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

Abstract

Background Shared 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 the current evidence for how to present numerical probabilities within patient decision aids. Methods Following the 2013 review method, we assembled a group of 9 international experts on risk communication across Australia, Germany, the Netherlands, the United Kingdom, and the United States. We expanded the topics covered in the first review to reflect emerging areas of research. Groups of 2 to 3 authors reviewed the relevant literature based on their expertise and wrote each section before review by the full authorship team. Results Of 10 topics identified, we present 5 fundamental issues in this article. Although some topics resulted in clear guidance (presenting the chance an event will occur, addressing numerical skills), other topics (context/evaluative labels, conveying uncertainty, risk over time) continue to have evolving knowledge bases. We recommend presenting numbers over a set time period with a clear denominator, using consistent formats between outcomes and interventions to enable unbiased comparisons, and interpreting the numbers for the reader to meet the needs of varying numeracy. Discussion Understanding how different numerical formats can bias risk perception will help decision aid developers communicate risks in a balanced, comprehensible manner and avoid accidental “nudging” toward a particular option. Decisions between probability formats need to consider the available evidence and user skills. The review may be useful for other areas of science communication in which unbiased presentation of probabilities is important.

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“…Numerical risk formats enable a precise understanding of risk 17 . Verbal formats should be added for people with limited numeracy.…”

“…Visuals, such as with icon arrays, also help people understand risk and benefit, particularly those with low health literacy or low English proficiency 18 . The same denominator and time period should be used when comparing across risks; a smaller denominator makes the probability easier to understand 17 …”

“…Numerical risk formats enable a precise understanding of risk. 17 Verbal formats should be added for people with limited numeracy. Visuals, such as with icon arrays, also help people understand risk and benefit, particularly those with low health literacy or low English proficiency.…”

“…18 The same denominator and time period should be used when comparing across risks; a smaller denominator makes the probability easier to understand. 17 …”