Med Decis Making - A demonstration of ''less can be more'' in risk graphics.


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CKGROUND: 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.

Resumo Limpo

ckground onlin tool adjuv provid tailor estim possibl outcom adjuv therapi option avail breast cancer patient graphic format typic display outcom simultan surviv mortal due cancer othercaus mortal increment surviv due adjuv treatmentobject test whether simpler format present baselin increment surviv improv comprehens relev risk statist andor affect treatment intentionsdesign random experiment manipul risk graphic shown includ internetadminist survey vignett adjuv therapi decis breast cancer patient er tumorsparticip demograph divers stratifi random sampl women age y recruit internet research panelintervent particip random view either pictograph icon array display possibl outcom pictograph show surviv outcomesmeasur comprehens key statist task complet time graph evalu rate perceiv interest adjuv chemotherapyresult primari studi n particip view survivalon pictograph better accuraci report total chanc surviv chemotherapi hormon therapi v p higher graph evalu rate x v p less interest ad chemotherapi hormon therapi v p adjust odd ratio p replic studi n confirm particip view survivalon graph higher graph evalu rate x v p reduc interest chemotherapi orplimit studi use general public sampl actual patient may process risk inform differentlyconclus take less approach omit redund mortal outcom statist can effect method risk communic may prefer use visual format pictograph

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