Availability and use of number needed to treat (NNT) based decision aids for pharmaceutical interventions

Antimicrobial prophylaxis for vesicoureteral reflux: which subgroups of children benefit the most?

“…This subgroup appears to have been driving the differences in the risk of recurrent UTI in the RIVUR trial. The observed NNT in this subgroup was 4 [13].…”

Risk communication: a pillar of shared decision making

“…This, together with evidence‐based medicine and SDM involving informed patient choices, completes the intersectional triad of optimal patient ‐centred healthcare (see Figure 2). 22 Effective risk communication by healthcare providers involving the shared understanding and accurate interpretation of probabilistic risk (in a way that reduces common cognitive biases) is therefore of central importance.…”

“…Recent risk communication recommendations have highlighted the signifi cance of effective patient-centred conversa-• Risk should be quantifi ed as absolute (rather than relative) risk and presented as a natural frequency (rather than as a percentage) • Colloquial descriptions of risk such as 'common' and 'rare' should be avoided • Risk statements should share the same denominator and be expressed using both positive and negative framing • Serious harms should be described, however unlikely • Risk communication can be facilitated by the use of patient decision aids (PDAs) and patient understanding checked, eg with 'chunk and check' and 'teach back' methods This, together with evidence-based medicine and SDM involving informed patient choices, completes the intersectional triad of optimal patient -centred healthcare (see Figure 2). 22 Effective risk communication by healthcare providers involving the shared understanding and accurate interpretation of probabilistic risk (in a way that reduces common cognitive biases) is therefore of central importance. However, it is equally apparent that patients' risk perception and ultimately their healthcare decisions may depend on far more than the simple understanding of numerical probabilities and the use of PDAs (however well-designed or evidence-based).…”

“…The illustration of framing provided in the NICE guideline (NG197) 1 concerns a treatment that will be successful for 97 out of 100 people and unsuccessful for 3 out of 100 people. However, in the absence of a treatment‐associated absolute risk reduction, this falls short of the framing of treatment‐specific benefits compared to a control intervention or placebo, provided by the number needed to treat (NNT) medical statistic (used as the basis of some decision tools) 22 . It is sobering to recall here that treated people who do not obtain a treatment benefit would still of course be exposed to potential treatment harms.…”

“…However, in the absence of a treatment-associated absolute risk reduction, this falls short of the framing of treatment-specifi c benefi ts compared to a control intervention or placebo, provided by the number needed to treat (NNT) medical statistic (used as the basis of some decision tools). 22 It is sobering to recall here that treated people who do not obtain a treatment benefi t would still of course be exposed to potential treatment harms. Table 3 provides a summary of risk communication recommendations and challenges.…”