Utilization of Continuous “Spinners” to Communicate Risk

Eyler, Rachel F.; Cordes, Sara; Szymanski, Benjamin R.; Fraenkel, Liana

doi:10.1177/0272989x17707198

Cited by 13 publications

(16 citation statements)

References 14 publications

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“…Others have also demonstrated less effect of visual aids among subjects with higher levels of education and/or numeracy. (8, 16, 18) In this study, college graduates may have had pre-existing perceptions of these drugs (e.g., due to higher prior knowledge) and therefore may have been less impacted by additional information. Alternatively, they may have been more confident in their own knowledge and/or beliefs, and may have overlooked the additional information describing risks.…”

Section: Discussionmentioning

confidence: 92%

“…This finding suggests that the conceptual illustrations may have had an impact on participants’ mental representations of risk associated with the graphic representation, but not the numbers only format. Numerous studies have compared graphic representations to other risk presentation formats (18, 20–26); however, the effect of combining formats is not well understood. Future studies using cognitive interviews, think aloud protocols, or hypothesis-driven experiments are needed to better understand the differential impact of the graphic representation and/or conceptual illustrations for rare and very rare events.…”

Section: Discussionmentioning

confidence: 99%

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Do visual aids influenced patients’ risk perceptions for rare and very rare risks?

Fraenkel

Reyna

Cozmuta

et al. 2018

Patient Education and Counseling

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Objective: To examine whether visual aids (a graphic representation and/or conceptual illustrations) influence patients’ risk perceptions for rare and very rare risks. Methods: Participants were randomized to a scenario which varied by probability of infection (2% or 0.2%) and visual aid: numbers only, numbers + graphic representation, numbers + conceptual illustrations, or numbers + graphic representation + conceptual illustrations. Risk perceptions and likelihood of starting the medication were examined across the four formats, separately, in participants with and without a college education. Results: Adding a graphic representation and/or conceptual illustrations did not affect risk perceptions among those with a higher level of education. Adding both a graphic representation + conceptual illustrations decreased risk perceptions and increased likelihood of starting the medication among participants randomized to the 2%, but not 0.2% scenario, among participants with lower levels of education. Conclusion: Adding a graphic representation + conceptual illustrations to numbers may influence perceptions for rare, but not very rare, risks among patients with lower education. Practice Implications: Clinicians should be aware of the differential effects of visual aids developed to facilitate risk communication. Patients with higher levels of education may be less responsive to visual aids than those with lower education.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Do visual aids influenced patients’ risk perceptions for rare and very rare risks?

Fraenkel

Reyna

Cozmuta

et al. 2018

Patient Education and Counseling

Self Cite

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“…24−28 A recent paper by Eyler et al proposed using a continuous "spinner" to communicate risk based on studies in children demonstrating improved understanding of probabilities when shown continuous versus discrete patterns. 29 The study found that both the spinner and icon array increased subjects' risk knowledge, although the effect was not modified by numeracy. 29 Our aim was to examine how individuals understand uncertainty as it relates to the probability of medication risks and benefits, and to specifically analyze their understanding of epistemic and aleatory uncertainty.…”

Section: Introductionmentioning

confidence: 89%

“…29 The study found that both the spinner and icon array increased subjects' risk knowledge, although the effect was not modified by numeracy. 29 Our aim was to examine how individuals understand uncertainty as it relates to the probability of medication risks and benefits, and to specifically analyze their understanding of epistemic and aleatory uncertainty. Additionally, given the conflicting evidence regarding the effectiveness of visual aids in increasing understanding of uncertainty, we aimed to study how people think about both the icon array and spinner.…”

Section: Introductionmentioning

confidence: 89%

Examining Notions of Uncertainty in the Healthcare Setting: A Qualitative Study

Meawad

Fraenkel

2019

Preprint

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Background: Shared decision-making relies on the premise that individuals are well-informed regarding the benefits and harms of all available treatment options before coming to a decision regarding their healthcare. There is often significant aleatory and epistemic uncertainty associated with proposed risks and benefits, but prior studies have demonstrated that uncertainty is rarely communicated in provider-patient interactions. Additionally, there has been conflicting evidence regarding the use of visual aids as a method to improve understanding of uncertainty.Methods: We conducted a qualitative, think-aloud study to examine how individuals understand uncertainty as it relates to the probability of medication risks and benefits. We used a within-subjects design and presented individuals with two hypothetical medications after which they received either no additional information, an icon array, or a spinner. We performed individual in-depth interviews following a semi-structured interview guide. Transcripts were analyzed using the constant comparative method of grounded theory.Results: We reached thematic saturation after 20 patient interviews. The participants’ mean (SD) age was 64.6 (18); 60% male, 84% were non-Hispanic Whites, 10% Blacks, and 60% had a college education or higher. Several themes regarding difficulties understanding uncertainty emerged: 1) Rejection of uncertainty; 2) Failure to distinguish between epistemic and aleatory uncertainty; 3) Difficulty distinguishing between different magnitudes of probabilities; 5) Reduction of uncertainty by manipulation of the scenario to eliminate choices. The use of visual aids did not appear to facilitate understanding of uncertainty in most cases.Conclusions: Providers must understand whether and how patients interpret probabilistic information in order to best communicate with them in the healthcare setting. Features such as “talk-back” should be used to ensure reasonable understanding of uncertainty during shared decision-making encounters.

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“…20 This has led to various recommendations about appropriate design and approaches used in patient decision aids. 11,17,[21][22][23][24][25][26][27] Visual representation of risk information has been shown to increase the accuracy of risk comprehension and improve decision making for patients. 11,17 Previous studies have identified conflicting evidence regarding the influence of icon arrays on improving risk comprehension (Minshall et al, unpublished data, 2018).…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

Benefits and harms of aspirin to reduce colorectal cancer risk: a cross-sectional study of methods to communicate risk in primary care

et al. 2019

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BackgroundNew Australian guidelines recommend that GPs actively consider prescribing low-dose aspirin to patients aged 50–70 years to reduce their risk of developing colorectal cancer (CRC). Patients and GPs need to understand the relative benefits and harms to support informed decision making.AimTo develop and examine different methods to communicate the benefits and harms of taking aspirin for CRC prevention.Design and settingA cross-sectional, vignette study with patients aged 50–70 years consecutively recruited from general practices in Melbourne, Australia, between July and August 2018.MethodSummary estimates from meta-analyses of the effects of aspirin on the incidence of CRC, cardiovascular disease, gastrointestinal bleeding, and incidence rates in the Australian population to estimate outcomes in a hypothetical population of 10 000 people aged 50–70 years. These estimates were presented using four different risk communication formats. Participants were shown these different formats and asked if they would take aspirin to prevent CRC.ResultsA total of 313 participants were recruited (95.1% recruitment rate), of whom 304 completed the study. Most participants (71.7–75.3%) reported they would take aspirin irrespective of risk format presented. Bar charts (odds ratio [OR] 1.20, 95% confidence intervals [CI] = 1.01 to 1.44) and expected frequency trees (OR 1.18, 95% CI = 0.99 to 1.41) were more strongly associated with the intentions to take aspirin compared with icon arrays. Bar charts were most preferred for presenting risk information.ConclusionA large proportion of participants in this study intended to take aspirin to reduce their CRC risk regardless of risk communication format. Bar charts and expected frequency trees were the preferred methods to present the benefits and harms of taking aspirin to prevent CRC.

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Utilization of Continuous “Spinners” to Communicate Risk

Cited by 13 publications

References 14 publications

Do visual aids influenced patients’ risk perceptions for rare and very rare risks?

Do visual aids influenced patients’ risk perceptions for rare and very rare risks?

Examining Notions of Uncertainty in the Healthcare Setting: A Qualitative Study

Benefits and harms of aspirin to reduce colorectal cancer risk: a cross-sectional study of methods to communicate risk in primary care

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