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BMC Medical Informatics and Decision Making
Published in: BMC Medical Informatics and Decision Making 2/2013

Open Access 01-11-2013 | Review

Presenting quantitative information about decision outcomes: a risk communication primer for patient decision aid developers

Authors: Lyndal J Trevena, Brian J Zikmund-Fisher, Adrian Edwards, Wolfgang Gaissmaier, Mirta Galesic, Paul KJ Han, John King, Margaret L Lawson, Suzanne K Linder, Isaac Lipkus, Elissa Ozanne, Ellen Peters, Danielle Timmermans, Steven Woloshin

Published in: BMC Medical Informatics and Decision Making | Special Issue 2/2013

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Abstract

Background

Making evidence-based decisions often requires comparison of two or more options. Research-based evidence may exist which quantifies how likely the outcomes are for each option. Understanding these numeric estimates improves patients’ risk perception and leads to better informed decision making. This paper summarises current “best practices” in communication of evidence-based numeric outcomes for developers of patient decision aids (PtDAs) and other health communication tools.

Method

An expert consensus group of fourteen researchers from North America, Europe, and Australasia identified eleven main issues in risk communication. Two experts for each issue wrote a “state of the art” summary of best evidence, drawing on the PtDA, health, psychological, and broader scientific literature. In addition, commonly used terms were defined and a set of guiding principles and key messages derived from the results.

Results

The eleven key components of risk communication were: 1) Presenting the chance an event will occur; 2) Presenting changes in numeric outcomes; 3) Outcome estimates for test and screening decisions; 4) Numeric estimates in context and with evaluative labels; 5) Conveying uncertainty; 6) Visual formats; 7) Tailoring estimates; 8) Formats for understanding outcomes over time; 9) Narrative methods for conveying the chance of an event; 10) Important skills for understanding numerical estimates; and 11) Interactive web-based formats. Guiding principles from the evidence summaries advise that risk communication formats should reflect the task required of the user, should always define a relevant reference class (i.e., denominator) over time, should aim to use a consistent format throughout documents, should avoid “1 in x” formats and variable denominators, consider the magnitude of numbers used and the possibility of format bias, and should take into account the numeracy and graph literacy of the audience.

Conclusion

A substantial and rapidly expanding evidence base exists for risk communication. Developers of tools to facilitate evidence-based decision making should apply these principles to improve the quality of risk communication in practice.
Appendix
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Metadata
Title
Presenting quantitative information about decision outcomes: a risk communication primer for patient decision aid developers
Authors
Lyndal J Trevena
Brian J Zikmund-Fisher
Adrian Edwards
Wolfgang Gaissmaier
Mirta Galesic
Paul KJ Han
John King
Margaret L Lawson
Suzanne K Linder
Isaac Lipkus
Elissa Ozanne
Ellen Peters
Danielle Timmermans
Steven Woloshin
Publication date
01-11-2013
Publisher
BioMed Central
DOI
https://doi.org/10.1186/1472-6947-13-S2-S7

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