Communicating side effect risks in a tamoxifen prophylaxis decision aid: The debiasing influence of pictographs
OBJECTIVE: To experimentally test whether using pictographs (image matrices), incremental risk formats, and varied risk denominators would influence perceptions and comprehension of side effect risks in an online decision aid about prophylactic use of tamoxifen to prevent primary breast cancers. METHODS: We recruited 631 women with elevated breast cancer risk from two healthcare organizations. Participants saw tailored estimates of the risks of 5 side effects: endometrial cancer, blood clotting, cataracts, hormonal symptoms, and sexual problems. Presentation format was randomly varied in a three factor design: (A) risk information was displayed either in pictographs or numeric text; (B) presentations either reported total risks with and without tamoxifen or highlighted the incremental risk most relevant for decision making; and (C) risk estimates used 100 or 1000 person denominators. Primary outcome measures included risk perceptions and gist knowledge. RESULTS: Incremental risk formats consistently lowered perceived risk of side effects but resulted in low knowledge when displayed by numeric text only. Adding pictographs, however, produced significantly higher comprehension levels. CONCLUSIONS: Pictographs make risk statistics easier to interpret, reducing biases associated with incremental risk presentations. PRACTICE IMPLICATIONS: Including graphs in risk communications is essential to support an informed treatment decision-making process.
Related Topics:
Doctor-patient communication,
Risk communication graphics,
Risk communication
Keywords:
Risk communication; Decision aids; Cognitive biases; Patient education
Citation
(view)
Zikmund-Fisher BJ, Ubel PA, Smith DM, Derry HA, McClure JB, Stark AT, Pitsch R, Fagerlin A. Communicating side effect risks in a tamoxifen prophylaxis decision aid: The debiasing influence of pictographs. Patient Education and Counseling 2008;73(2):209-214.
Brian Zikmund-Fisher, PhD
Brian J. Zikmund-Fisher is an Assistant Professor in the Department of Health Behavior and Health Education, University of Michigan School of Public Health, as well as a Research Assistant Professor in the Division of General Internal Medicine, University of Michigan Medical School. He is...
Peter Ubel, MD
Peter A. Ubel, MD, is Professor of Medicine and Professor of Psychology at the University of Michigan; a primary care physician at the Ann Arbor Veterans Affairs Medical Center; Associate Director of the Michigan Robert Wood Johnson Clinical Scholars...
Dylan Smith, PhD
Dylan Smith studied social psychology at Arizona State University, where his work focused on interpersonal and intergroup relations and evolutionary psychology. His current research seeks to translate theoretical and methodological advances in the behavioral sciences to the study of health-related...
Rosemarie Pitsch, MPH
Rosemarie has been with CBDSM since January 2004. She holds a Master of Public Health degree in health behavior and health education from the University of Michigan School of Public Health. She earned her bachelor's degree in biology from the University of South Florida. Prior to joining CBDSM, she...
Angela Fagerlin, PhD
Angie Fagerlin studied psychology and literature at Hope College and received her PhD in experimental (cognitive) psychology at Kent State University. Her primary research focus is testing methods for communicating the risks and benefits of treatment to patients (e.g., in decision aids). Her other...
