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Introduction: Despite decades of research on risk-communication approaches, questions remain about the optimal methods for conveying risks for different outcomes across multiple time points, which can be necessary in applications such as discrete choice experiments (DCEs). We sought to compare the effects of 3 design factors: 1) separated versus integrated presentations of the risks for different outcomes, 2) use or omission of icon arrays, and 3) vertical versus horizontal orientation of the time dimension. Methods: We conducted a randomized study among a demographically diverse sample of 2,242 US adults recruited from an online panel (mean age 59.8 y, s = 10.4 y; 21.9% African American) that compared risk-communication approaches that varied in the 3 factors noted above. The primary outcome was the number of correct responses to 12 multiple-choice questions asking survey respondents to identify specific numbers, contrast options to recognize dominance (larger v. smaller risks), and compute differences. We used linear regression to test the effects of the 3 design factors, controlling for health literacy, graph literacy, and numeracy. We also measured choice consistency in a subsequent DCE choice module Results: Mean comprehension varied significantly across versions (P < 0.001), with higher comprehension in the 3 versions that provided separated risk information for each risk. In the multivariable regression, separated risk presentation was associated with 0.58 more correct responses (P < 0.001; 95% confidence interval: 0.39, 0.77) compared with integrated risk information. Neither providing icon arrays nor using vertical versus horizontal time formats affected comprehension rates, although participant understanding did correlate with DCE choice consistency. Conclusions: In presentations of multiple risks over multiple time points, presenting risk information separately for each health outcome appears to increase understanding. Highlights: When conveying information about risks of different outcomes at multiple time points, separate presentations of single-outcome risks resulted in higher comprehension than presentations that combined risk information for different outcomes. We also observed benefits of presenting single-outcome risks separately among respondents with lower numeracy and graph literacy. Study participants who scored higher on risk understanding were more internally consistent in their responses to a discrete choice experiment. [ABSTRACT FROM AUTHOR]

Background. In a companion article, the authors describe the Subjective Numeracy Scale (SNS), a self-assessment of numerical aptitude and preferences for numbers that correlates strongly with objective numeracy. Objective. The objective of this article is to validate the Subjective Numeracy Scale using measures of subjects' capacity to recall and comprehend complex risk statistics and to complete utility elicitations. Research Design. The study is composed of 3 general public surveys: 2 administered via the Web and 1 by paper and pencil. Subjects. Studies 1 and 3 surveyed 862 and 1234 people, respectively, recruited via a nationwide commercial Internet survey panel. Study 2 involved 245 people who completed paper-and-pencil surveys in a Veterans Administration hospital. Measures. The authors tested whether one's score on the SNS predicted the likelihood of correct recall and interpretation of risk information (studies 1 and 2A) or the likelihood of effectively completing a time tradeoff or person-tradeoff utility elicitation (studies 2B and 3). In Studies 1 and 2, the authors also tested whether an objective test of quantitative ability would predict performance. Results. In all studies, survey participants with higher SNS scores performed significantly better than other respondents. The predictive ability of the SNS approached that observed for objective numeracy. Conclusions. The SNS effectively predicts both risk comprehension and completion of utility elicitations without requiring survey participants to complete time-consuming and stress-inducing mathematics tests. The authors encourage the use of the SNS in a variety of health services research contexts. Key words: numeracy; risk communication; decision making; literacy; utility measurement. (Med Decis Making 2007;27:663-671), The Subjective Numeracy Scale (SNS) is a self-report measure of perceived ability to perform various mathematical tasks and preference for the use of numerical versus prose information.(1) The 8-item scale [...]

Background. Basic numeracy skills are necessary before patients can understand the risks of medical treatments. Previous research has used objective measures, similar to mathematics tests, to evaluate numeracy. Objectives. To design a subjective measure (i.e., self-assessment) of quantitative ability that distinguishes low- and high-numerate individuals yet is less aversive, quicker to administer, and more useable for telephone and Internet surveys than existing numeracy measures. Research Design. Paper-and-pencil questionnaires. Subjects. The general public (N=703) surveyed at 2 hospitals. Measures. Forty-nine subjective numeracy questions were compared to measures of objective numeracy. Results. An 8-item measure, the Subjective Numeracy Scale (SNS), was developed through several rounds of testing. Four items measure people's beliefs about their skill in performing various mathematical operations, and 4 measure people's preferences regarding the presentation of numerical information. The SNS was significantly correlated with Lipkus and others' objective numeracy scale (correlations: 0.63-0.68) yet was completed in less time (24 s/item v. 31 s/item, P, To make informed decisions, patients need to be aware of and understand the risks and benefits of their treatment options. However, many patients have substantial difficulty understanding such risks and [...]

Objective. Person tradeoff (PTO) elicitations assess people's values for health states by asking them to compare the value of treatment programs. For example, people might be asked how many patients [...]

Purpose. When making medical decisions, people often care not only about what happens but also about whether the outcome was a result of actions voluntarily taken or a result of [...]

Background. Breast cancer patients’ misunderstanding of their systemic cancer recurrence risk has consequences on decision-making and quality of life. Little is known about how women derive their risk estimates. Methods. Using Los Angeles and Georgia’s SEER registries (2014–2015), a random sample of early-stage breast cancer patients was sent surveys about 2 to 3 months after surgery (N = 3930; RR, 68%). We conducted an inductive thematic analysis of open-ended responses about why women chose their risk estimates in a uniquely large sub-sample (N = 1,754). Clinician estimates of systemic recurrence risk were provided for patient sub-groups with DCIS and with low-, intermediate-, and high-risk invasive disease. Women’s perceived risk of systemic recurrence (0% to 100%) was categorized as overestimation, reasonably accurate estimation, or underestimation (0% for invasive disease) and was compared across identified factors and by clinical presentation. Results. Women identified 9 main factors related to their clinical experience (e.g., diagnosis and testing; treatment) and non-clinical beliefs (e.g., uncertainty; spirituality). Women who mentioned at least one clinical experience factor were significantly less likely to overestimate their risk (12% v. 43%, P < 0.001). Most women who were influenced by “communication with a clinician” had reasonably accurate recurrence estimates (68%). “Uncertainty” and “family and personal history” were associated with overestimation, particularly for women with DCIS (75%; 84%). “Spirituality, religion, and faith” was associated with an underestimation of risk (63% v. 20%, P < 0.001). Limitations. The quantification of our qualitative results is subject to any biases that may have occurred during the coding process despite rigorous methodology. Conclusions. Patient-clinician communication is important for breast cancer patients’ understanding of their numeric risk of systemic recurrence. Clinician discussions about recurrence risk should address uncertainty and relevance of family and personal history. [ABSTRACT FROM AUTHOR]

The author discourages the use of the 1-in-X risk communication format in clinical practice. He cites the results of a study which support the conclusion that 1-in-X formats reduced patient understanding of risk information and tended to increase risk perceptions. He also comments on a meta-analysis of five separate studies further exploring the 1-in-X effect published within the issue.

An essay is presented on the role of simplifying medical data for more educated patient risk and treatment decisions. It offers studies on modern systems, such as Adjuvant! Online, which transforms medical data into more graphic and streamlines information relevant to the patient's information needs. The author relates how he ventured in his studies after meeting with Dr. Dan Hayes to discuss patient decision-making problems in breast cancer care.