Document Detail

A demonstration of ''less can be more'' in risk graphics.
MedLine Citation:
PMID:  20375419     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Online tools such as Adjuvant! provide tailored estimates of the possible outcomes of adjuvant therapy options available to breast cancer patients. The graphical format typically displays 4 outcomes simultaneously: survival, mortality due to cancer, other-cause mortality, and incremental survival due to adjuvant treatment.
OBJECTIVE: To test whether simpler formats that present only baseline and incremental survival would improve comprehension of the relevant risk statistics and/or affect treatment intentions.
DESIGN: . Randomized experimental manipulation of risk graphics shown included in Internet-administered survey vignettes about adjuvant therapy decisions for breast cancer patients with ER + tumors.
PARTICIPANTS: Demographically diverse, stratified random samples of women ages 40 to 74 y recruited from an Internet research panel.
INTERVENTION: Participants were randomized to view either pictographs (icon arrays) that displayed all 4 possible outcomes or pictographs that showed only survival outcomes.
MEASUREMENTS: Comprehension of key statistics, task completion times, graph evaluation ratings, and perceived interest in adjuvant chemotherapy.
RESULTS: In the primary study (N = 832), participants who viewed survival-only pictographs had better accuracy when reporting the total chance of survival with both chemotherapy and hormonal therapy (63% v. 50%, P < 0.001), higher graph evaluation ratings (x = 7.98 v. 7.67, P = 0.04), and less interest in adding chemotherapy to hormonal therapy (43% v. 50%, P = 0.04; adjusted odds ratio [OR] = 0.68, P = 0.008). A replication study (N = 714) confirmed that participants who viewed survival-only graphs had higher graph evaluation ratings (x = 8.06 v. 7.72, P = 0.04) and reduced interest in chemotherapy (OR=0.67,P=0.03).
LIMITATIONS: Studies used general public samples; actual patients may process risk information differently.
CONCLUSIONS: Taking a ''less is more'' approach by omitting redundant mortality outcome statistics can be an effective method of risk communication and may be preferable when using visual formats such as pictographs.
Brian J Zikmund-Fisher; Angela Fagerlin; Peter A Ubel
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, Non-P.H.S.     Date:  2010-04-07
Journal Detail:
Title:  Medical decision making : an international journal of the Society for Medical Decision Making     Volume:  30     ISSN:  1552-681X     ISO Abbreviation:  Med Decis Making     Publication Date:    2010 Nov-Dec
Date Detail:
Created Date:  2010-12-24     Completed Date:  2011-04-26     Revised Date:  2013-09-04    
Medline Journal Info:
Nlm Unique ID:  8109073     Medline TA:  Med Decis Making     Country:  United States    
Other Details:
Languages:  eng     Pagination:  661-71     Citation Subset:  IM    
VA Health Services Research & Development Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
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MeSH Terms
Breast Neoplasms / drug therapy*,  mortality,  psychology
Computer Graphics*
Data Display
Data Interpretation, Statistical*
Decision Support Techniques
Linear Models
Logistic Models
Middle Aged
Models, Statistical
Multivariate Analysis
Odds Ratio
Patient Education as Topic / methods*,  statistics & numerical data
Risk Assessment / methods*,  statistics & numerical data
United States
Grant Support
P50 CA101451/CA/NCI NIH HHS; R01 CA087595/CA/NCI NIH HHS; R01 CA87595/CA/NCI NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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