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In a randomized trial, Cheryl Carling and colleagues evaluate how people respond to different statistical presentations regarding the consequences of taking antibiotic treatment for sore throat., Background We conducted an Internet-based randomized trial comparing four graphical displays of the benefits of antibiotics for people with sore throat who must decide whether to go to the doctor to seek treatment. Our objective was to determine which display resulted in choices most consistent with participants' values. Methods and Findings This was the first of a series of televised trials undertaken in cooperation with the Norwegian Broadcasting Company. We recruited adult volunteers in Norway through a nationally televised weekly health program. Participants went to our Web site and rated the relative importance of the consequences of treatment using visual analogue scales (VAS). They viewed the graphical display (or no information) to which they were randomized and were asked to decide whether to go to the doctor for an antibiotic prescription. We compared four presentations: face icons (happy/sad) or a bar graph showing the proportion of people with symptoms on day three with and without treatment, a bar graph of the average duration of symptoms, and a bar graph of proportion with symptoms on both days three and seven. Before completing the study, all participants were shown all the displays and detailed patient information about the treatment of sore throat and were asked to decide again. We calculated a relative importance score (RIS) by subtracting the VAS scores for the undesirable consequences of antibiotics from the VAS score for the benefit of symptom relief. We used logistic regression to determine the association between participants' RIS and their choice. 1,760 participants completed the study. There were statistically significant differences in the likelihood of choosing to go to the doctor in relation to different values (RIS). Of the four presentations, the bar graph of duration of symptoms resulted in decisions that were most consistent with the more fully informed second decision. Most participants also preferred this presentation (38%) and found it easiest to understand (37%). Participants shown the other three presentations were more likely to decide to go to the doctor based on their first decision than everyone based on the second decision. Participants preferred the graph using faces the least (14.4%). Conclusions For decisions about going to the doctor to get antibiotics for sore throat, treatment effects presented by a bar graph showing the duration of symptoms helped people make decisions more consistent with their values than treatment effects presented as graphical displays of proportions of people with sore throat following treatment. Clinical Trials Registration ISRCTN58507086 Please see later in the article for the Editors' Summary, Editors' Summary Background In the past, patients usually believed that their doctor knew what was best for them and that they had little say in deciding what treatment they would receive. But many modern interventions have complex trade-offs. Patients' opinions about the relative desirability of the possible outcomes of health care interventions depend on their lifestyle and expectations, and these “values” need to be considered when making decisions about medical treatments. Consequently, shared decision-making is increasingly superseding the traditional, paternalistic approach to medical decision-making. In shared decision-making, health care professionals talk to their patients about the risks and benefits of the various treatment options, and patients tell the health care professionals what they expect and/or require from their treatment. Why Was This Study Done? Shared decision-making can only succeed if patients know about the treatment options that are available for their medical condition and understand the consequences of each option. But how does the presentation of information about treatment options to patients affect their decisions? In 2002, a series of internet-based randomized trials (studies in which participants are randomly allocated to different “treatment” groups) called the Health Information Project: Presentation Online (HIPPO) was initiated to answer this question. Here, the researchers describe HIPPO 3, a trial that investigates how alternative graphical displays of the benefits of antibiotics for the treatment of sore throat affect whether people decide to seek treatment. In particular, the researchers ask which display results in people making a treatment decision most consistent with their values, i.e., in terms of the relative importance to them of the treatment's desirable and undesirable outcomes. What Did the Researchers Do and Find? Adult Norwegians recruited through a television health program numerically rated the importance of symptom relief and of several negative consequences (for example, side effects) of antibiotic treatment for sore throat on the trial's Web site. Relative importance scores (which indicate the participants' values) were calculated for each participant by subtracting their ratings for the importance of the negative consequences of seeking antibiotic treatment from his or her rating for the importance of symptom relief. The participants were then asked to decide whether to visit a doctor for antibiotics without receiving any further information or after being shown one of four graphical displays illustrating the benefits of antibiotic treatment. Two bar charts and one display of happy- and sad-face icons showed the proportion of people with symptoms at specific times after sore throat onset with and without treatment. A third bar chart indicated symptom duration with and without antibiotics. Finally, all the participants were shown all the displays and other information about sore throat and were asked to decide again about seeking treatment. The researchers found a clear association between the participants' values and the likelihood of their deciding to go to the doctor, and this likelihood depended on which graphical display the participants saw. People shown information on the proportion of patients with symptoms were more likely to decide to visit a doctor than those shown information on symptom duration. Furthermore, first decisions reached after being given information on symptom duration or no information were more consistent with the fully informed second decision than first decisions reached after seeing the other displays. What Do These Findings Mean? These findings suggest that, for people considering whether to seek antibiotic treatment for sore throat, a bar graph showing the duration of symptoms is more likely to help them make a decision that is consistent with their own values than a bar chart showing the proportions of people with sore throat following treatment. The researchers also found that the bar chart showing symptom duration was preferred by more of the participants than any of the other representations. Whether these results can be applied to other health care decisions or in other settings is not known. However, the researchers suggest that these findings may be most relevant to treatments that, like antibiotic treatment of sore throat, have a short-lived benefit and relatively important downsides. Additional Information Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1000140. A PLoS Medicine Editorial discusses this trial and the results of another HIPPO trial that are presented in a separate PLoS Medicine Research Article by Carling et al.; details of a pilot HIPPO trial are also available The Foundation for Informed Medical Decision Making (a US-based nonprofit organization) provides information on many aspects of medical decision making The Dartmouth-Hitchcock Medical Center provides information to help people make health care decisions through its Center for Shared Decision Making The Ottawa Hospital Research Institute provides information on patient decision aids, including an inventory of decision aids available on the Web (in English and French) MedlinePlus provides links to information and advice about sore throat (in English and Spanish)