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A Demonstration of ‘‘Less Can Be More’’ in Risk Graphics

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  • Brian J. Zikmund-Fisher

    (VA Health Services Research & Development Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, Center for Behavioral and Decision Sciences in Medicine, Ann Arbor, MI, Division of General Internal Medicine, University of Michigan, Ann Arbor, MI, bzikmund@umich.edu)

  • Angela Fagerlin

    (VA Health Services Research & Development Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, Center for Behavioral and Decision Sciences in Medicine, Ann Arbor, MI, Division of General Internal Medicine, University of Michigan, Ann Arbor, MI)

  • Peter A. Ubel

    (VA Health Services Research & Development Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, Center for Behavioral and Decision Sciences in Medicine, Ann Arbor, MI, Division of General Internal Medicine, University of Michigan, Ann Arbor, MI, Department of Psychology, University of Michigan, Ann Arbor, MI)

Abstract

Background. Online tools such as Adjuvant! provide tailored estimates of the possible outcomes of adjuvant therapy options available to breast cancer patients. The graphical format typically displays 4 outcomes simultaneously: survival, mortality due to cancer, other-cause mortality, and incremental survival due to adjuvant treatment. Objective. To test whether simpler formats that present only baseline and incremental survival would improve comprehension of the relevant risk statistics and/or affect treatment intentions. Design. Randomized experimental manipulation of risk graphics shown included in Internet-administered survey vignettes about adjuvant therapy decisions for breast cancer patients with ER + tumors. Participants. Demographically diverse, stratified random samples of women ages 40 to 74 y recruited from an Internet research panel. Intervention. Participants were randomized to view either pictographs (icon arrays) that displayed all 4 possible outcomes or pictographs that showed only survival outcomes. Measurements. Comprehension of key statistics, task completion times, graph evaluation ratings, and perceived interest in adjuvant chemotherapy. Results. In the primary study (N = 832), participants who viewed survival-only pictographs had better accuracy when reporting the total chance of survival with both chemotherapy and hormonal therapy (63% v. 50%, P

Suggested Citation

  • Brian J. Zikmund-Fisher & Angela Fagerlin & Peter A. Ubel, 2010. "A Demonstration of ‘‘Less Can Be More’’ in Risk Graphics," Medical Decision Making, , vol. 30(6), pages 661-671, November.
    • Handle: RePEc:sae:medema:v:30:y:2010:i:6:p:661-671
    DOI: 10.1177/0272989X10364244
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    References listed on IDEAS

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    1. Brian J. Zikmund-Fisher & Dylan M. Smith & Peter A. Ubel & Angela Fagerlin, 2007. "Validation of the Subjective Numeracy Scale: Effects of Low Numeracy on Comprehension of Risk Communications and Utility Elicitations," Medical Decision Making, , vol. 27(5), pages 663-671, September.
    2. Hogarth, Robin M. (ed.), 1990. "Insights in Decision Making," University of Chicago Press Economics Books, University of Chicago Press, edition 1, number 9780226348551, September.
    3. repec:cup:judgdm:v:1:y:2006:i::p:64-75 is not listed on IDEAS
    4. Baron, Jonathan, 1997. "Confusion of Relative and Absolute Risk in Valuation," Journal of Risk and Uncertainty, Springer, vol. 14(3), pages 301-309, May-June.
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