Communicating side effect risks in a tamoxifen prophylaxis decision aid: The debiasing influence of pictographs

PATIENT EDUCATION AND COUNSELING

卷:73

Article; Proceedings Paper

Zikmund-Fisher, Brian J.^1,2,3  Ubel, Peter A.^1,2,3,4  Smith, Dylan M.^1,2,3  Derry, Holly A.⁵  McClure, Jennifer B.⁶  Stark, Azadeh⁷  Pitsch, Rosemarie K.^1,3  Fagerlin, Angela^1,2,3 

[1] Ctr Behav & Decis Sci Med, Ann Arbor, MI 48109 USA

[2] VA Ann Arbor Healthcare Syst, VA Hlth Serv Res & Dev Ctr Excellence, Ann Arbor, MI USA

[3] Univ Michigan, Dept Internal Med, Div Gen Med, Ann Arbor, MI 48109 USA

[4] Univ Michigan, Dept Psychol, Ann Arbor, MI USA

[5] Univ Michigan, Ctr Hlth Commun Res, Ann Arbor, MI 48109 USA

[6] Grp Hlth Ctr Hlth Studies, Seattle, WA USA

[7] Henry Ford Hlth Syst, Detroit, MI USA

关键词: Risk communication;    Decision aids;    Cognitive biases;    Patient education;   

DOI  :  10.1016/j.pec.2008.05.010

来源: Elsevier

【 摘 要 】

Objective: To experimentally test whether using pictographs (image matrices), incremental risk formats, and varied risk denominators would influence perceptions and comprehension of side effect risks in an online decision aid about Prophylactic use of tamoxifen to prevent primary breast cancers. Methods: We recruited 631 women with elevated breast cancer risk from two healthcare organizations. Participants saw tailored estimates of the risks of 5 side effects: endometrial cancer, blood clotting, cataracts, hormonal symptoms, and sexual problems. Presentation format was randomly varied in a three factor design: (A) risk information was displayed either in Pictographs OF numeric text; (B) presentations either reported total risks with and without tamoxifen or highlighted the incremental risk most relevant for decision making; and (C) risk estimates used 100 or 1000 person denominators. Primary outcome measures included risk perceptions and gist knowledge. Results: Incremental Fisk formats consistently lowered perceived risk of side effects but resulted in low knowledge when displayed by numeric text only. Adding pictographs, however, produced significantly higher comprehension levels. Conclusions: Pictographs make risk statistics easier to interpret, reducing biases associated with incremental risk presentations. Practice implications: Including graphs in Fisk communications is essential to Support in informed treatment decision-making process. Published by Elsevier Ireland Ltd.

【 授权许可】

Free