As patients want to participate more in decision making, and as the range of medical options expands, clinicians are challenged to improve their communication of risk and supportive skills. Are practitioners' counselling skills up to the job?

Different decisions require different strategies to communicate risk and support decisions, and we consider that two broad classes of decisions exist for patients. The first class lies in the area of “effective” health services, in which the benefits are large compared with harms–the participation of patients improves control of chronic conditions1 and the widespread underuse of these beneficial options.2 The second is in “preference sensitive” health services, in which the ratios of benefit to harm are either uncertain or dependent on patient values2–participation of patients improves quality of decisions and prevents overuse in the subset of informed patients who don't value the options.3

We investigated practical and effective approaches that doctors and practitioners can use when counselling patients about these two classes of decisions. Box 1 shows the sources we used. These approaches should help patients to understand options, benefits, harms, probabilities, and scientific uncertainties; clarify the personal value of the ratio of benefit to harm; and participate in decision making according to needs.