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Kelley Jones C, Scott S, Pashayan N, Morris S, Okan Y, Waller J. Risk-Adapted Breast Screening for Women at Low Predicted Risk of Breast Cancer: An Online Discrete Choice Experiment. Med Decis Making 2024:272989X241254828. [PMID: 38828503 DOI: 10.1177/0272989x241254828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
BACKGROUND A risk-stratified breast screening program could offer low-risk women less screening than is currently offered by the National Health Service. The acceptability of this approach may be enhanced if it corresponds to UK women's screening preferences and values. OBJECTIVES To elicit and quantify preferences for low-risk screening options. METHODS Women aged 40 to 70 y with no history of breast cancer took part in an online discrete choice experiment. We generated 32 hypothetical low-risk screening programs defined by 5 attributes (start age, end age, screening interval, risk of dying from breast cancer, and risk of overdiagnosis), the levels of which were systematically varied between the programs. Respondents were presented with 8 choice sets and asked to choose between 2 screening alternatives or no screening. Preference data were analyzed using conditional logit regression models. The relative importance of attributes and the mean predicted probability of choosing each program were estimated. RESULTS Participants (N = 502) preferred all screening programs over no screening. An older starting age of screening, younger end age of screening, longer intervals between screening, and increased risk of dying had a negative impact on support for screening programs (P < 0.01). Although the risk of overdiagnosis was of low relative importance, a decreased risk of this harm had a small positive impact on screening choices. The mean predicted probabilities that risk-adapted screening programs would be supported relative to current guidelines were low (range, 0.18 to 0.52). CONCLUSIONS A deintensified screening pathway for women at low risk of breast cancer, especially one that recommends a later screening start age, would run counter to women's breast screening preferences. Further research is needed to enhance the acceptability of offering less screening to those at low risk of breast cancer. HIGHLIGHTS Risk-based breast screening may involve the deintensification of screening for women at low risk of breast cancer.Low-risk screening pathways run counter to women's screening preferences and values.Longer screening intervals may be preferable to a later start age.Work is needed to enhance the acceptability of a low-risk screening pathway.
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Affiliation(s)
| | - Suzanne Scott
- Professor of Health Psychology, Queen Mary University London, London, UK
| | - Nora Pashayan
- Professor of Applied Cancer Research, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, UK
| | - Stephen Morris
- Rand Professor of Health Services Research, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Yasmina Okan
- Department of Communication, Pompeu Fabra University, Barcelona, Spain
- Centre for Decision Research, Leeds University Business School, Leeds, UK
| | - Jo Waller
- Professor of Cancer Behavioural Science, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Smittenaar R, Quaife SL, von Wagner C, Higgins T, Hubbell E, Lee L. Impact of screening participation on modelled mortality benefits of a multi-cancer early detection test by socioeconomic group in England. J Epidemiol Community Health 2024; 78:345-353. [PMID: 38429085 PMCID: PMC11103338 DOI: 10.1136/jech-2023-220834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 02/10/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Cancer burden is higher and cancer screening participation is lower among individuals living in more socioeconomically deprived areas of England, contributing to worse health outcomes and shorter life expectancy. Owing to higher multi-cancer early detection (MCED) test sensitivity for poor-prognosis cancers and greater cancer burden in groups experiencing greater deprivation, MCED screening programmes may have greater relative benefits in these groups. We modelled potential differential benefits of MCED screening between deprivation groups in England at different levels of screening participation. METHODS We applied the interception multi-cancer screening model to cancer incidence and survival data made available by the National Cancer Registration and Analysis Service in England to estimate reductions in late-stage diagnoses and cancer mortality from an MCED screening programme by deprivation group across 24 cancer types. We assessed the impact of varying the proportion of people who participated in annual screening in each deprivation group on these estimates. RESULTS The modelled benefits of an MCED screening programme were substantial: reductions in late-stage diagnoses were 160 and 274 per 100 000 persons in the least and most deprived groups, respectively. Reductions in cancer mortality were 60 and 99 per 100 000 persons in the least and most deprived groups, respectively. Benefits were greatest in the most deprived group at every participation level and were attenuated with lower screening participation. CONCLUSIONS For the greatest possible population benefit and to decrease health inequalities, an MCED implementation strategy should focus on enhancing equitable, informed participation, enabling equal participation across all socioeconomic deprivation groups. TRIAL REGISTRATION NUMBER NCT05611632.
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Affiliation(s)
| | | | | | - Thomas Higgins
- National Cancer Registration and Analysis Service, Leeds, UK
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Czerniecki JM, Matlock D, Henderson AW, Rohs C, Suckow B, Turner AP, Norvell DC. Development of the AMPDECIDE Decision Aid to Facilitate Shared Decision Making in Patients Facing Amputation Secondary to Chronic Limb Threatening Ischemia. J Surg Res 2024; 299:68-75. [PMID: 38714006 DOI: 10.1016/j.jss.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 01/09/2024] [Accepted: 03/18/2024] [Indexed: 05/09/2024]
Abstract
INTRODUCTION We developed a patient decision aid to enhance patient participation in amputation level decision making when there is a choice between a transmetatarsal or transtibial amputation. METHODS In accordance with International Patient Decision Aid Standards, we developed an amputation level patient decision aid for patients who are being considered for either a transmetatarsal or transtibial amputation, incorporating qualitative literature data, quantitative literature data, qualitative provider and patient interviews, expert panel input and iterative patient feedback. RESULTS The rapid qualitative literature review and qualitative interviews identified five domains outcome priority domains important to patients facing amputation secondary to chronic limb threatening ischemia: 1) the ability to walk, 2) healing and risk for reamputation, 3) rehabilitation program intensity, 4) ease of prosthetic use, and 5) limb length after amputation. The rapid quantitative review identified only two domains with adequate evidence comparing differences in outcomes between the two amputation levels: mobility and reamputation. Patient, surgeon, rehabilitation and decision aid expert feedback allowed us to integrate critical facets of the decision including addressing the emotional context of loss of limb, fear and anxiety as an obstacle to decision making, shaping the decision in the context of remaining life years, and how to facilitate patient knowledge of value tradeoffs. CONCLUSIONS Amputation level choice is associated with significant outcome trade-offs. The AMPDECIDE patient decision aid can facilitate acknowledgment of patient fears, enhance knowledge of amputation level outcomes, assist patients in determining their personal outcome priorities, and facilitate shared amputation level decision making.
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Affiliation(s)
- Joseph M Czerniecki
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington; CLiMB - Center for Limb Loss and Mobility, Seattle VA Medical Center, Seattle, Washington; VA Puget Sound Health Care System, Seattle, Washington
| | - Daniel Matlock
- Departments of Medicine and Geriatrics, University of Colorado, Denver, Colorado; VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, Colorado
| | - Alison W Henderson
- CLiMB - Center for Limb Loss and Mobility, Seattle VA Medical Center, Seattle, Washington; VA Puget Sound Health Care System, Seattle, Washington.
| | - Carly Rohs
- VA Seattle - Denver COIN (Center of Innovation), Seattle, Washington & Denver, Colorado
| | - Bjoern Suckow
- Section of Vascular Surgery, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Aaron P Turner
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington; CLiMB - Center for Limb Loss and Mobility, Seattle VA Medical Center, Seattle, Washington; VA Puget Sound Health Care System, Seattle, Washington
| | - Daniel C Norvell
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington; CLiMB - Center for Limb Loss and Mobility, Seattle VA Medical Center, Seattle, Washington; VA Puget Sound Health Care System, Seattle, Washington
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Kostick-Quenet KM, Lang B, Dorfman N, Estep J, Mehra MR, Bhimaraj A, Civitello A, Jorde U, Trachtenberg B, Uriel N, Kaplan H, Gilmore-Szott E, Volk R, Kassi M, Blumenthal-Barby JS. Patients' and physicians' beliefs and attitudes towards integrating personalized risk estimates into patient education about left ventricular assist device therapy. PATIENT EDUCATION AND COUNSELING 2024; 122:108157. [PMID: 38290171 DOI: 10.1016/j.pec.2024.108157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 01/06/2024] [Accepted: 01/14/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Personalized risk (PR) estimates may enhance clinical decision making and risk communication by providing individualized estimates of patient outcomes. We explored stakeholder attitudes toward the utility, acceptability, usefulness and best-practices for integrating PR estimates into patient education and decision making about Left Ventricular Assist Device (LVAD). METHODS AND RESULTS As part of a 5-year multi-institutional AHRQ project, we conducted 40 interviews with stakeholders (physicians, nurse coordinators, patients, and caregivers), analyzed using Thematic Content Analysis. All stakeholder groups voiced positive views towards integrating PR in decision making. Patients, caregivers and coordinators emphasized that PR can help to better understand a patient's condition and risks, prepare mentally and logistically for likely outcomes, and meaningfully engage in decision making. Physicians felt it can improve their decision making by enhancing insight into outcomes, enhance tailored pre-emptive care, increase confidence in decisions, and reduce bias and subjectivity. All stakeholder groups also raised concerns about accuracy, representativeness and relevance of algorithms; predictive uncertainty; utility in relation to physician's expertise; potential negative reactions among patients; and overreliance. CONCLUSION Stakeholders are optimistic about integrating PR into clinical decision making, but acceptability depends on prospectively demonstrating accuracy, relevance and evidence that benefits of PR outweigh potential negative impacts on decision making quality.
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Affiliation(s)
| | - Benjamin Lang
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Natalie Dorfman
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | | | | | | | | | | | | | - Nir Uriel
- Columbia University Irving Medical Center, New York, NY, USA
| | - Holland Kaplan
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Eleanor Gilmore-Szott
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
| | - Robert Volk
- University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | | | - J S Blumenthal-Barby
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, USA
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Vromans RD, Bol N, van Wezel MMC, Krahmer EJ. "R" you getting this? Factors contributing to the public's understanding, evaluation, and use of basic reproduction numbers for infectious diseases. BMC Public Health 2024; 24:1209. [PMID: 38693508 PMCID: PMC11064422 DOI: 10.1186/s12889-024-18669-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 04/19/2024] [Indexed: 05/03/2024] Open
Abstract
BACKGROUND We (1) examined the effects of evaluative labels and visual aids on people's understanding, evaluation, and use of the COVID-19 reproduction number (or "r-number"), (2) examined whether people's perceived susceptibility and (intended) adherence to preventive measures changed after being exposed to the r-number, and (3) explored whether these effects and changes depended on people's numeracy skills. METHODS In an online experiment, participants from a large Dutch representative sample (N = 1,168) received information about the COVID-19 r-number displayed on the corona dashboard of the Dutch Ministry of Health, Welfare and Sport. The r-number was either presented with or without a categorical line display (i.e., evaluative label) and with or without an icon-based tree diagram (i.e., visual aid) explaining how the number works. Regarding people's use of the statistic, we measured perceived susceptibility to COVID-19 and adherence (intention) to five preventive measures before and after exposure to the r-number. After exposure, we also measured participants' understanding, perceived usefulness, affective and cognitive evaluation, and objective numeracy. RESULTS About 56% of participants correctly interpreted the r-number, with highly numerate people having better understanding than less numerate people. Information about the r-number was perceived as more useful when presented with a visual aid. There were no differences across experimental conditions in people's understanding, affective, and cognitive evaluations. Finally, independent of experimental conditions, intention to adhere to preventive measures was higher after seeing the r-number, but only among highly numerate people. CONCLUSIONS Although evaluative labels and visual aids did not facilitate people's understanding and evaluation of the r-number, our results show that the statistic is perceived as useful and may be used to stimulate adherence to preventive measures. Policy makers and public health communicators are advised to clearly explain why they are giving these numbers to - especially - the less numerate people, but also how people could use them for behavior change to combat the spread of virus during a pandemic.
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Affiliation(s)
- Ruben D Vromans
- Department of Communication and Cognition, Tilburg center for Cognition and Communication, Tilburg School of Humanities and Digital Sciences, Tilburg University, P.O. Box 90153, Tilburg, 5037 LE, The Netherlands.
| | - Nadine Bol
- Department of Communication and Cognition, Tilburg center for Cognition and Communication, Tilburg School of Humanities and Digital Sciences, Tilburg University, P.O. Box 90153, Tilburg, 5037 LE, The Netherlands
| | - Marloes M C van Wezel
- Department of Communication and Cognition, Tilburg center for Cognition and Communication, Tilburg School of Humanities and Digital Sciences, Tilburg University, P.O. Box 90153, Tilburg, 5037 LE, The Netherlands
| | - Emiel J Krahmer
- Department of Communication and Cognition, Tilburg center for Cognition and Communication, Tilburg School of Humanities and Digital Sciences, Tilburg University, P.O. Box 90153, Tilburg, 5037 LE, The Netherlands
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Gamble AR, McKay MJ, Anderson DB, Pappas E, Alvarez Cooper I, Macpherson S, Harris IA, Filbay SR, McCaffery K, Thompson R, Hoffmann TC, Maher CG, Zadro JR. Development of a patient decision aid for children and adolescents following anterior cruciate ligament rupture: an international mixed-methods study. BMJ Open 2024; 14:e081421. [PMID: 38684251 PMCID: PMC11086191 DOI: 10.1136/bmjopen-2023-081421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 04/08/2024] [Indexed: 05/02/2024] Open
Abstract
AIM To develop and user test an evidence-based patient decision aid for children and adolescents who are considering anterior cruciate ligament (ACL) reconstruction. DESIGN Mixed-methods study describing the development of a patient decision aid. SETTING A draft decision aid was developed by a multidisciplinary steering group (including various types of health professionals and researchers, and consumers) informed by the best available evidence and existing patient decision aids. PARTICIPANTS People who ruptured their ACL when they were under 18 years old (ie, adolescents), their parents, and health professionals who manage these patients. Participants were recruited through social media and the network outreach of the steering group. PRIMARY AND SECONDARY OUTCOMES Semistructured interviews and questionnaires were used to gather feedback on the decision aid. The feedback was used to refine the decision aid and assess acceptability. An iterative cycle of interviews, refining the aid according to feedback and further interviews, was used. Interviews were analysed using reflexive thematic analysis. RESULTS We conducted 32 interviews; 16 health professionals (12 physiotherapists, 4 orthopaedic surgeons) and 16 people who ruptured their ACL when they were under 18 years old (7 were adolescents and 9 were adults at the time of the interview). Parents participated in 8 interviews. Most health professionals, patients and parents rated the aid's acceptability as good-to-excellent. Health professionals and patients agreed on most aspects of the decision aid, but some health professionals had differing views on non-surgical management, risk of harms, treatment protocols and evidence on benefits and harms. CONCLUSION Our patient decision aid is an acceptable tool to help children and adolescents choose an appropriate management option following ACL rupture with their parents and health professionals. A clinical trial evaluating the potential benefit of this tool for children and adolescents considering ACL reconstruction is warranted.
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Affiliation(s)
- Andrew R Gamble
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Musculoskeletal Health and Institute for Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Marnee J McKay
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - David B Anderson
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Evangelos Pappas
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | | | - Sophie Macpherson
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ian A Harris
- Sydney Musculoskeletal Health and Institute for Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW, Sydney, New South Wales, Australia
| | - Stephanie R Filbay
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Rachel Thompson
- Discipline of Behavioural and Social Sciences in Health, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Christopher G Maher
- Sydney Musculoskeletal Health and Institute for Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Joshua R Zadro
- Sydney Musculoskeletal Health and Institute for Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
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Naser-Tavakolian A, Gale R, Luu M, Masterson JM, Venkataramana A, Khodyakov D, Anger JT, Posadas E, Sandler H, Freedland SJ, Spiegel B, Daskivich TJ. Use of Persuasive Language in Communication of Risk during Prostate Cancer Treatment Consultations. Med Decis Making 2024; 44:320-334. [PMID: 38347686 PMCID: PMC11102816 DOI: 10.1177/0272989x241228612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Physician treatment preference may influence how risks are communicated in prostate cancer consultations. We identified persuasive language used when describing cancer prognosis, life expectancy, and side effects in relation to a physician's recommendation for aggressive (surgery/radiation) or nonaggressive (active surveillance/watchful waiting) treatment. METHODS A qualitative analysis was performed on transcribed treatment consultations of 40 men with low- and intermediate-risk prostate cancer across 10 multidisciplinary providers. Quotes pertaining to cancer prognosis, life expectancy, and side effects were randomized. Coders predicted physician treatment recommendations from isolated blinded quotes. Testing characteristics of consensus predictions against the physician's treatment recommendation were reported. Coders then identified persuasive strategies favoring aggressive/nonaggressive treatment for each quote. Frequencies of persuasive strategies favoring aggressive/nonaggressive treatment were reported. Logistic regression quantified associations between persuasive strategies and physician treatment recommendations. RESULTS A total of 496 quotes about cancer prognosis (n = 127), life expectancy (n = 51), and side effects (n = 318) were identified. The accuracy of predicting treatment recommendation based on individual quotes containing persuasive language (n = 256/496, 52%) was 91%. When favoring aggressive treatment, persuasive language downplayed side effect risks and amplified cancer risk (recurrence, progression, or mortality). Significant predictors (P < 0.05) of aggressive treatment recommendation included favorable side effect interpretation, downplaying side effects, and long time horizon for cancer risk due to longevity. When favoring nonaggressive treatment, persuasive language amplified side effect risks and downplayed cancer risk. Significant predictors of nonaggressive treatment recommendation included unfavorable side effect interpretation, favorable interpretation of cancer risk, and short time horizon for cancer risk due to longevity. CONCLUSIONS Physicians use persuasive language favoring their preferred treatment, regardless of whether their recommendation is appropriate. IMPLICATIONS Clinicians should quantify risk so patients can judge potential harm without solely relying on persuasive language. HIGHLIGHTS Physicians use persuasive language favoring their treatment recommendation when communicating risks of prostate cancer treatment, which may influence a patient's treatment choice.Coders predicted physician treatment recommendations based on isolated, randomized quotes about cancer prognosis, life expectancy, and side effects with 91% accuracy.Qualitative analysis revealed that when favoring nonaggressive treatment, physicians used persuasive language that amplified side effect risks and downplayed cancer risk. When favoring aggressive treatment, physicians did the opposite.Providers should be cognizant of using persuasive strategies and aim to provide quantified assessments of risk that are jointly interpreted with the patient so that patients can make evidence-based conclusions regarding risks without solely relying on persuasive language.
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Affiliation(s)
| | - Rebecca Gale
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Michael Luu
- Department of Biostatistics, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | | | | | - Jennifer T. Anger
- Department of Urology, University of California, San Diego, San Diego, CA
| | - Edwin Posadas
- Department of Medicine, Division of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Howard Sandler
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Stephen J. Freedland
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
- Section of Urology, Durham VA Medical Center, Durham, NC
| | - Brennan Spiegel
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Cedars-Sinai Medical Center, Los Angeles, CA
- Department of Medicine, Divisions of Gastroenterology and Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Timothy J. Daskivich
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Cedars-Sinai Medical Center, Los Angeles, CA
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Durand MA, Selby K, Okan Y. Visualisation of evidence for shared decision making. BMJ Evid Based Med 2024; 29:117-120. [PMID: 37968088 DOI: 10.1136/bmjebm-2023-112565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Marie-Anne Durand
- Centre d'Epidémiologie et de Recherche en santé des Populations, Team EQUITY, Université Toulouse III Paul Sabatier, Toulouse, France
- Département des policliniques, Unisanté, Lausanne, Vaud, Switzerland
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Kevin Selby
- Département des policliniques, Unisanté, Lausanne, Vaud, Switzerland
| | - Yasmina Okan
- Department of Communication, Pompeu Fabra University, Barcelona, Spain
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Hamilton DE, Albright J, Seth M, Painter I, Maynard C, Hira RS, Sukul D, Gurm HS. Merging machine learning and patient preference: a novel tool for risk prediction of percutaneous coronary interventions. Eur Heart J 2024; 45:601-609. [PMID: 38233027 DOI: 10.1093/eurheartj/ehad836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/01/2023] [Accepted: 12/05/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND AND AIMS Predicting personalized risk for adverse events following percutaneous coronary intervention (PCI) remains critical in weighing treatment options, employing risk mitigation strategies, and enhancing shared decision-making. This study aimed to employ machine learning models using pre-procedural variables to accurately predict common post-PCI complications. METHODS A group of 66 adults underwent a semiquantitative survey assessing a preferred list of outcomes and model display. The machine learning cohort included 107 793 patients undergoing PCI procedures performed at 48 hospitals in Michigan between 1 April 2018 and 31 December 2021 in the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) registry separated into training and validation cohorts. External validation was conducted in the Cardiac Care Outcomes Assessment Program database of 56 583 procedures in 33 hospitals in Washington. RESULTS Overall rate of in-hospital mortality was 1.85% (n = 1999), acute kidney injury 2.51% (n = 2519), new-onset dialysis 0.44% (n = 462), stroke 0.41% (n = 447), major bleeding 0.89% (n = 942), and transfusion 2.41% (n = 2592). The model demonstrated robust discrimination and calibration for mortality {area under the receiver-operating characteristic curve [AUC]: 0.930 [95% confidence interval (CI) 0.920-0.940]}, acute kidney injury [AUC: 0.893 (95% CI 0.883-0.903)], dialysis [AUC: 0.951 (95% CI 0.939-0.964)], stroke [AUC: 0.751 (95%CI 0.714-0.787)], transfusion [AUC: 0.917 (95% CI 0.907-0.925)], and major bleeding [AUC: 0.887 (95% CI 0.870-0.905)]. Similar discrimination was noted in the external validation population. Survey subjects preferred a comprehensive list of individually reported post-procedure outcomes. CONCLUSIONS Using common pre-procedural risk factors, the BMC2 machine learning models accurately predict post-PCI outcomes. Utilizing patient feedback, the BMC2 models employ a patient-centred tool to clearly display risks to patients and providers (https://shiny.bmc2.org/pci-prediction/). Enhanced risk prediction prior to PCI could help inform treatment selection and shared decision-making discussions.
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Affiliation(s)
- David E Hamilton
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI 48109-5853, USA
| | - Jeremy Albright
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI 48109-5853, USA
| | - Milan Seth
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI 48109-5853, USA
| | - Ian Painter
- Foundation for Health Care Quality, Seattle, WA, USA
| | - Charles Maynard
- Foundation for Health Care Quality, Seattle, WA, USA
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Ravi S Hira
- Foundation for Health Care Quality, Seattle, WA, USA
- Pulse Heart Institute and Multicare Health System, Tacoma, WA, USA
| | - Devraj Sukul
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI 48109-5853, USA
| | - Hitinder S Gurm
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI 48109-5853, USA
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Casillan A, Florido ME, Galarza-Cornejo J, Bakken S, Lynch JA, Chung WK, Mittendorf KF, Berner ES, Connolly JJ, Weng C, Holm IA, Khan A, Kiryluk K, Limdi NA, Petukhova L, Sabatello M, Wynn J. Participant-guided development of bilingual genomic educational infographics for Electronic Medical Records and Genomics Phase IV study. J Am Med Inform Assoc 2024; 31:306-316. [PMID: 37860921 PMCID: PMC10797276 DOI: 10.1093/jamia/ocad207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 09/11/2023] [Accepted: 10/06/2023] [Indexed: 10/21/2023] Open
Abstract
OBJECTIVE Developing targeted, culturally competent educational materials is critical for participant understanding of engagement in a large genomic study that uses computational pipelines to produce genome-informed risk assessments. MATERIALS AND METHODS Guided by the Smerecnik framework that theorizes understanding of multifactorial genetic disease through 3 knowledge types, we developed English and Spanish infographics for individuals enrolled in the Electronic Medical Records and Genomics Network. Infographics were developed to explain concepts in lay language and visualizations. We conducted iterative sessions using a modified "think-aloud" process with 10 participants (6 English, 4 Spanish-speaking) to explore comprehension of and attitudes towards the infographics. RESULTS We found that all but one participant had "awareness knowledge" of genetic disease risk factors upon viewing the infographics. Many participants had difficulty with "how-to" knowledge of applying genetic risk factors to specific monogenic and polygenic risks. Participant attitudes towards the iteratively-refined infographics indicated that design saturation was reached. DISCUSSION There were several elements that contributed to the participants' comprehension (or misunderstanding) of the infographics. Visualization and iconography techniques best resonated with those who could draw on prior experiences or knowledge and were absent in those without. Limited graphicacy interfered with the understanding of absolute and relative risks when presented in graph format. Notably, narrative and storytelling theory that informed the creation of a vignette infographic was most accessible to all participants. CONCLUSION Engagement with the intended audience who can identify strengths and points for improvement of the intervention is necessary to the development of effective infographics.
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Affiliation(s)
- Aimiel Casillan
- Genetic Counseling Graduate Program, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, United States
| | - Michelle E Florido
- Genetic Counseling Graduate Program, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, United States
- Department of Genetics and Development, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, 10032, United States
| | - Jamie Galarza-Cornejo
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Suzanne Bakken
- Department of Nursing Scholarship and Research, School of Nursing, Columbia University Irving Medical Center, New York, NY 10032, United States
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - John A Lynch
- Department of Communication, School of Communication, Film, and Media Studies, University of Cincinnati, Cincinnati, OH 45221, United States
| | - Wendy K Chung
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Kathleen F Mittendorf
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Eta S Berner
- Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, Birmingham, AL 35294, United States
| | - John J Connolly
- Center for Applied Genomics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, United States
| | - Chunhua Weng
- Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Ingrid A Holm
- Division of Genetics and Genomics and Manton Center for Orphan Diseases Research, Boston Children’s Hospital, Boston, MA 02115, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, United States
| | - Atlas Khan
- Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, United States
- Department of Medicine, Division of Nephrology, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY 10032, United States
| | - Krzysztof Kiryluk
- Department of Medicine, Division of Nephrology, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY 10032, United States
| | - Nita A Limdi
- Department of Neurology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35233, United States
| | - Lynn Petukhova
- Department of Epidemiology, Columbia Mailman School of Public Health, New York, NY 10032, United States
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Maya Sabatello
- Department of Medicine, Center for Precision Medicine and Genomics, Columbia University Irving Medical Center, New York, NY 10032, United States
- Department of Medical Humanities and Ethics, Division of Ethics, Columbia University Irving Medical Center, New York, NY 10032, United States
| | - Julia Wynn
- Genetic Counseling Graduate Program, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY 10032, United States
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, United States
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11
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Desai PM, Harkins S, Rahman S, Kumar S, Hermann A, Joly R, Zhang Y, Pathak J, Kim J, D’Angelo D, Benda NC, Reading Turchioe M. Visualizing machine learning-based predictions of postpartum depression risk for lay audiences. J Am Med Inform Assoc 2024; 31:289-297. [PMID: 37847667 PMCID: PMC10797282 DOI: 10.1093/jamia/ocad198] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 08/15/2023] [Accepted: 09/28/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVES To determine if different formats for conveying machine learning (ML)-derived postpartum depression risks impact patient classification of recommended actions (primary outcome) and intention to seek care, perceived risk, trust, and preferences (secondary outcomes). MATERIALS AND METHODS We recruited English-speaking females of childbearing age (18-45 years) using an online survey platform. We created 2 exposure variables (presentation format and risk severity), each with 4 levels, manipulated within-subject. Presentation formats consisted of text only, numeric only, gradient number line, and segmented number line. For each format viewed, participants answered questions regarding each outcome. RESULTS Five hundred four participants (mean age 31 years) completed the survey. For the risk classification question, performance was high (93%) with no significant differences between presentation formats. There were main effects of risk level (all P < .001) such that participants perceived higher risk, were more likely to agree to treatment, and more trusting in their obstetrics team as the risk level increased, but we found inconsistencies in which presentation format corresponded to the highest perceived risk, trust, or behavioral intention. The gradient number line was the most preferred format (43%). DISCUSSION AND CONCLUSION All formats resulted high accuracy related to the classification outcome (primary), but there were nuanced differences in risk perceptions, behavioral intentions, and trust. Investigators should choose health data visualizations based on the primary goal they want lay audiences to accomplish with the ML risk score.
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Affiliation(s)
- Pooja M Desai
- Department of Biomedical Informatics, Columbia University, New York, NY 10032, United States
| | - Sarah Harkins
- Columbia University School of Nursing, New York, NY 10032, United States
| | - Saanjaana Rahman
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY 10065, United States
| | - Shiveen Kumar
- College of Agriculture and Life Science University, Cornell University, Ithaca, NY 14850, United States
| | - Alison Hermann
- Department of Psychiatry, Weill Cornell Medical College, New York, NY 10065, United States
| | - Rochelle Joly
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY 10065, United States
| | - Yiye Zhang
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY 10065, United States
| | - Jyotishman Pathak
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY 10065, United States
| | - Jessica Kim
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY 10065, United States
| | - Deborah D’Angelo
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY 10065, United States
| | - Natalie C Benda
- Columbia University School of Nursing, New York, NY 10032, United States
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12
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Arcia A, Benda NC, Wu DTY. Advancing the science of visualization of health data for lay audiences. J Am Med Inform Assoc 2024; 31:283-288. [PMID: 38238784 PMCID: PMC10796313 DOI: 10.1093/jamia/ocad255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 12/18/2023] [Indexed: 01/22/2024] Open
Affiliation(s)
- Adriana Arcia
- Hahn School of Nursing and Health Science, University of San Diego, San Diego, CA 92110, United States
| | - Natalie C Benda
- School of Nursing, Columbia University, New York, NY 10032, United States
| | - Danny T Y Wu
- Department of Biomedical Informatics, University of Cincinnati, College of Medicine, Cincinnati, OH 45229, United States
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13
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Goulão B, Morris TP, Blazeby J, Gamble C, Gillies K, Laidlaw L, Ramsay C, Soulsby I, Stewart D, Totton N. Involving patients and the public In sTatistIcal Analysis pLans (INITIAL): A delphi survey. PLoS One 2023; 18:e0292257. [PMID: 38096223 PMCID: PMC10721002 DOI: 10.1371/journal.pone.0292257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 09/17/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Patient and public involvement (PPI) in trials aims to enhance research by improving its relevance and transparency. Planning for statistical analysis begins at the design stage of a trial within the protocol and is refined and detailed in a Statistical Analysis Plan (SAP). While PPI is common in design and protocol development it is less common within SAPs. This study aimed to reach consensus on the most important and relevant statistical analysis items within an SAP to involve patients and the public. METHODS We developed a UK-based, two-round Delphi survey through an iterative consultation with public partners, statisticians, and trialists. The consultation process started with 55 items from international guidance for statistical analysis plans. We aimed to recruit at least 20 participants per key stakeholder group for inclusion in the final analysis of the Delphi survey. Participants were asked to vote on each item using a Likert scale from 1 to 9, where a rating of 1 to 3 was labelled as having 'limited importance'; 4 to 6 as 'important but not critical' and 7 to 9 as 'critical' to involve patients and the public. Results from the second round determined consensus on critical items for PPI. RESULTS The consultation exercise led to the inclusion of 15 statistical items in the Delphi survey. We recruited 179 participants, of whom 72% (129: 36 statisticians, 29 patients or public partners, 25 clinical researchers or methodologists, 27 trial managers, and 12 PPI coordinators) completed both rounds. Participants were on average 48 years old, 60% were female, 84% were White, 64% were based in England and 84% had at least five years' experience in trials. Four items reached consensus regarding critical importance for patient and public involvement: presentation of results to trial participants; summary and presentation of harms; interpretation and presentation of findings in an academic setting; factors impacting how well a treatment works. No consensus was reached for the remaining 11 items. In general, the results were consistent across stakeholder groups. DISCUSSION We identified four critical items to involve patients and the public in statistical analysis plans. The remaining 11 items did not reach consensus and need to be considered in a case-by-case basis with most responders considering patient and public involvement important (but not critical). Our research provides a platform to enable focused future efforts to improve patient and public involvement in trials and enhance the relevance of statistical analyses to patients and the public.
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Affiliation(s)
- Beatriz Goulão
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Tim P. Morris
- MRC Clinical Trials Unit at UCL, London, United Kingdom
| | - Jane Blazeby
- Bristol NIHR Biomedical Research Centre, Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, United Kingdom
| | - Carrol Gamble
- Liverpool Clinical Trials Centre, University of Liverpool, Liverpool, United Kingdom
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Lynn Laidlaw
- Public Partner Co-author, INITIAL Advisory Group, University of Aberdeen, Aberdeen, United Kingdom
| | - Craig Ramsay
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Irene Soulsby
- Public Partner Co-author, INITIAL Advisory Group, University of Aberdeen, Aberdeen, United Kingdom
| | - Derek Stewart
- Public Partner Co-author, INITIAL Advisory Group, University of Aberdeen, Aberdeen, United Kingdom
- University of Galway, Galway, Ireland
| | - Nikki Totton
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
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14
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Smith NR, Hassmiller Lich K, Ng SW, Hall MG, Trogdon JG, Frerichs L. Implementation costs of sugary drink policies in the United States. J Public Health Policy 2023; 44:566-587. [PMID: 37714964 PMCID: PMC10841536 DOI: 10.1057/s41271-023-00435-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 09/17/2023]
Abstract
To support implementation of important public health policies, policymakers need information about implementation costs over time and across stakeholder groups. We assessed implementation costs of two federal sugar-sweetened beverage (SSB) policies of current policy interest and with evidence to support their effects: excise taxes and health warning labels. Our analysis encompassed the entire policy life cycle using the Exploration, Preparation, Implementation, and Sustainment framework. We identified implementation actions using key informant interviews and developed quantitative estimates of implementation costs using published literature and government documents. Results show that implementation costs vary over time and among stakeholders. Explicitly integrating implementation science theory and using mixed methods improved the comprehensiveness of our results. Although this work is specific to federal SSB policies, the process can inform how we understand the costs of many public health policies, providing crucial information for public health policy making.
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Affiliation(s)
- Natalie Riva Smith
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA.
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - Marissa G Hall
- Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Justin G Trogdon
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Leah Frerichs
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
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15
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Masterson Creber R, Benda N, Dimagli A, Myers A, Niño de Rivera S, Omollo S, Sharma Y, Goyal P, Turchioe MR. Using Patient Decision Aids for Cardiology Care in Diverse Populations. Curr Cardiol Rep 2023; 25:1543-1553. [PMID: 37943426 PMCID: PMC10914300 DOI: 10.1007/s11886-023-01953-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 11/10/2023]
Abstract
PURPOSE OF REVIEW Patient decision aids (PDAs) are tools that help guide treatment decisions and support shared decision-making when there is equipoise between treatment options. This review focuses on decision aids that are available to support cardiac treatment options for underrepresented groups. RECENT FINDINGS PDAs have been developed to support multiple treatment decisions in cardiology related to coronary artery disease, valvular heart disease, cardiac arrhythmias, heart failure, and cholesterol management. By considering the unique needs and preferences of diverse populations, PDAs can enhance patient engagement and promote equitable healthcare delivery in cardiology. In this review, we examine the benefits, challenges, and current trends in implementing PDAs, with a focus on improving decision-making processes and outcomes for patients from underrepresented racial and ethnic groups. In addition, the article highlights key considerations when implementing PDAs and potential future directions in the field.
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Affiliation(s)
- Ruth Masterson Creber
- Columbia University School of Nursing, Columbia University Irving Medical Center, 560 W 168th St, New York, NY, 10032, USA.
| | - Natalie Benda
- Columbia University School of Nursing, Columbia University Irving Medical Center, 560 W 168th St, New York, NY, 10032, USA
| | - Arnaldo Dimagli
- Columbia University School of Nursing, Columbia University Irving Medical Center, 560 W 168th St, New York, NY, 10032, USA
| | - Annie Myers
- Columbia University School of Nursing, Columbia University Irving Medical Center, 560 W 168th St, New York, NY, 10032, USA
| | - Stephanie Niño de Rivera
- Columbia University School of Nursing, Columbia University Irving Medical Center, 560 W 168th St, New York, NY, 10032, USA
| | - Shalom Omollo
- Columbia University School of Nursing, Columbia University Irving Medical Center, 560 W 168th St, New York, NY, 10032, USA
| | - Yashika Sharma
- Columbia University School of Nursing, Columbia University Irving Medical Center, 560 W 168th St, New York, NY, 10032, USA
| | | | - Meghan Reading Turchioe
- Columbia University School of Nursing, Columbia University Irving Medical Center, 560 W 168th St, New York, NY, 10032, USA
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16
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Tiede KE, Gaissmaier W. How Do People Process Different Representations of Statistical Information? Insights into Cognitive Effort, Representational Inconsistencies, and Individual Differences. Med Decis Making 2023; 43:803-820. [PMID: 37842816 PMCID: PMC10625726 DOI: 10.1177/0272989x231202505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/23/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Graphical representation formats (e.g., icon arrays) have been shown to lead to better understanding of the benefits and risks of treatments compared to numbers. We investigate the cognitive processes underlying the effects of format on understanding: how much cognitive effort is required to process numerical and graphical representations, how people process inconsistent representations, and how numeracy and graph literacy affect information processing. METHODS In a preregistered between-participants experiment, 665 participants answered questions about the relative frequencies of benefits and side effects of 6 medications. First, we manipulated whether the medical information was represented numerically, graphically (as icon arrays), or inconsistently (numerically for 3 medications and graphically for the other 3). Second, to examine cognitive effort, we manipulated whether there was time pressure or not. In an additional intervention condition, participants translated graphical information into numerical information before answering questions. We also assessed numeracy and graph literacy. RESULTS Processing icon arrays was more strongly affected by time pressure than processing numbers, suggesting that graphical formats required more cognitive effort. Understanding was lower when information was represented inconsistently (v. consistently) but not if there was a preceding intervention. Decisions based on inconsistent representations were biased toward graphically represented options. People with higher numeracy processed quantitative information more efficiently than people with lower numeracy did. Graph literacy was not related to processing efficiency. LIMITATIONS Our study was conducted with a nonpatient sample, and the medical information was hypothetical. CONCLUSIONS Although graphical (v. numerical) formats have previously been found to lead to better understanding, they may require more cognitive effort. Therefore, the goal of risk communication may play an important role when choosing how to communicate medical information. HIGHLIGHTS This article investigates the cognitive processes underlying the effects of representation format on the understanding of statistical information and individual differences therein.Processing icon arrays required more cognitive effort than processing numbers did.When information was represented inconsistently (i.e., partly numerically and partly graphically), understanding was lower than with consistent representation, and decisions were biased toward the graphically represented options.People with higher numeracy processed quantitative information more efficiently than people with lower numeracy did.
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Affiliation(s)
- Kevin E. Tiede
- Center for Adaptive Rationality, Max Planck Institute for Human Development, Germany
- Department of Psychology, University of Konstanz, Germany
- Graduate School of Decision Sciences, University of Konstanz, Germany
| | - Wolfgang Gaissmaier
- Department of Psychology, University of Konstanz, Germany
- Centre for the Advanced Study of Collective Behaviour, University of Konstanz, Germany
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17
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Gaissmaier W, Tiede KE, Garcia-Retamero R. The Lure of Beauty: People Select Representations of Statistical Information Largely Based on Attractiveness, Not Comprehensibility. Med Decis Making 2023; 43:774-788. [PMID: 37872798 PMCID: PMC10625725 DOI: 10.1177/0272989x231201579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/28/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVE People differ in whether they understand graphical or numerical representations of statistical information better. However, assessing these skills is often not feasible when deciding which representation to select or use. This study investigates whether people choose the representation they understand better, whether this choice can improve risk comprehension, and whether results are influenced by participants' skills (graph literacy and numeracy). METHODS In an experiment, 160 participants received information about the benefits and side effects of painkillers using either a numerical or a graphical representation. In the "no choice" condition, the representation was randomly assigned to each participant. In the "choice" condition, participants could select the representation they would like to receive. The study assessed gist and verbatim knowledge (immediate comprehension and recall), accessibility of the information, attractiveness of the representation, as well as graph literacy and numeracy. RESULTS In the "choice" condition, most (62.5%) chose the graphical format, yet there was no difference in graph literacy or numeracy (nor age or gender) between people who chose the graphical or the numerical format. Whereas choice slightly increased verbatim knowledge, it did not improve gist or overall knowledge compared with random assignment. However, participants who chose a representation rated the representation as more attractive, and those who chose graphs rated them as more accessible than those without a choice. LIMITATIONS The sample consisted of highly educated undergraduate students with higher graph literacy than the general population. The task was inconsequential for participants in terms of their health. CONCLUSIONS When people can choose between representations, they fail to identify what they comprehend better but largely base that choice on how attractive the representation is for them. HIGHLIGHTS People differ systematically in whether they understand graphical or numerical representations of statistical information better. However, assessing these underlying skills to get the right representation to the right people is not feasible in practice. A simple and efficient method to achieve this could be to let people choose among representations themselves.However, our study showed that allowing participants to choose a representation (numerical v. graphical) did not improve overall or gist knowledge compared with determining the representation randomly, even though it did slightly improve verbatim knowledge.Rather, participants largely chose the representation they found more attractive. Most preferred the graphical representation, including those with low graph literacy.It would therefore be important to develop graphical representations that are not only attractive but also comprehensible even for people with low graph literacy.
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Affiliation(s)
- Wolfgang Gaissmaier
- Department of Psychology, University of Konstanz, Konstanz, Germany
- Centre for the Advanced Study of Collective Behaviour, University of Konstanz, Germany
| | - Kevin E. Tiede
- Department of Psychology, University of Konstanz, Konstanz, Germany
- Center for Adaptive Rationality, Max Planck Institute for Human Development, Berlin, Germany
- Graduate School of Decision Sciences, University of Konstanz, Germany
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18
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Bekker HL, Winterbottom AE, Gavaruzzi T, Finderup J, Mooney A. Decision aids to assist patients and professionals in choosing the right treatment for kidney failure. Clin Kidney J 2023; 16:i20-i38. [PMID: 37711634 PMCID: PMC10497379 DOI: 10.1093/ckj/sfad172] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Indexed: 09/16/2023] Open
Abstract
Background Kidney services vary in the way they involve people with kidney failure (PwKF) in treatment decisions as management needs change. We discuss how decision-science applications support proactively PwKF to make informed decisions between treatment options with kidney professionals. Methods A conceptual review of findings about decision making and use of decision aids in kidney services, synthesized with reference to: the Making Informed Decisions-Individually and Together (MIND-IT) multiple stakeholder decision makers framework; and the Medical Research Council-Complex Intervention Development and Evaluation research framework. Results This schema represents the different types of decision aids that support PwKF and professional reasoning as they manage kidney disease individually and together; adjustments at micro, meso and macro levels supports integration in practice. Conclusion Innovating services to meet clinical guidelines on enhancing shared decision making processes means enabling all stakeholders to use decision aids to meet their goals within kidney pathways at individual, service and organizational levels.
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Affiliation(s)
- Hilary L Bekker
- Leeds Unit of Complex Intervention Development (LUCID), Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
- Department of Public Health, Aarhus University, Denmark
- ResCenPI – Research Centre for Patient Involvement, Aarhus University, Aarhus and the Central Denmark Region, Denmark
| | - Anna E Winterbottom
- Leeds Unit of Complex Intervention Development (LUCID), Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
- Renal Unit, St James's University Hospital, Leeds Teaching Hospital Trust, Leeds, UK
| | - Teresa Gavaruzzi
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Jeanette Finderup
- ResCenPI – Research Centre for Patient Involvement, Aarhus University, Aarhus and the Central Denmark Region, Denmark
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Andrew Mooney
- Leeds Unit of Complex Intervention Development (LUCID), Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Leeds, UK
- Renal Unit, St James's University Hospital, Leeds Teaching Hospital Trust, Leeds, UK
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Webb EJD, Meads D, Eskytė I, Ford HL, Bekker HL, Chataway J, Pepper G, Marti J, Okan Y, Pavitt SH, Schmierer K, Manzano A. Decision Making About Disease-Modifying Treatments for Relapsing-Remitting Multiple Sclerosis: Stated Preferences and Real-World Choices. THE PATIENT 2023; 16:457-471. [PMID: 37072663 DOI: 10.1007/s40271-023-00622-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND People with relapsing-remitting multiple sclerosis can benefit from disease-modifying treatments (DMTs). Several DMTs are available that vary in their efficacy, side-effect profile and mode of administration. OBJECTIVE We aimed to measure the preferences of people with relapsing-remitting multiple sclerosis for DMTs using a discrete choice experiment and to assess which stated preference attributes correlate with the attributes of the DMTs they take in the real world. METHODS Discrete choice experiment attributes were developed from literature reviews, interviews and focus groups. In a discrete choice experiment, participants were shown two hypothetical DMTs, then chose whether they preferred one of the DMTs or no treatment. A mixed logit model was estimated from responses and individual-level estimates of participants' preferences conditional on their discrete choice experiment choices calculated. Logit models were estimated with stated preferences predicting current real-world on-treatment status, DMT mode of administration and current DMT. RESULTS A stated intrinsic preference for taking a DMT was correlated with currently taking a DMT, and stated preferences for mode of administration were correlated with the modes of administration of the DMTs participants were currently taking. Stated preferences for treatment effectiveness and adverse effects were not correlated with real-world behaviour. CONCLUSIONS There was variation in which discrete choice experiment attributes correlated with participants' real-world DMT choices. This may indicate patient preferences for treatment efficacy/risk are not adequately taken account of in prescribing. Treatment guidelines must ensure they take into consideration patients' preferences and improve communication around treatment efficacy/risk.
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Affiliation(s)
- Edward J D Webb
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
| | - David Meads
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ieva Eskytė
- School of Law, University of Leeds, Leeds, UK
| | | | - Hilary L Bekker
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
- The Research Centre for Patient Involvement, Central Denmark Region, Aarhus, Denmark
| | - Jeremy Chataway
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, University College London, London, UK
- Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | | | - Joachim Marti
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Yasmina Okan
- Centre for Decision Research, Leeds University Business School, University of Leeds, Leeds, UK
- Department of Communication, Pompeu Fabra University, Barcelona, Spain
| | - Sue H Pavitt
- Dental Translational and Clinical Research Unit, School of Dentistry, University of Leeds, Leeds, UK
| | - Klaus Schmierer
- Blizard Institute (Neuroscience) Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Clinical Board Medicine (Neuroscience), The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Ana Manzano
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
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20
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Tang YT, Chooi WT. A systematic review of the effects of positive versus negative framing on cancer treatment decision making. Psychol Health 2023; 38:1148-1173. [PMID: 34856837 DOI: 10.1080/08870446.2021.2006197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/21/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Presenting treatment outcomes positively or negatively may differently influence treatment preferences and lead to sub-optimal decision in a medical context. This review systematically organised how positive versus negative framing of treatment outcomes influenced cancer treatment decisions of cancer patients and individuals without a cancer diagnosis. DESIGN Three databases (PubMed, PsycInfo and Scopus) were searched for studies reporting the effects of positive versus negative framing on cancer treatment decision-making from 1981 to December 2020. MAIN OUTCOME MEASURE The effects of positive versus negative framing on cancer treatment preferences and the elimination of framing effect were evaluated. RESULTS A total of 12 studies that met inclusion criteria were reviewed. Framing effect was consistently observed in individuals without a cancer diagnosis. There was not enough evidence to suggest a robust framing effect in cancer patients. Surgery was preferred in positive framing, whereas adjuvant therapy was preferred in negative framing. Justification intervention significantly eliminated framing effect. Mixed framing failed to eliminate framing effect. CONCLUSION Current recommendations for presenting treatment options are based on research in cancer-screening decision-making. Knowledge of how positive versus negative framing affect cancer patients' treatment decisions is still limited. Our review highlighted the need for continued research in this area.
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Affiliation(s)
- Yi-Ting Tang
- School of Social Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia
| | - Weng-Tink Chooi
- School of Social Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia
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21
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Montembeau SC, Merchant FM, Speight C, Kramer DB, Matlock DD, Horný M, Dickert NW, Rao BR. Patients' Perspectives Regarding Generator Exchanges of Implantable Cardioverter Defibrillators. Circ Cardiovasc Qual Outcomes 2023; 16:509-518. [PMID: 37492959 PMCID: PMC10524607 DOI: 10.1161/circoutcomes.122.009827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/25/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Shared decision-making is mandated for patients receiving primary prevention implantable cardioverter defibrillators (ICDs). Less attention has been paid to generator exchange decisions, although at the time of generator exchange, patients' risk of sudden cardiac death, risk of procedural complications, quality of life, or prognosis may have changed. This study was designed to explore how patients make ICD generator exchange decisions. METHODS Emory Healthcare patients with primary prevention ICDs implanted from 2013 to 2021 were recruited to complete in-depth interviews exploring perspectives regarding generator exchanges. Interviews were conducted in 2021. Transcribed interviews were qualitatively coded using multilevel template analytic methods. To investigate benefit thresholds for pursuing generator exchanges, patients were presented standard-gamble type hypothetical scenarios where their ICD battery was depleted but their 5-year risk of sudden cardiac death at that time varied (10%, 5%, and 1%). RESULTS Fifty patients were interviewed; 18 had a prior generator exchange, 16 had received ICD therapy, and 17 had improved left ventricular ejection fraction. As sudden cardiac death risk decreased from 10% to 5% to 1%, the number of participants willing to undergo a generator exchange decreased from 48 to 42 to 33, respectively. Responses suggest that doctor's recommendations are likely to substantially impact patients' decision-making. Other drivers of decision-making included past experiences with ICD therapy and device implantation, as well as risk aversion. Therapeutic inertia and misconceptions about ICD therapy were common and represent substantive barriers to effective shared decision-making in this context. CONCLUSIONS Strong defaults may exist to continue therapy and exchange ICD generators. Updated risk stratification may facilitate shared decision-making and reduce generator exchanges in very low-risk patients, especially if these interventions are directed toward clinicians. Interventions targeting phenomena such as therapeutic inertia may be more impactful and warrant exploration in randomized trials.
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Affiliation(s)
- Sarah C. Montembeau
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Faisal M. Merchant
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Candace Speight
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Daniel B. Kramer
- The Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Daniel D. Matlock
- Department of Medicine, University of Colorado School of Medicine, Aurora, CO
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO
| | - Michal Horný
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
- Department of Health Policy and Management Rollins School of Public Health, Atlanta, GA
| | - Neal W. Dickert
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
| | - Birju R. Rao
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA
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22
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Abukmail E, Bakhit M, Jones M, Del Mar C, Hoffmann T. Effect of different visual presentations on the public's comprehension of prognostic information using acute and chronic condition scenarios: two online randomised controlled trials. BMJ Open 2023; 13:e067624. [PMID: 37316324 DOI: 10.1136/bmjopen-2022-067624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES To assess the effectiveness of bar graph, pictograph and line graph compared with text-only, and to each other, for communicating prognosis to the public. DESIGN Two online four-arm parallel-group randomised controlled trials. Statistical significance was set at p<0.016 to allow for three-primary comparisons. PARTICIPANTS AND SETTING Two Australian samples were recruited from members registered at Dynata online survey company. In trial A: 470 participants were randomised to one of the four arms, 417 were included in the analysis. In trial B: 499 were randomised and 433 were analysed. INTERVENTIONS In each trial four visual presentations were tested: bar graph, pictograph, line graph and text-only. Trial A communicated prognostic information about an acute condition (acute otitis media) and trial B about a chronic condition (lateral epicondylitis). Both conditions are typically managed in primary care where 'wait and see' is a legitimate option. MAIN OUTCOME Comprehension of information (scored 0-6). SECONDARY OUTCOMES Decision intention, presentation satisfaction and preferences. RESULTS In both trials, the mean comprehension score was 3.7 for the text-only group. None of the visual presentations were superior to text-only. In trial A, the adjusted mean difference (MD) compared with text-only was: 0.19 (95% CI -0.16 to 0.55) for bar graph, 0.4 (0.04 to 0.76) for pictograph and 0.06 (-0.32 to 0.44) for line graph. In trial B, the adjusted MD was: 0.1 (-0.27 to 0.47) for bar graph), 0.38 (0.01 to 0.74) for pictograph and 0.1 (-0.27 to 0.48) for line graph. Pairwise comparisons between the three graphs showed all were clinically equivalent (95% CIs between -1.0 and 1.0). In both trials, bar graph was the most preferred presentation (chosen by 32.9% of trial A participants and 35.6% in trial B). CONCLUSIONS Any of the four visual presentations tested may be suitable to use when discussing quantitative prognostic information. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12621001305819).
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Affiliation(s)
- Eman Abukmail
- Institute for Evidence-Based Healthcare (IEBH), Faculty of Health Sciences and Medicine (HSM), Bond University, Robina, Queensland, Australia
| | - Mina Bakhit
- Institute for Evidence-Based Healthcare (IEBH), Faculty of Health Sciences and Medicine (HSM), Bond University, Robina, Queensland, Australia
| | - Mark Jones
- Institute for Evidence-Based Healthcare (IEBH), Faculty of Health Sciences and Medicine (HSM), Bond University, Robina, Queensland, Australia
| | - Chris Del Mar
- Institute for Evidence-Based Healthcare (IEBH), Faculty of Health Sciences and Medicine (HSM), Bond University, Robina, Queensland, Australia
| | - Tammy Hoffmann
- Institute for Evidence-Based Healthcare (IEBH), Faculty of Health Sciences and Medicine (HSM), Bond University, Robina, Queensland, Australia
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23
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Housten AJ, Kozower BD, Engelhardt KE, Robinson C, Puri V, Samson P, Cooksey K, Politi MC. Developing an Educational and Decision Support Tool for Stage I Lung Cancer Using Decision Science. Ann Thorac Surg 2023; 115:299-308. [PMID: 35926640 DOI: 10.1016/j.athoracsur.2022.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/26/2022] [Accepted: 07/19/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Guidelines recommend shared decision-making about treatment options for high-risk, operable stage I lung cancer. Patient decision aids can facilitate shared decision-making; however, their development, implementation, and evaluation in routine clinical practice presents numerous challenges and opportunities. METHODS The purpose of this review is to reflect on the process of tool development; identify the challenges associated with meeting the needs of patients, clinicians from multiple disciplines, and institutional workflow during implementation; and propose recommendations for future clinicians who wish to develop, refine, or implement similar tools into routine care. RESULTS In this review, we: (1) discuss guidelines for decision aid development; (2) describe how we applied those to create an education and decision support tool for patients with clinical stage I lung cancer deciding between radiation therapy and surgical resection; and (3) highlight challenges in implementing and evaluating the tool. CONCLUSIONS We provide recommendations for those seeking to develop, refine, or implement similar tools into routine care.
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Affiliation(s)
- Ashley J Housten
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis, St Louis, Missouri
| | - Benjamin D Kozower
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St Louis, St Louis, Missouri
| | - Kathryn E Engelhardt
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St Louis, St Louis, Missouri
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University in St Louis, St Louis, Missouri
| | - Varun Puri
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St Louis, St Louis, Missouri
| | - Pamela Samson
- Department of Radiation Oncology, Washington University in St Louis, St Louis, Missouri
| | - Krista Cooksey
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis, St Louis, Missouri
| | - Mary C Politi
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis, St Louis, Missouri.
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24
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Thompson CA, Mielicki MK, Rivera F, Fitzsimmons CJ, Scheibe DA, Sidney PG, Schiller LK, Taber JM, Waters EA. Leveraging Math Cognition to Combat Health Innumeracy. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2023; 18:152-177. [PMID: 35943825 DOI: 10.1177/17456916221083277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Rational numbers (i.e., fractions, percentages, decimals, and whole-number frequencies) are notoriously difficult mathematical constructs. Yet correctly interpreting rational numbers is imperative for understanding health statistics, such as gauging the likelihood of side effects from a medication. Several pernicious biases affect health decision-making involving rational numbers. In our novel developmental framework, the natural-number bias-a tendency to misapply knowledge about natural numbers to all numbers-is the mechanism underlying other biases that shape health decision-making. Natural-number bias occurs when people automatically process natural-number magnitudes and disregard ratio magnitudes. Math-cognition researchers have identified individual differences and environmental factors underlying natural-number bias and devised ways to teach people how to avoid these biases. Although effective interventions from other areas of research can help adults evaluate numerical health information, they circumvent the core issue: people's penchant to automatically process natural-number magnitudes and disregard ratio magnitudes. We describe the origins of natural-number bias and how researchers may harness the bias to improve rational-number understanding and ameliorate innumeracy in real-world contexts, including health. We recommend modifications to formal math education to help children learn the connections among natural and rational numbers. We also call on researchers to consider individual differences people bring to health decision-making contexts and how measures from math cognition might identify those who would benefit most from support when interpreting health statistics. Investigating innumeracy with an interdisciplinary lens could advance understanding of innumeracy in theoretically meaningful and practical ways.
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Affiliation(s)
| | | | - Ferdinand Rivera
- Department of Mathematics and Statistics, San Jose State University
| | | | | | | | - Lauren K Schiller
- Department of Human Development, Teachers College, Columbia University
| | | | - Erika A Waters
- Department of Surgery, Washington University School of Medicine in St. Louis
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25
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Ostinelli EG, Efthimiou O, Naci H, Furukawa TA, Leucht S, Salanti G, Wainwright L, Zangani C, De Crescenzo F, Smith K, Stevens K, Liu Q, Cipriani A. Vitruvian plot: a visualisation tool for multiple outcomes in network meta-analysis. EVIDENCE-BASED MENTAL HEALTH 2022; 25:e65-e70. [PMID: 35613849 PMCID: PMC9811072 DOI: 10.1136/ebmental-2022-300457] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/10/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE A network meta-analysis (NMA) usually assesses multiple outcomes across several treatment comparisons. The Vitruvian plot aims to facilitate communication of multiple outcomes from NMAs to patients and clinicians. METHODS We developed this tool following the recommendations on the communication of benefit-risk information from the available literature. We collected and implemented feedback from researchers, statisticians, methodologists, clinicians and people with lived experience of physical and mental health issues. RESULTS We present the Vitruvian plot, which graphically presents absolute estimates and relative performance of competing interventions against a common comparator for several outcomes of interest. We use two alternative colour schemes to highlight either the strength of statistical evidence or the confidence in the evidence. Confidence in the evidence is evaluated across six domains (within-study bias, reporting bias, indirectness, imprecision, heterogeneity and incoherence) using the Confidence in Network Meta-Analysis (CINeMA) system. CONCLUSIONS The Vitruvian plot allows reporting of multiple outcomes from NMAs, with colourings appropriate to inform credibility of the presented evidence.
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Affiliation(s)
- Edoardo Giuseppe Ostinelli
- Department of Psychiatry, University of Oxford, Oxford, UK,Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Orestis Efthimiou
- Department of Psychiatry, University of Oxford, Oxford, UK,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland,Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, School of Public Health, Kyoto, Japan
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technical University of Munich, Munchen, Germany
| | - Georgia Salanti
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Laurence Wainwright
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
| | - Caroline Zangani
- Department of Psychiatry, University of Oxford, Oxford, UK,Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Franco De Crescenzo
- Department of Psychiatry, University of Oxford, Oxford, UK,Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
| | - Katharine Smith
- Department of Psychiatry, University of Oxford, Oxford, UK,Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Katherine Stevens
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
| | - Qiang Liu
- Department of Psychiatry, University of Oxford, Oxford, UK,Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, UK,Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, UK,Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
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26
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Ubbink DT, Damman OC, de Jong BA. Shared decision-making in patients with multiple sclerosis. Front Neurol 2022; 13:1063904. [PMID: 36438979 PMCID: PMC9691958 DOI: 10.3389/fneur.2022.1063904] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/25/2022] [Indexed: 09/09/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic and progressive neurological disorder impacting physical, cognitive, and psychosocial health. The disease course, severity, and presence of symptoms differ within and between persons over time and are unpredictable. Given the preference-sensitive nature of many key decisions to be made, and the increasing numbers of disease-modifying therapies, shared decision-making (SDM) with patients seems to be key in offering optimum care and outcomes for people suffering from MS. In this paper, we describe our perspective on how to achieve SDM in patients with MS, following key SDM-elements from established SDM-frameworks. As for deliberation in the clinical encounter, SDM communication training of professionals and feedback on their current performance are key aspects, as well as encouraging patients to participate. Concerning information for patients, it is important to provide balanced, evidence-based information about the benefits and the harms of different treatment options, including the option of surveillance only. At the same time, attention is needed for the optimal dosage of that information, given the symptoms of cognitive dysfunction and fatigue among MS-patients, and the uncertainties they have to cope with. Finally, for broader communication, a system is required that assures patient preferences are actually implemented by multidisciplinary MS-teams. As SDM is also being implemented in many countries within the context of value-based health care, we consider the systematic use of outcome information, such as patient-reported outcome measures (PROMs) and Patient Decision Aids, as an opportunity to achieve SDM.
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Affiliation(s)
- Dirk T. Ubbink
- Department of Surgery, Amsterdam University Medical Centers, Public Health Research Institute, University of Amsterdam, Amsterdam, Netherlands
| | - Olga C. Damman
- Department of Public and Occupational Health, Amsterdam University Medical Centers, Public Health Research Institute, Free University of Amsterdam, Amsterdam, Netherlands
| | - Brigit A. de Jong
- Department of Neurology, Amsterdam University Medical Centers, MS Center Amsterdam, Amsterdam Neuroscience Research Institute, Public Health Research Institute, Free University of Amsterdam, Amsterdam, Netherlands
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27
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Lim JR, Liu BF, Atwell Seate A. Are you prepared for the next storm? Developing social norms messages to motivate community members to perform disaster risk mitigation behaviors. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2022; 42:2550-2568. [PMID: 35701149 PMCID: PMC10084415 DOI: 10.1111/risa.13957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Preparing for natural disasters and adapting to climate change can save lives. Yet, minimal research has examined how governments can motivate community members to prepare for disasters (e.g., purchasing flood insurance or installing water barriers in homes for floods and hurricanes). Instead, studies have focused on how to communicate actions individuals should take during disasters, rather than before disasters. This study develops messages targeting social norms, which are promising approaches to motivate community members to adopt disaster risk preparedness and mitigation behaviors. Specifically, we developed a variety of messages integrating descriptive norms (i.e., what others do), injunctive norms (i.e., what others believe should be done), and a social norms-based fear appeal, or social disapproval rationale (i.e., a negative social result of [not] taking behaviors). Then, we tested these messages through two between-subject factorial online experiments in flood- and hurricane-prone U.S. states with adult samples (N = 2,286). In experiment 1 (i.e., purchasing flood insurance), the injunctive norms message using weather forecasters and the social disapproval rationale message significantly increased social norms perceptions, which in turn influenced behavioral intentions. In experiment 2 (i.e., installing water barriers), the injunctive norms message using weather forecasters, the injunctive norms message using neighbors, and the social disapproval rationale message significantly increased social norms perceptions, which in turn influenced mitigation intentions. However, the descriptive social norms message was not effective in increasing social norms perceptions. We provide some of the first empirical evidence on how organizations' risk communication can empower community members to prepare and mitigate the impact of disasters.
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Affiliation(s)
- JungKyu Rhys Lim
- Department of CommunicationUniversity of MarylandCollege ParkMarylandUSA
| | - Brooke Fisher Liu
- Department of CommunicationUniversity of MarylandCollege ParkMarylandUSA
| | - Anita Atwell Seate
- Department of CommunicationUniversity of MarylandCollege ParkMarylandUSA
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28
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Vromans RD, Hommes S, Clouth FJ, Lo-Fo-Wong DNN, Verbeek XAAM, van de Poll-Franse L, Pauws S, Krahmer E. Need for numbers: assessing cancer survivors' needs for personalized and generic statistical information. BMC Med Inform Decis Mak 2022; 22:260. [PMID: 36199092 PMCID: PMC9535944 DOI: 10.1186/s12911-022-02005-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 09/28/2022] [Indexed: 11/12/2022] Open
Abstract
Background Statistical information (e.g., on long-term survival or side effects) may be valuable for healthcare providers to share with their patients to facilitate shared decision making on treatment options. In this pre-registered study, we assessed cancer survivors’ need for generic (population-based) versus personalized (tailored towards patient/tumor characteristics) statistical information after their diagnosis. We examined how information coping style, subjective numeracy, and anxiety levels of survivors relate to these needs and identified statistical need profiles. Additionally, we qualitatively explored survivors’ considerations for (not) wanting statistical information. Methods Cancer survivors’ need for statistics regarding incidence, survival, recurrence, side effects and quality of life were assessed with an online questionnaire. For each of these topics, survivors were asked to think back to their first cancer diagnosis and to indicate their need for generic and personalized statistics on a 4-point scale (‘not at all’- ‘very much’). Associations between information coping style, subjective numeracy, and anxiety with need for generic and personalized statistics were examined with Pearson’s correlations. Statistical need profiles were identified using latent class analysis. Considerations for (not) wanting statistics were analyzed qualitatively. Results Overall, cancer survivors (n = 174) had a higher need for personalized than for generic statistics (p < .001, d = 0.74). Need for personalized statistics was associated with higher subjective numeracy (r = .29) and an information-seeking coping style (r = .41). Three statistical need profiles were identified (1) a strong need for both generic and personalized statistics (34%), (2) a stronger need for personalized than for generic statistics (55%), and (3) a little need for both generic and personalized statistics (11%). Considerations for wanting personalized cancer statistics ranged from feelings of being in control to making better informed decisions about treatment. Considerations for not wanting statistics related to negative experience with statistics and to the unpredictability of future events for individual patients. Conclusions In light of the increased possibilities for using personalized statistics in clinical practice and decision aids, it appears that most cancer survivors want personalized statistical information during treatment decision-making. Subjective numeracy and information coping style seem important factors influencing this need. We encourage further development and implementation of data-driven personalized decision support technologies in oncological care to support patients in treatment decision making. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-02005-2.
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Affiliation(s)
- Ruben D Vromans
- Department of Communication and Cognition, Tilburg Center for Cognition and Communication, Tilburg School of Humanities and Digital Sciences, Tilburg University, P.O. Box 90153, 5037 LE, Tilburg, The Netherlands. .,Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.
| | - Saar Hommes
- Department of Communication and Cognition, Tilburg Center for Cognition and Communication, Tilburg School of Humanities and Digital Sciences, Tilburg University, P.O. Box 90153, 5037 LE, Tilburg, The Netherlands.,Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Felix J Clouth
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.,Department of Statistics and Methodology, Tilburg School of Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Deborah N N Lo-Fo-Wong
- Department of Medical Psychology and Psychotherapy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Xander A A M Verbeek
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Lonneke van de Poll-Franse
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands.,Department of Medical and Clinical Psychology, Tilburg School of Behavioral Sciences, Tilburg University, Tilburg, The Netherlands.,Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Steffen Pauws
- Department of Communication and Cognition, Tilburg Center for Cognition and Communication, Tilburg School of Humanities and Digital Sciences, Tilburg University, P.O. Box 90153, 5037 LE, Tilburg, The Netherlands.,Collaborative Care Solutions, Philips Research, Eindhoven, The Netherlands
| | - Emiel Krahmer
- Department of Communication and Cognition, Tilburg Center for Cognition and Communication, Tilburg School of Humanities and Digital Sciences, Tilburg University, P.O. Box 90153, 5037 LE, Tilburg, The Netherlands
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29
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Jallow M, Bonfield S, Kurtidu C, Baldwin DR, Black G, Brain KE, Donnelly M, Janes SM, McCutchan G, Robb KA, Ruparel M, Van Os S, Quaife SL. Decision Support Tools for Low-Dose CT Lung Cancer Screening: A Scoping Review of Information Content, Format, and Presentation Methods. Chest 2022; 162:930-941. [PMID: 34922933 PMCID: PMC9562440 DOI: 10.1016/j.chest.2021.12.638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/08/2021] [Accepted: 12/08/2021] [Indexed: 11/21/2022] Open
Abstract
Several countries mandate informed or shared decision-making for low-dose CT (LDCT) lung cancer screening, but knowledge is limited about the type of information and presentation techniques used to support decision-making in practice. This review aimed to characterize the content, format, mode, and presentation methods of decision support tools (DSTs) for LDCT lung cancer screening. DSTs reported within peer-reviewed articles (January 2000-April 2021) were identified systematically from PubMed, PsycInfo, EMBASE, and CINAHL Plus. Inclusion criteria revolved around the development or evaluation of a resource or tool intended to support individual or shared decision-making for LDCT lung cancer screening. The data-charting and extraction framework was based on the International Patient Decision Aids Standards instrument and Template for Intervention Description and Reporting. Extracted data were organized within two categories: (1) study characteristics and context, format, and mode of DST use and (2) DST content and presentation methods. This review identified 22 DSTs in paper, video, or electronic formats across 26 articles. Most DSTs (n = 13) focused on knowledge exchange, whereas seven used interactive techniques to support values clarification (eg, Likert scales) and nine DSTs guided deliberation (eg, suggested discussion topics). The DSTs addressed similar topics, but the detail, quantification of probability, and presentation methods varied considerably. None described all the potential screening harms and results. The heterogeneity in DST design may affect the quality of decision-making, particularly for participants with lower literacy and numeracy. Evidence-based consensus guidelines for DST content and presentation methods should be developed collaboratively with screening-eligible adults.
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Affiliation(s)
- Mbasan Jallow
- Research Department of Behavioural Science and Health, University College London, London, England
| | - Stefanie Bonfield
- Research Department of Behavioural Science and Health, University College London, London, England; Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, England
| | - Clara Kurtidu
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - David R Baldwin
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, City Hospital, Nottingham, England
| | - Georgia Black
- Department of Applied Health Research, University College London, London, England
| | - Kate E Brain
- Division of Population Medicine, Cardiff University, Cardiff, Wales
| | - Michael Donnelly
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland
| | - Samuel M Janes
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, England
| | - Grace McCutchan
- Division of Population Medicine, Cardiff University, Cardiff, Wales
| | - Kathryn A Robb
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Mamta Ruparel
- Lungs for Living Research Centre, UCL Respiratory, Division of Medicine, University College London, London, England
| | - Sandra Van Os
- Department of Applied Health Research, University College London, London, England
| | - Samantha L Quaife
- Research Department of Behavioural Science and Health, University College London, London, England; Wolfson Institute of Population Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, England.
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30
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Zadro JR, Karunaratne S, Harris IA, Jones CM, O'Keeffe M, Ferreira GE, Buchbinder R, McCaffery K, Thompson R, Maher CG, Hoffmann T. The impact of a patient decision aid on intention to undergo surgery for subacromial pain syndrome: An online randomised controlled trial. PATIENT EDUCATION AND COUNSELING 2022; 105:2951-2961. [PMID: 35589459 DOI: 10.1016/j.pec.2022.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 04/08/2022] [Accepted: 05/07/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate the effects of a patient decision aid for people considering shoulder surgery. METHODS Participants with shoulder pain considering shoulder surgery (n = 425) were recruited online and randomised to (i) a decision aid outlining the benefits and harms of shoulder surgery and non-surgical options (then randomised to a side-by-side vs. top-and-bottom display of options); and (ii) general information about shoulder pain from the NHS. Outcomes included treatment intention (primary), knowledge, attitudes, informed choice, and decisional conflict. Linear and logistic regression models were used to evaluate between-groups differences in outcomes. RESULTS 409 participants (96%) had post-intervention data. Mean age was 41.3 years, 44.2% were female. There was no between-group difference in post-intervention treatment intention (MD -0.2, 95% CI: -3.3 to 2.8) and likelihood of intending to have shoulder surgery (OR 0.7, 95% CI: 0.3-1.5). The decision aid slightly improved knowledge (MD 4.4, 95% CI: 0.2-8.6), but not any other secondary outcomes. The display of options did not influence any outcome. CONCLUSIONS In this online trial, a co-designed patient decision aid had no effect on treatment intention, attitudes, informed choice, and decisional conflict, but a small effect on improving knowledge. PRACTICE IMPLICATIONS Research is needed to understand reasons for the lack of anticipated effects. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry (ACTRN12621000992808).
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Affiliation(s)
- Joshua R Zadro
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, New South Wales, Australia.
| | - Sascha Karunaratne
- Surgical Outcomes Research Centre, Royal Prince Alfred Hospital, New South Wales, Australia
| | - Ian A Harris
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, New South Wales, Australia; Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Sydney, New South Wales, Australia
| | - Caitlin Mp Jones
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, New South Wales, Australia
| | - Mary O'Keeffe
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, New South Wales, Australia
| | - Giovanni E Ferreira
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, New South Wales, Australia
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Victoria, Australia; Monash Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Victoria, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Rachel Thompson
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, New South Wales, Australia
| | - Christopher G Maher
- Institute for Musculoskeletal Health, School of Public Health, Faculty of Medicine and Health, The University of Sydney and Sydney Local Health District, New South Wales, Australia
| | - Tammy Hoffmann
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Queensland, Australia
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Reyna VF, Edelson S, Hayes B, Garavito D. Supporting Health and Medical Decision Making: Findings and Insights from Fuzzy-Trace Theory. Med Decis Making 2022; 42:741-754. [PMID: 35735225 PMCID: PMC9283268 DOI: 10.1177/0272989x221105473] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
HIGHLIGHTS Fuzzy-trace theory (FTT) supports practical approaches to improving health and medicine.FTT differs in important respects from other theories of decision making, which has implications for how to help patients, providers, and health communicators.Gist mental representations emphasize categorical distinctions, reflect understanding in context, and help cue values relevant to health and patient care.Understanding the science behind theory is crucial for evidence-based medicine.
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Affiliation(s)
- Valerie F Reyna
- Human Neuroscience Institute and Center for Behavioral Economics and Decision Research, Cornell University, Ithaca, NY, USA
| | - Sarah Edelson
- Human Neuroscience Institute and Center for Behavioral Economics and Decision Research, Cornell University, Ithaca, NY, USA
| | - Bridget Hayes
- Human Neuroscience Institute and Center for Behavioral Economics and Decision Research, Cornell University, Ithaca, NY, USA
| | - David Garavito
- Human Neuroscience Institute and Center for Behavioral Economics and Decision Research, Cornell University, Ithaca, NY, USA
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32
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Benoit ID, Miller EG, Mirabito AM, Catlin JR. Medical decision-making with tables and graphs: The role of cognition, emotions, and analytic thinking. Health Mark Q 2022; 40:59-81. [PMID: 35796608 DOI: 10.1080/07359683.2022.2094101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The shift from one-way to two-way communication in healthcare decision-making has heightened the need to understand the role of display formats including tables and graphs as decision aids. In this paper, we investigate cognitive and affective influences on decision-making involving display formats. We find that a display format's impact on decision quality is mediated by two distinct components of cognition (verbatim and gist knowledge), and that tables compared to bar graphs improve decision quality. We also find evidence that analytic thinking and lower negative affect can improve decision quality. Implications for marketers, better engaging patients, and encouraging improved decision-making are discussed.
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Affiliation(s)
- Ilgım Dara Benoit
- Department of Marketing & Supply Chain Management, Walker College of Business at Appalachian State University, Boone, NC, USA
| | - Elizabeth G Miller
- Marketing Department, Isenberg School of Management at University of Massachusetts Amherst, Amherst, MA, USA
| | - Ann M Mirabito
- Marketing Department, Hankamer School of Business at Baylor University, Waco, TX, USA
| | - Jesse R Catlin
- Department of Marketing & Supply Chain Management, College of Business Administration at California State University, Sacramento, CA, USA
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33
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Tracy MC, Thompson R, Muscat DM, Bonner C, Hoffmann T, McCaffery K, Shepherd HL. Implementing shared decision-making in Australia. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 171:15-21. [PMID: 35562274 DOI: 10.1016/j.zefq.2022.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 03/31/2022] [Accepted: 04/02/2022] [Indexed: 06/15/2023]
Abstract
Person-centred care (PCC) and shared decision-making (SDM) are part of national clinical standards for an increasing number of areas of health care delivery. In addition to existing standards for accrediting hospitals, day surgery facilities, public dental services and medical education in Australia, new standards governing primary health care and digital mental health services have been added. Implementation and measurement of PCC and SDM to comply with standards, and training of health professionals, remain challenges for the Australian health sector. Consumer involvement in health research, policy and clinical service governance continues to increase and the National Health and Medical Research Council has begun to encourage consumer and community involvement in health and medical research. This increased consumer engagement and moves towards more PCC provision is reflected in a focus on encouraging patients to ask questions during their clinical care and supports improvements in consumer health literacy. SDM support tools are now being culturally adapted whilst a need for more systemic approaches to their development and implementation persists. With increasing resources and tools for all aspects of PCC and SDM challenges to find sustainable solutions to ensure tools are kept up to date with the best available evidence remain.
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Affiliation(s)
- Marguerite C Tracy
- Sydney Health Literacy Lab, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Rachel Thompson
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Danielle Marie Muscat
- Sydney Health Literacy Lab, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Carissa Bonner
- Sydney Health Literacy Lab, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Tammy Hoffmann
- Centre for Evidence-Informed Health Decisions in the Institute of Evidence-Based Healthcare, Bond University, Robina, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Heather L Shepherd
- Sydney Health Literacy Lab, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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34
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Harris E, Conway D, Jimenez-Aranda A, Butts J, Hedley-Takhar P, Thomson R, Astin F. Development and user-testing of a digital patient decision aid to facilitate shared decision-making for people with stable angina. BMC Med Inform Decis Mak 2022; 22:143. [PMID: 35624456 PMCID: PMC9137092 DOI: 10.1186/s12911-022-01882-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background Research shows that people with stable angina need decision support when considering elective treatments. Initial treatment is with medicines but patients may gain further benefit with invasive percutaneous coronary intervention (PCI). Choosing between these treatments can be challenging for patients because both confer similar benefits but have different risks. Patient decision aids (PtDAs) are evidence-based interventions that support shared decision-making (SDM) when making healthcare decisions. This study aimed to develop and user-test a digital patient decision aid (CONNECT) to facilitate SDM for people with stable angina considering invasive treatment with elective PCI. Methods A multi-phase study was conducted to develop and test CONNECT (COroNary aNgioplasty dECision Tool) using approaches recommended by the International Patient Decision Aid Standards Collaboration: (i) Steering Group assembled, (ii) review of clinical guidance, (iii) co-design workshops with patients and cardiology health professionals, (iv) first prototype developed and ‘alpha’ tested (semi-structured cognitive interviews and 12-item acceptability questionnaire) with patients, cardiologists and cardiac nurses, recruited from two hospitals in Northern England, and (v) final PtDA refined following iterative user-feedback. Quantitative data were analysed descriptively and qualitative data from the interviews analysed using deductive content analysis. Results CONNECT was developed and user-tested with 34 patients and 29 cardiology health professionals. Findings showed that CONNECT was generally acceptable, usable, comprehensible, and desirable. Participants suggested that CONNECT had the potential to improve care quality by personalising consultations and facilitating SDM and informed consent. Patient safety may be improved as CONNECT includes questions about symptom burden which can identify asymptomatic patients unlikely to benefit from PCI, as well as those who may need to be fast tracked because of worsening symptoms. Conclusions CONNECT is the first digital PtDA for people with stable angina considering elective PCI, developed in the UK using recommended processes and fulfilling international quality criteria. CONNECT shows promise as an approach to facilitate SDM and should be evaluated in a clinical trial. Further work is required to standardise the provision of probabilistic risk information for people considering elective PCI and to understand how CONNECT can be accessible to underserved communities. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01882-x.
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Affiliation(s)
- Emma Harris
- Centre for Applied Research in Health, School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK
| | - Dwayne Conway
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Angel Jimenez-Aranda
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,NIHR Devices for Dignity MedTech Co-Operative, Sheffield, UK
| | - Jeremy Butts
- Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK
| | - Philippa Hedley-Takhar
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.,NIHR Devices for Dignity MedTech Co-Operative, Sheffield, UK
| | - Richard Thomson
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Felicity Astin
- Centre for Applied Research in Health, School of Human and Health Sciences, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH, UK. .,Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, UK.
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35
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Peters E, Shoots-Reinhard B. Numeracy and the Motivational Mind: The Power of Numeric Self-efficacy. Med Decis Making 2022; 42:729-740. [PMID: 35583117 DOI: 10.1177/0272989x221099904] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Objective numeracy appears to support better medical decisions and health outcomes. The more numerate generally understand and use numbers more and make better medical decisions, including more informed medical choices. Numeric self-efficacy-an aspect of subjective numeracy that is also known as numeric confidence-also relates to decision making via emotional reactions to and inferences from experienced difficulty with numbers and via persistence linked with numeric comprehension and healthier behaviors over time. Furthermore, it moderates the effects of objective numeracy on medical outcomes. PURPOSE We briefly review the numeracy and decision-making literature and then summarize more recent literature on 3 separable effects of numeric self-efficacy. Although dual-process theories can account for the generally superior decision making of the highly numerate, they have neglected effects of numeric self-efficacy. We discuss implications for medical decision-making (MDM) research and practice. Finally, we propose a modification to dual-process theories, adding a "motivational mind" to integrate the effects of numeric self-efficacy on decision-making processes (i.e., inferences from experienced difficulty with numbers, greater persistence, and greater use of objective-numeracy skills) important to high-quality MDM. CONCLUSIONS The power of numeric self-efficacy (confidence) has been little considered in MDM, but many medical decisions and behaviors require persistence to be successful over time (e.g., comprehension, medical-recommendation adherence). Including numeric self-efficacy in research and theorizing will increase understanding of MDM and promote development of better decision interventions. HIGHLIGHTS Research demonstrates that objective numeracy supports better medical decisions and health outcomes.The power of numeric self-efficacy (aka numeric confidence) has been little considered but appears critical to emotional reactions and inferences that patients and others make when encountering numeric information (e.g., in decision aids) and to greater persistence in medical decision-making tasks involving numbers.The present article proposes a novel modification to dual-process theory to account for newer findings and to describe how numeracy mechanisms can be better understood.Because being able to adapt interventions to improve medical decisions depends in part on having a good theory, future research should incorporate numeric self-efficacy into medical decision-making theories and interventions.
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Affiliation(s)
- Ellen Peters
- Center for Science Communication Research, School of Journalism and Communication, University of Oregon, Eugene, OR, USA.,Psychology Department, University of Oregon, Eugene, OR, USA
| | - Brittany Shoots-Reinhard
- Center for Science Communication Research, School of Journalism and Communication, University of Oregon, Eugene, OR, USA.,Psychology Department, The Ohio State University, Columbus, OH, USA
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36
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van Strien-Knippenberg IS, Boshuizen MCS, Determann D, de Boer JH, Damman OC. Cocreation with Dutch patients of decision-relevant information to support shared decision-making about adjuvant treatment in breast cancer care. Health Expect 2022; 25:1664-1677. [PMID: 35579109 PMCID: PMC9327829 DOI: 10.1111/hex.13510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 11/30/2022] Open
Abstract
Background To support patients in shared decision‐making about treatment options, patient decision aids (PtDAs) usually provide benefit/harm information and value clarification methods (VCMs). Recently, personalized risk information from prediction models is also being integrated into PtDAs. This study aimed to design decision‐relevant information (i.e., personalized survival rates, harm information and VCMs) about adjuvant breast cancer treatment in cocreation with patients, in a way that suits their needs and is easily understandable. Methods Three cocreation sessions with breast cancer patients (N = 7–10; of whom N = 5 low health literate) were performed. Participants completed creative assignments and evaluated prototypes of benefit/harm information and VCMs. Prototypes were further explored through user testing with patients (N = 10) and healthcare providers (N = 10). The researchers interpreted the collected data, for example, creative and homework assignments, and participants' presentations, to identify key themes. User tests were transcribed and analysed using ATLAS.ti to assess the understanding of the prototypes. Results Important information needs were: (a) need for overview/structure of information directly after diagnosis and; (b) need for transparent benefit/harm information for all treatment options, including detailed harm information. Regarding VCMs, patients stressed the importance of a summary/conclusion. A bar graph seemed the most appropriate way of displaying personalized survival rates; the impact of most other formats was perceived as too distressful. The concept of ‘personalization’ was not understood by multiple patients. Conclusions A PtDA about adjuvant breast cancer treatment should provide patients with an overview of the steps and treatment options, with layers for detailed information. Transparent information about the likelihood of benefits and harm should be provided. Given the current lack of information on the likelihood of side effects/late effects, efforts should be made to collect and share these data with patients. Further quantitative studies are needed to validate the results and to investigate how the concept of ‘personalization’ can be communicated. Patient or Public Contribution Ten breast cancer patients participated in three cocreation sessions to develop decision‐relevant information. Subsequent user testing included 10 patients. The Dutch Breast Cancer Association (BVN) was involved as an advisor in the general study design.
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Affiliation(s)
- Inge S van Strien-Knippenberg
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | | | - Jasmijn H de Boer
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Olga C Damman
- Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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37
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Affiliation(s)
- Bob Steele
- Consultant to Bowel Screening Centre, University of Dundee, Dundee, UK
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38
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Morton K, Kohut K, Turner L, Smith S, Crosbie EJ, Ryan N, Grimmett C, Eccles DM, Foster C. Person-based co-design of a decision aid template for people with a genetic predisposition to cancer. Front Digit Health 2022; 4:1039701. [PMID: 36518561 PMCID: PMC9743799 DOI: 10.3389/fdgth.2022.1039701] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background People with genetic predispositions to cancer are faced with complex health decisions about managing their risk. Decision aids can support informed, values-based decisions, alongside shared decision-making with a clinician. Whilst diagnoses of genetic predispositions to cancer are increasing, there is no scalable decision aid to support these people. This paper presents an accessible, relevant decision aid template which can be adapted for different predispositions to cancer. Methods The decision aid template was co-developed with 12 patients affected by cancer and informed by empirical and theoretical literature. In addition, consultations were conducted with a further 19 people with Lynch syndrome; a specific genetic predisposition to cancer. Clinical stakeholders were consulted regularly. Coulter's framework for decision aid development guided the process, and these activities were complemented by the International Patient Decision Aid Standards, and the latest evidence on communicating risk in decision aids. Programme theory was developed to hypothesise how the decision aid would support decision-making and contextual factors which could influence the process. Guiding principles co-developed with the patient panel described how the decision aid could effectively engage people. Results The in-depth co-design process led to the identification of five core components of an accessible decision aid template for people with a genetic predisposition to cancer: defining the decision; option grid showing implications of each option; optional further details such as icon arrays to show tailored risk and personal narratives; values clarification activity; and a summary to facilitate discussion with a clinician. Specific guidance was produced describing how to develop each component. The guiding principles identified that the decision aid template needed to promote trust, reduce distress, and be comprehensive, personally relevant and accessible in order to engage people. Conclusion Adopting a co-design process helped ensure that the decision aid components were relevant and accessible to the target population. The template could have widespread application through being adapted for different genetic predispositions. The exact content should be co-designed with people from diverse backgrounds with lived experience of the specific predisposition to ensure it is as useful, engaging and relevant as possible.
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Affiliation(s)
- Kate Morton
- Centre for Psychosocial Research in Cancer, Health Sciences, University of Southampton, Southampton, United Kingdom
- Correspondence: Kate Morton
| | - Kelly Kohut
- Centre for Psychosocial Research in Cancer, Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Lesley Turner
- Patient and Public Contributor, Southampton, United Kingdom
| | - Sian Smith
- Aston University, College of Health and Life Sciences, School of Optometry, Birmingham, United Kingdom
| | - Emma J. Crosbie
- Department of Gynaecology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Division of Cancer Science, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, United Kingdom
| | - Neil Ryan
- College of Medicine and Veterinary Medicine, University of Edinburgh, United Kingdom
| | - Chloe Grimmett
- Centre for Psychosocial Research in Cancer, Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Diana M. Eccles
- Department of Medicine, University of Southampton, Southampton, United Kingdom
| | - Claire Foster
- Centre for Psychosocial Research in Cancer, Health Sciences, University of Southampton, Southampton, United Kingdom
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39
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Sheridan SL. Translating Evidence Updates to International Standards: Is More Certainty Needed for International Standards on Decision Aids? Med Decis Making 2021; 42:3-7. [PMID: 34845947 DOI: 10.1177/0272989x211063429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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40
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Bonner C, Batcup C, Ayre J, Cvejic E, Trevena L, McCaffery K, Doust J. The impact of health literacy-sensitive design and heart age in a cardiovascular disease prevention decision aid: randomised controlled trial and end user testing (Preprint). JMIR Cardio 2021; 6:e34142. [PMID: 35436208 PMCID: PMC9055529 DOI: 10.2196/34142] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/10/2022] [Accepted: 03/05/2022] [Indexed: 12/30/2022] Open
Affiliation(s)
- Carissa Bonner
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Carys Batcup
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Julie Ayre
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Erin Cvejic
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Lyndal Trevena
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Kirsten McCaffery
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Jenny Doust
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
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41
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Stacey D, Volk RJ. The International Patient Decision Aid Standards (IPDAS) Collaboration: Evidence Update 2.0. Med Decis Making 2021; 41:729-733. [PMID: 34416841 PMCID: PMC8474333 DOI: 10.1177/0272989x211035681] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Dawn Stacey
- School of Nursing, University of Ottawa; Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Robert J Volk
- Department of Health Services Research, the University of Texas MD Anderson Cancer Center, Houston, TX, USA
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42
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Witteman HO, Ndjaboue R, Vaisson G, Dansokho SC, Arnold B, Bridges JFP, Comeau S, Fagerlin A, Gavaruzzi T, Marcoux M, Pieterse A, Pignone M, Provencher T, Racine C, Regier D, Rochefort-Brihay C, Thokala P, Weernink M, White DB, Wills CE, Jansen J. Clarifying Values: An Updated and Expanded Systematic Review and Meta-Analysis. Med Decis Making 2021; 41:801-820. [PMID: 34565196 PMCID: PMC8482297 DOI: 10.1177/0272989x211037946] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Patient decision aids should help people make evidence-informed decisions aligned with their values. There is limited guidance about how to achieve such alignment. Purpose To describe the range of values clarification methods available to patient decision aid developers, synthesize evidence regarding their relative merits, and foster collection of evidence by offering researchers a proposed set of outcomes to report when evaluating the effects of values clarification methods. Data Sources MEDLINE, EMBASE, PubMed, Web of Science, the Cochrane Library, and CINAHL. Study Selection We included articles that described randomized trials of 1 or more explicit values clarification methods. From 30,648 records screened, we identified 33 articles describing trials of 43 values clarification methods. Data Extraction Two independent reviewers extracted details about each values clarification method and its evaluation. Data Synthesis Compared to control conditions or to implicit values clarification methods, explicit values clarification methods decreased the frequency of values-incongruent choices (risk difference, –0.04; 95% confidence interval [CI], –0.06 to –0.02; P < 0.001) and decisional conflict (standardized mean difference, –0.20; 95% CI, –0.29 to –0.11; P < 0.001). Multicriteria decision analysis led to more values-congruent decisions than other values clarification methods (χ2 = 9.25, P = 0.01). There were no differences between different values clarification methods regarding decisional conflict (χ2 = 6.08, P = 0.05). Limitations Some meta-analyses had high heterogeneity. We grouped values clarification methods into broad categories. Conclusions Current evidence suggests patient decision aids should include an explicit values clarification method. Developers may wish to specifically consider multicriteria decision analysis. Future evaluations of values clarification methods should report their effects on decisional conflict, decisions made, values congruence, and decisional regret.
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Affiliation(s)
- Holly O Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.,VITAM Research Centre, Quebec City, Quebec, Canada.,CHU de Québec Research Centre, Quebec City, Quebec, Canada
| | - Ruth Ndjaboue
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.,VITAM Research Centre, Quebec City, Quebec, Canada
| | - Gratianne Vaisson
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.,CHU de Québec Research Centre, Quebec City, Quebec, Canada
| | - Selma Chipenda Dansokho
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Bob Arnold
- UPMC Palliative and Supportive Institute, Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh, Pittsburgh, PA, USA
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Sandrine Comeau
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Teresa Gavaruzzi
- Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy
| | - Melina Marcoux
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Arwen Pieterse
- Leiden University Medical Center, Leiden, The Netherlands
| | - Michael Pignone
- Departments of Internal Medicine and Population Health, Dell Medical School, University of Texas, Austin, TX, USA
| | - Thierry Provencher
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Charles Racine
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Dean Regier
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charlotte Rochefort-Brihay
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Praveen Thokala
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Douglas B White
- Program on Ethics and Decision Making in Critical Illness, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Celia E Wills
- College of Nursing, Center on Healthy Aging, Self-Management and Complex Care, The Ohio State University, Columbus, OH, USA
| | - Jesse Jansen
- Department of Family Medicine/CAPHRI, Maastricht University, Maastricht, The Netherlands
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Scalia P, Schubbe DC, Lu ES, Durand MA, Frascara J, Noel G, O’Malley AJ, Elwyn G. Comparing the impact of an icon array versus a bar graph on preference and understanding of risk information: Results from an online, randomized study. PLoS One 2021; 16:e0253644. [PMID: 34297713 PMCID: PMC8301663 DOI: 10.1371/journal.pone.0253644] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/09/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Few studies have examined the best way to convey the probability of serious events occurring in the future (i.e., risk of stroke or death) to persons with low numeracy or graph literacy proficiency. To address this gap, we developed and user-tested a bar graph and compared it to icon arrays to assess its impact on understanding and preference for viewing risk information. OBJECTIVES To determine the: (i) formats' impact on participants' understanding of risk information; (ii) formats' impact on understanding and format preference across numeracy and graph literacy subgroups; (iii) rationale supporting participants' preference for each graphical display format. METHODS An online sample (evenly made up of participants with high and low objective numeracy and graph literacy) was randomized to view either the icon array or the bar graph. Each format conveyed the risk of major stroke and death five years after choosing surgery, a stent, or medication to treat carotid artery stenosis. Participants answered questions to assess their understanding of the risk information. Lastly, both formats were presented in parallel, and participants were asked to identify their preferred format to view risk information and explain their preference. RESULTS Of the 407 participants, 197 were assigned the icon array and 210 the bar graph. Understanding of risk information and format preference did not differ significantly between the two trial arms, irrespective of numeracy and graph literacy proficiency. High numeracy and graph literacy proficiency was associated with high understanding (p<0.01) and a preference for the bar graph (p = 0.01). CONCLUSION We found no evidence to demonstrate the superiority of one format over another on understanding. The majority of participants preferred viewing the risk information using the bar graph format.
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Affiliation(s)
- Peter Scalia
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America
| | - Danielle C. Schubbe
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America
| | - Emily S. Lu
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America
- UMR 1095, Université de Toulouse, Inserm, Université Toulouse III Paul Sabatier, Toulouse, France
- Unisanté, Centre Universitaire de Médecine Générale et Santé Publique, Lausanne, Switzerland
| | - Jorge Frascara
- Department of Art and Design, University of Alberta, Edmonton, Alberta, Canada
| | - Guillermina Noel
- Lucerne School of Arts and Design, Lucerne University of Applied Sciences and Arts, Luzern-Emmenbrucke, Switzerland
| | - A. James O’Malley
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, United States of America
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