How should I approach discussions with patients about treatment options when the evidence is conflicting or limited?

Approach discussions with patients about treatment options when evidence is conflicting or limited by:

• Engaging in shared decision making: Collaborate with the patient to reach a joint decision that considers both the available evidence and the patient's individual preferences, values, and circumstances. Emphasise that choosing no treatment or maintaining current care are valid options.
• Communicating uncertainty clearly: Personalise information about risks, benefits, and consequences as much as possible, making clear how much uncertainty is associated with the evidence and how it applies to the patient personally.
• Using patient decision aids: Provide decision aids in formats suited to the patient's needs (printed, online, different languages) to help them understand options and clarify their values without directing them to a specific choice.
• Presenting information in manageable chunks: Break down complex or uncertain information into smaller parts and use techniques like teach back to confirm understanding before proceeding.
• Discussing risks and benefits with balanced framing: Use absolute risks, natural frequencies, and both positive and negative framing to help patients grasp the potential outcomes clearly.
• Allowing time and support: Give patients sufficient time to consider options, ask questions, and revisit decisions if needed. Support from other staff (e.g., nurses, interpreters) can help patients engage fully.
• Agreeing on next steps: Make a joint plan about treatment or care, including when it will be reviewed, and document what matters to the patient in decision-making.

This approach ensures patients are supported to make informed, values-based decisions even when evidence is limited or conflicting, respecting their autonomy and individual context.