Sanford School of Public Policy
Duke University
Publications [#301808] of Peter A Ubel
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Journal Articles
- Zikmund-Fisher, BJ; Fagerlin, A; Ubel, PA. "A demonstration of ''less can be more'' in risk graphics.." Medical decision making : an international journal of the Society for Medical Decision Making 30.6 (November, 2010): 661-671. [20375419], [doi]
(last updated on 2024/04/23)
Abstract:
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.