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Open accessJournal ArticleDOI: 10.1177/0272989X21996342

Current Challenges When Using Numbers in Patient Decision Aids: Advanced Concepts.

04 Mar 2021-Medical Decision Making (SAGE Publications Inc.)-Vol. 41, Iss: 7, pp 834-847
Abstract: BackgroundDecision aid developers have to convey complex task-specific numeric information in a way that minimizes bias and promotes understanding of the options available within a particular decis...

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Topics: Decision aids (60%)
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5 results found


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 accessPosted ContentDOI: 10.1101/2021.09.20.21263868
Carissa Bonner1, Carys Batcup1, Julie Ayre1, Erin Cvejic1  +3 moreInstitutions (1)
22 Sep 2021-medRxiv
Abstract: Introduction: Shared decision making is as an essential principle for cardiovascular disease (CVD) prevention, where asymptomatic people are considering lifelong medication and lifestyle changes. This project aimed to develop and evaluate the first literacy-sensitive CVD prevention decision aid (DA) developed for people with low health literacy, and investigate the impact of literacy-sensitive design and heart age. Methods: We developed the standard DA based on international standards. The literacy-sensitive version included simple language, supporting images, white space and a lifestyle action plan. A randomised trial included 859 people aged 45-74 using a 3 (DA: standard, literacy-sensitive, control) x 2 (heart age: heart age + percentage risk, percentage risk only) factorial design, with outcomes including prevention intentions/behaviours, gist/verbatim knowledge of risk, credibility, emotional response and decisional conflict. We iteratively improved the literacy-sensitive version based on end user testing interviews with 20 people with varying health literacy levels. Results: Immediately post-intervention (n=859), there were no differences between the DA groups on any outcome. The heart age group was less likely to have a positive emotional response, perceived the message as less credible, and had higher gist/verbatim knowledge of heart age risk but not percentage risk. After 4 weeks (n=596), the DA groups had better gist knowledge of percentage risk than control. The literacy-sensitive decision aid group had higher fruit consumption, and the standard decision aid group had better verbatim knowledge of percentage risk. Verbatim knowledge was higher for heart age than percentage risk amongst those who received both. Discussion: The literacy-sensitive DA resulted in increased knowledge and lifestyle change for participants with varying health literacy levels and CVD risk results. Adding heart age did not increase lifestyle change intentions or behaviour but did affect psychological outcomes, consistent with previous findings. Key words: decision aids, shared decision making, risk communication, heart age, cardiovascular disease prevention, behaviour change, health literacy MeSH Terms: Health Literacy, Cardiovascular Diseases, Decision Making (Shared), Life Style, Decision Support Techniques

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Topics: Health literacy (61%)

Open accessJournal ArticleDOI: 10.1371/JOURNAL.PONE.0253644
Peter Scalia1, Danielle Schubbe1, Emily S. Lu1, Marie-Anne Durand1  +7 moreInstitutions (6)
23 Jul 2021-PLOS ONE
Abstract: Background Few studies have examined the best way to convey the probability of serious events occurring in the future (i.e., risk of stroke or death) to persons with low numeracy or graph literacy proficiency. To address this gap, we developed and user-tested a bar graph and compared it to icon arrays to assess its impact on understanding and preference for viewing risk information. Objectives To determine the: (i) formats’ impact on participants’ understanding of risk information; (ii) formats’ impact on understanding and format preference across numeracy and graph literacy subgroups; (iii) rationale supporting participants’ preference for each graphical display format. Methods An online sample (evenly made up of participants with high and low objective numeracy and graph literacy) was randomized to view either the icon array or the bar graph. Each format conveyed the risk of major stroke and death five years after choosing surgery, a stent, or medication to treat carotid artery stenosis. Participants answered questions to assess their understanding of the risk information. Lastly, both formats were presented in parallel, and participants were asked to identify their preferred format to view risk information and explain their preference. Results Of the 407 participants, 197 were assigned the icon array and 210 the bar graph. Understanding of risk information and format preference did not differ significantly between the two trial arms, irrespective of numeracy and graph literacy proficiency. High numeracy and graph literacy proficiency was associated with high understanding (p<0.01) and a preference for the bar graph (p = 0.01). Conclusion We found no evidence to demonstrate the superiority of one format over another on understanding. The majority of participants preferred viewing the risk information using the bar graph format.

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Topics: Graph (abstract data type) (54%), Numeracy (53%), Bar chart (51%)
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Journal ArticleDOI: 10.1126/SCIENCE.7455683
Amos Tversky1, Daniel Kahneman2Institutions (2)
30 Jan 1981-Science
Abstract: The psychological principles that govern the perception of decision problems and the evaluation of probabilities and outcomes produce predictable shifts of preference when the same problem is framed in different ways. Reversals of preference are demonstrated in choices regarding monetary outcomes, both hypothetical and real, and in questions pertaining to the loss of human lives. The effects of frames on preferences are compared to the effects of perspectives on perceptual appearance. The dependence of preferences on the formulation of decision problems is a significant concern for the theory of rational choice.

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Topics: Decision field theory (60%), Framing effect (56%), Fuzzy-trace theory (53%) ... read more

14,525 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%) ... read more

1,329 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%) ... read more

1,036 Citations


Open accessJournal ArticleDOI: 10.1136/BMJ.E256
27 Jan 2012-BMJ
Abstract: Although many clinicians feel they already use shared decision making, research shows a perception-reality gap. A M Stiggelbout and colleagues discuss why it is important and highlight some best practices

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652 Citations


Open accessJournal ArticleDOI: 10.1177/0272989X07307271
Isaac M. Lipkus1Institutions (1)
Abstract: Perception of health risk can affect medical decisions and health behavior change Yet the concept of risk is a difficult one for the public to grasp Whether perceptions of risk affect decisions and behaviors often relies on how messages of risk magnitudes (ie, likelihood) are conveyed Based on expert opinion, this article offers, when possible, best practices for conveying magnitude of health risks using numeric, verbal, and visual formats This expert opinion is based on existing empirical evidence, review of papers and books, and consultations with experts in risk communication This article also discusses formats to use pertaining to unique risk communication challenges (eg, conveying small-probability events, interactions) Several recommendations are suggested for enhancing precision in perception of risk by presenting risk magnitudes numerically and visually Overall, there are little data to suggest best practices for verbal communication of risk magnitudes Across the 3 formats, few overall recommendations could be suggested because of 1) lack of consistency in testing formats using the same outcomes in the domain of interest, 2) lack of critical tests using randomized controlled studies pitting formats against one another, and 3) lack of theoretical progress detailing and testing mechanisms why one format should be more efficacious in a specific context to affect risk magnitudes than others Areas of future research are provided that it is hoped will help illuminate future best practices

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Topics: Risk perception (54%), Risk assessment (53%)

621 Citations


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