways ](#key-takeaways) 10. [ Conclusion ](#conclusion) 11. [ Frequently Asked Questions ](#blog-faqs) 12. [ References ](#references-heading) On this page 1. [ Start With the Decision, Not the Recommendation ](#start-with-the-decision-not-the-recommendation) 2. [ Identify where preferences can change the answer ](#identify-where-preferences-can-change-the-answer) 3. [ Translate Relative Effects Into Absolute Outcomes ](#translate-relative-effects-into-absolute-outcomes) 4. [ Ask: how many events change for this patient? ](#ask-how-many-events-change-for-this-patient) 5. [ Make Baseline Risk Clinically Credible ](#make-baseline-risk-clinically-credible) 6. [ Check the population before running the calculator ](#check-the-population-before-running-the-calculator) 7. [ Find Out What a Good Decision Means to the Patient ](#find-out-what-a-good-decision-means-to-the-patient) 8. [ Compare options, then elicit the trade-off ](#compare-options-then-elicit-the-trade-off) 9. [ Key Takeaways ](#key-takeaways) 10. [ Conclusion ](#conclusion) 11. [ Frequently Asked Questions ](#blog-faqs) 12. [ References ](#references-heading) A patient with an estimated 8% ten-year cardiovascular risk asks whether a statin is worth taking. You could quote a guideline or a relative risk reduction, but neither tells you what matters most: how much benefit this patient might gain, what treatment asks of them, and whether the trade-off fits their goals. That is the work of **shared decision-making**. Start With the Decision, Not the Recommendation ----------------------------------------------- ### Identify where preferences can change the answer Shared decision-making is especially important when several medically reasonable options have different benefits, harms, or burdens. In primary care, these often include starting a preventive medication, choosing a screening test, or deciding whether to continue surveillance. Include the option of no intervention when it is clinically reasonable; do not present it as a failure to choose. [\[1\]](#cite-1 "Reference [1]") First check whether the evidence applies. A trial may study a different population, outcome, or follow-up period than the decision in front of you. A guideline can establish which options are reasonable, but it cannot tell you how this patient weighs an avoided event against daily medication, adverse effects, cost, or uncertainty. [\[1\]](#cite-1 "Reference [1]") Translate Relative Effects Into Absolute Outcomes ------------------------------------------------- ### Ask: how many events change for this patient? Relative risk reduction (RRR) describes the proportional drop in risk. Absolute risk reduction (ARR) is the difference between untreated and treated event rates over the same interval. For a beneficial outcome, **NNT = 1 ÷ ARR**, with ARR expressed as a proportion; round the result up to a whole person. [\[1\]](#cite-1 "Reference [1]") Consider an *illustrative, not treatment-specific* 25% relative reduction in a ten-year event risk. The same relative effect produces different absolute benefits: Ten-year risk without treatmentRisk with treatmentARR; NNT over ten years8 in 1006 in 1002 in 100; NNT 502 in 1001.5 in 1000.5 in 100; NNT 200 Do not turn these hypothetical numbers into a statin promise. In practice, use evidence relevant to the treatment and patient, then explain uncertainty in the individual estimate. Baseline risk matters because the same relative effect generally yields a larger absolute benefit when untreated risk is higher. [\[1\]](#cite-1 "Reference [1]") For harms, **NNH = 1 ÷ absolute risk increase**: subtract the untreated adverse-event rate from the treated rate, using the same outcome and follow-up period. NNT and NNH are useful shorthand for clinicians, but they do not tell patients how severe either event is. Present the underlying frequencies instead of relying on NNT alone. [\[2\]](#cite-2 "Reference [2]") > **Clinical Pearl:** Never compare a ten-year NNT for preventing one event with a one-year NNH for causing another as though they describe the same trade-off. Match time horizons, name the outcomes, and discuss their consequences. Make Baseline Risk Clinically Credible -------------------------------------- ### Check the population before running the calculator For primary prevention, establish whether the patient already has the disease or event you aim to prevent. Then estimate baseline risk using an appropriate, current tool and the patient's relevant characteristics. A population average is a starting point—not a personalized prediction—especially when key risk factors or competing health concerns are missing. [\[3\]](#cite-3 "Reference [3]") The USPSTF illustrates why this step matters. For adults aged 40–75 with at least one specified cardiovascular risk factor, it recommends selectively offering a statin when estimated ten-year CVD risk is 7.5% to less than 10%; preferences matter when the expected net benefit is small. That recommendation is not interchangeable with guidance for someone who already has CVD. [\[4\]](#cite-4 "Reference [4]") Keep benefit and harm estimates distinct. The patient at higher cardiovascular risk may also have factors that raise treatment harm; greater potential benefit does not automatically settle the decision. If the evidence cannot support a reliable personal estimate, say so rather than inventing precision. [\[1\]](#cite-1 "Reference [1]") Find Out What a Good Decision Means to the Patient -------------------------------------------------- ### Compare options, then elicit the trade-off Give each option a fair hearing: expected benefit, important harms, practical burden, and what happens without treatment. Use a common denominator and time frame—such as events per 100 people over ten years—and show both events and non-events. Avoid leading with “your risk drops 25%” when the absolute difference may be small. [\[1\]](#cite-1 "Reference [1]") Ask a question that can change the plan: “Would preventing a future event outweigh taking a daily medicine for you?” Follow with “Which possible harms worry you most?” A patient prioritizing fewer medications may reasonably choose differently from one prioritizing the greatest achievable risk reduction, provided both understand the options. [\[5\]](#cite-5 "Reference [5]") A decision aid can make the numbers visible, but it cannot replace the conversation. Check understanding with teach-back, ask whether the choice fits the patient's stated goal, and document the options, material risks, preference, and follow-up plan. Revisit the decision when risk or priorities change. [\[1\]](#cite-1 "Reference [1]") Key Takeaways ------------- - Lead with **absolute risk**; use relative risk to explain the effect, not to sell it. [\[1\]](#cite-1 "Reference [1]") - Calculate NNT and NNH from absolute differences for specified outcomes and time periods. [\[2\]](#cite-2 "Reference [2]") - Stratify baseline risk before applying a trial result or guideline to an individual. [\[1\]](#cite-1 "Reference [1]") - In preference-sensitive care, a sound decision reflects both credible evidence and the patient's goals. [\[5\]](#cite-5 "Reference [5]") Conclusion ---------- The board-exam calculation is straightforward; the clinical skill is using it honestly. Show what changes in absolute terms, acknowledge uncertainty, and let the patient's priorities shape the choice among reasonable options. [\[1\]](#cite-1 "Reference [1]") Frequently Asked Questions ---------------------------- ### Why shouldn't I lead a patient conversation with relative risk reduction? The same relative reduction can mean very different absolute benefits at different baseline risks. Give event rates over a defined period first. [\[1\]](#cite-1 "Reference [1]") ### Should I explain NNT directly to every patient? Calculate it to appraise benefit, but usually communicate events per 100 or 1,000 people instead; NNT alone can be difficult to interpret. [\[2\]](#cite-2 "Reference [2]") ### Can I compare a treatment's NNT with its NNH? Only with care: identify each outcome, its severity, and its time horizon. The two numbers alone cannot determine which option a patient should choose. [\[1\]](#cite-1 "Reference [1]") ### Does shared decision-making mean offering every option equally? No. Explain which options are medically reasonable for this patient, including no intervention when appropriate, then explore how their values affect the choice. [\[1\]](#cite-1 "Reference [1]") References (5) ------------------ 1. 1. [ NICE. Shared decision making: guideline NG197. ](https://www.nice.org.uk/guidance/ng197/chapter/Recommendations) [↩](#cite-ref-1-1 "Back to text") 2. 2. [ AHRQ. The SHARE Approach: Communicate Numbers Clearly. ](https://www.ahrq.gov/sites/default/files/wysiwyg/sdm/share-approach/share-communicating-numbers.pdf) [↩](#cite-ref-2-1 "Back to text") 3. 3. [ USPSTF. Aspirin Use to Prevent Cardiovascular Disease: Preventive Medication. ](https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/aspirin-to-prevent-cardiovascular-disease-preventive-medication) [↩](#cite-ref-3-1 "Back to text") 4. 4. [ USPSTF. Statin Use for the Primary Prevention of Cardiovascular Disease in Adults. ](https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/statin-use-in-adults-preventive-medication) [↩](#cite-ref-4-1 "Back to text") 5. 5. [ www.ahrq.gov/sdm/share-approach/index.html ](https://www.ahrq.gov/sdm/share-approach/index.html) [↩](#cite-ref-5-1 "Back to text") Next step Stay consistent in Family Medicine prep with a guided pathway --------------------------------------------------------------- - Broad coverage without the overwhelm - Short daily sessions that compound - See your progress and focus on weak areas [ Start practicing ](https://mdster.com/user/dashboard) [ Explore Family Medicine ](https://mdster.com/speciality/family-medicine) [ View pricing ](https://mdster.com/pricing) [ Explore features ](https://mdster.com/features) No credit card required. Full access to all features\*. No commitment. Cancel anytime. \*AI SOE Examiner is limited to 10 cases monthly for Advanced & Bundle subscribers. 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