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Open accessJournal ArticleDOI: 10.1177/0272989X21996328

Current Best Practice for Presenting Probabilities in Patient Decision Aids: Fundamental Principles

04 Mar 2021-Medical Decision Making (SAGE Publications Inc.)-Vol. 41, Iss: 7, pp 821-833
Abstract: BackgroundShared decision making requires evidence to be conveyed to the patient in a way they can easily understand and compare. Patient decision aids facilitate this process. This article reviews...

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Topics: Decision aids (68%)
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Open accessJournal ArticleDOI: 10.1177/0272989X211037946
Abstract: BackgroundPatient decision aids should help people make evidence-informed decisions aligned with their values. There is limited guidance about how to achieve such alignment.PurposeTo describe the r...

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3 Citations



Open accessJournal ArticleDOI: 10.1177/23814683211033249
20 Jul 2021-
Abstract: Background. When stakeholders offer divergent input, it can be unclear how to prioritize information for decision aids (DAs) on mammography screening. Objectives. This analysis triangulates perspectives (breast cancer screening experts, primary care providers [PCPs], and patients with limited health literacy [LHL]) to understand areas of divergent and convergent input across stakeholder groups in developing a breast cancer screening DA for younger women with LHL. Design. A modified online Delphi panel of 8 experts rated 57 statements for inclusion in a breast cancer screening DA over three rounds. Individual interviews with 25 patients with LHL and 20 PCPs from a large safety net hospital explored informational needs about mammography decision making. Codes from the qualitative interviews and open-ended responses from the Delphi process were mapped across stakeholders to ascertain areas where stakeholder preferences converged or diverged. Results. Four themes regarding informational needs were identified regarding 1) the benefits and harms of screening, 2) different screening modalities, 3) the experience of mammography, and 4) communication about breast cancer risk. Patients viewed pain as the primary harm, while PCPs and experts emphasized the harm of false positives. Patients, but not PCPs or experts, felt that information about the process of getting a mammogram was important. PCPs believed that mammography was the only evidence-based screening modality, while patients believed breast self-exam was also important for screening. All stakeholders described incorporating personal risk information as important. Limitations. As participants came from one hospital, perceptions may reflect local practices. The Delphi sample size was small. Conclusions. Patients, experts, and PCPs had divergent views on the most important information needed for screening decisions. More evidence is needed to guide integration of multiple stakeholder perspectives into the content of DAs.

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Topics: Breast cancer screening (62%), Delphi method (54%), Health literacy (52%) ... show more

Open accessJournal ArticleDOI: 10.1002/CAM4.4072
21 Jun 2021-Cancer Medicine
Abstract: OBJECTIVES To develop a new interface for the widely used prognostic breast cancer tool: Predict: Breast Cancer. To facilitate decision-making around post-surgery breast cancer treatments. To derive recommendations for communicating the outputs of prognostic models to patients and their clinicians. METHOD We employed a user-centred design process comprised of background research and iterative testing of prototypes with clinicians and patients. Methods included surveys, focus groups and usability testing. RESULTS The updated interface now caters to the needs of a wider audience through the addition of new visualisations, instantaneous updating of results, enhanced explanatory information and the addition of new predictors and outputs. A programme of future research was identified and is now underway, including the provision of quantitative data on the adverse effects of adjuvant breast cancer treatments. Based on our user-centred design process, we identify six recommendations for communicating the outputs of prognostic models including the need to contextualise statistics, identify and address gaps in knowledge, and the critical importance of engaging with prospective users when designing communications. CONCLUSIONS For prognostic algorithms to fulfil their potential to assist with decision-making they need carefully designed interfaces. User-centred design puts patients and clinicians needs at the forefront, allowing them to derive the maximum benefit from prognostic models.

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Topics: Usability (50%)

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113 results found


Open accessJournal ArticleDOI: 10.2307/1884324
Daniel Ellsberg1Institutions (1)
Abstract: Are there uncertainties that are not risks? There has always been a good deal of skepticism about the behavioral significance of Frank Knight's distinction between “measurable uncertainty” or “risk”, which may be represented by numerical probabilities, and “unmeasurable uncertainty” which cannot. Knight maintained that the latter “uncertainty” prevailed – and hence that numerical probabilities were inapplicable – in situations when the decision-maker was ignorant of the statistical frequencies of events relevant to his decision; or when a priori calculations were impossible; or when the relevant events were in some sense unique; or when an important, once-and-for-all decision was concerned. Yet the feeling has persisted that, even in these situations, people tend to behave “as though” they assigned numerical probabilities, or “degrees of belief,” to the events impinging on their actions. However, it is hard either to confirm or to deny such a proposition in the absence of precisely-defined procedures for measuring these alleged “degrees of belief.” What might it mean operationally, in terms of refutable predictions about observable phenomena, to say that someone behaves “as if” he assigned quantitative likelihoods to events: or to say that he does not? An intuitive answer may emerge if we consider an example proposed by Shackle, who takes an extreme form of the Knightian position that statistical information on frequencies within a large, repetitive class of events is strictly irrelevant to a decision whose outcome depends on a single trial.

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Topics: Knightian uncertainty (56%), Sure-thing principle (55%), Ambiguity effect (51%) ... show more

6,526 Citations


Open accessJournal ArticleDOI: 10.1136/BMJ.38926.629329.AE
Glyn Elwyn1, Annette M. O'Connor2, Dawn Stacey3, Robert J. Volk  +18 moreInstitutions (4)
24 Aug 2006-BMJ
Abstract: Objective To develop a set of quality criteria for patient decision support technologies (decision aids). Design and setting Two stage web based Delphi process using online rating process to enable international collaboration. Participants Individuals from four stakeholder groups (researchers, practitioners, patients, policy makers) representing 14 countries reviewed evidence summaries and rated the importance of 80 criteria in 12 quality domains ona1to9 scale. Second round participants received feedback from the first round and repeated their assessment of the 80 criteria plus three new ones. Main outcome measure Aggregate ratings for each criterion calculated using medians weighted to compensate for different numbers in stakeholder groups; criteria rated between 7 and 9 were retained. Results 212 nominated people were invited to participate. Of those invited, 122 participated in the first round (77 researchers, 21 patients, 10 practitioners, 14 policy makers); 104/122 (85%) participated in the second round. 74 of 83 criteria were retained in the following domains: systematic development process (9/9 criteria); providing information about options (13/13); presenting probabilities (11/13); clarifying and expressing values (3/3); using patient stories (2/5); guiding/coaching (3/5); disclosing conflicts of interest (5/5); providing internet access (6/6); balanced presentation of options (3/3); using plain language (4/6); basing information on up to date evidence (7/7); and establishing effectiveness (8/8). Conclusions Criteria were given the highest ratings where evidence existed, and these were retained. Gaps in research were highlighted. Developers, users, and purchasers of patient decision aids now have a checklist for appraising quality. An instrument for measuring quality of decision aids is being developed.

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Topics: Delphi method (53%), Decision aids (53%), Patient participation (52%) ... show more

1,329 Citations


Journal ArticleDOI: 10.1177/0272989X0102100105
Abstract: Background. Numeracy, how facile people are with basic probability and mathematical concepts, is associated with how people perceive health risks. Performance on simple numeracy problems has been poor among populations with little as well as more formal education. Here, we examine how highly educated participants performed on a general and an expanded numeracy scale. The latter was designed within the context of health risks. Method. A total of 463 men and women aged 40 and older completed a 3-item general and an expanded 7-item numeracy scale. The expanded scale assessed how well people 1) differentiate and perform simple mathematical operations on risk magnitudes using percentages and proportions, 2) convert percentages to proportions, 3) convert proportions to percentages, and 4) convert probabilities to proportions. Results. On average, 18% and 32% of participants correctly answered all of the general and expanded numeracy scale items. Approximately 16% to 20% incorrectly answered the most straightfor...

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1,277 Citations


Open accessJournal ArticleDOI: 10.1111/J.1525-1497.2006.00540.X
David W. Baker1Institutions (1)
Abstract: Health literacy is a complicated construct that depends on individual capacity to communicate and the demands posed by society and the health care system. More comprehensive tests are needed to understand the gap between capacities and current demands to help guide efforts to educate children and adults about health issues and to develop health-related information that more of the general public can understand. For research, new instruments are needed that will measure individuals reading fluency more precisely without posing an undue response burden. Computer-assisted testing, which selects items from a bank of possible items according to a baseline-predicted reading ability and responses to previous questions, should allow more accurate measurement of indiidual capacity without increasing the time required to complete testing. It remains unclear whether it is possible to develop an accurate, practical “screening” test to identify individuals with limited health literacy. Even if this goal is achieved, it remains unclear whether it is better to screen patients or to adopt “universal precautions” to avoid miscommunication by using plain language in all oral and written communication and confirming understanding with all patients by having them repeat back their understanding of their diagnosis and treatment plan. George Bernard Shaw said, “The main problem with communication is the assumption that it has occurred.” This is a universal truth that transcends reading ability.

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Topics: Health literacy (62%), Literacy (53%), Health care (53%) ... show more

1,036 Citations


Journal ArticleDOI: 10.1111/J.1467-9280.2006.01720.X
Ellen Peters1, Daniel Västfjäll2, Paul Slovic1, C. K. Mertz  +2 moreInstitutions (3)
Abstract: A series of four studies explored how the ability to comprehend and transform probability numbers relates to performance on judgment and decision tasks. On the surface, the tasks in the four studies appear to be widely different; at a conceptual level, however, they all involve processing numbers and the potential to show an influence of affect. Findings were consistent with highly numerate individuals being more likely to retrieve and use appropriate numerical principles, thus making themselves less susceptible to framing effects, compared with less numerate individuals. In addition, the highly numerate tended to draw different (generally stronger or more precise) affective meaning from numbers and numerical comparisons, and their affective responses were more precise. Although generally helpful, this tendency may sometimes lead to worse decisions. The less numerate were influenced more by competing, irrelevant affective considerations. Analyses showed that the effect of numeracy was not due to general intelligence. Numerical ability appears to matter to judgments and decisions in important ways.

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Topics: Mathematical ability (55%)

1,012 Citations


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