Evaluation of risk communication in a mammography patient decision aid

Abstract

Objectives We characterized patients’ comprehension, memory, and impressions of risk communication messages in a patient decision aid (PtDA), Mammopad, and clarified perceived importance of numeric risk information in medical decision making. Methods Participants were 75 women in their forties with average risk factors for breast cancer. We used mixed methods, comprising a risk estimation problem administered within a pretest–posttest design, and semi-structured qualitative interviews with a subsample of 21 women. Results Participants’ positive predictive value estimates of screening mammography improved after using Mammopad. Although risk information was only briefly memorable, through content analysis, we identified themes describing why participants value quantitative risk information, and obstacles to understanding. We describe ways the most complicated graphic was incompletely comprehended. Conclusions Comprehension of risk information following Mammopad use could be improved. Patients valued receiving numeric statistical information, particularly in pictograph format. Obstacles to understanding risk information, including potential for confusion between statistics, should be identified and mitigated in PtDA design. Practice implications Using simple pictographs accompanied by text, PtDAs may enhance a shared decision-making discussion. PtDA designers and providers should be aware of benefits and limitations of graphical risk presentations. Incorporating comprehension checks could help identify and correct misapprehensions of graphically presented statistics

Key Elements of Mammography Shared Decision-Making: a Scoping Review of the Literature

“…22,24,38 Formats such as absolute risk reduction, natural frequencies, constant denominators, descriptive, everyday language rather than technical jargon, visual aid, and real-world examples are preferred by women, benefit comprehension, and facilitate SDM. 15,17,20,25,27,30 The interpersonal communication between a woman and her clinician is a critical mechanism for SDM deliberation. Important roles for clinicians include assessing the woman's information understanding and exploring personal preferences.…”

“…15 Natural frequency is superior to percentage or probability for ease of understanding and interpretation, 15,17,27,30 and women prefer clear enumeration of outcomes. 25 Additionally, in an RCT comparing formats of presenting numerical information, women who perceived the consequences of breast cancer as most serious, visual aids increase comprehension in comparison to text or fact box formats. 32 Pasternack 30 argues that all textual modalities should be used, including numbers, text, and visual images, to promote understanding.…”

“…33 Women value grounding risk information into real-world examples and the connection of information to medical research for credibility. 25 Research has also identified specific language that is more favorable for discussing breast cancer risk factors. Overall tone should be neutral and balanced, 27,30 using a personal and active voice (e.g., Byou^rather than Bone^).…”

Explanation and elaboration of the Standards for UNiversal reporting of patient Decision Aid Evaluations (SUNDAE) guidelines: examples of reporting SUNDAE items from patient decision aid evaluation literature

“…Incorporating comprehension checks into PtDAs would help identify misapprehension of graphically presented data and correct misunderstandings. 85 …”

Use of stakeholder engagement to support policy transfer: A case of contaminated land management in Nigeria

“…Despite the region's relatively high literacy rate, there was a risk that workshop participants might not comprehend, or might misunderstand, the written text used to communicate social values. We used postcards to overcome this limitation as a means to simplify communication for the benefit of comprehension (Klein et al, 2016). In general, our approach was well received, but some individuals felt that the graphics on the postcards could have been more specific in order to communicate a stronger message.…”