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An Objective Measure of Decisional Clarity to Assess Decision Aid Effectiveness in Situations with Equipoise: A Randomized Trial

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  • Jessica K. Witt

Abstract

Background Decision aids can help patients make medical decisions, which is especially advantageous in situations with equipoise. However, when there is no correct answer, it is difficult to assess whether a decision aid is helpful. The goal of this research is to propose and validate an objective method for measuring decision aid effectiveness by quantifying the clarity participants achieved when making decisions. Design The measure of decisional clarity was tested in a convenience sample of 131 college-aged students making hypothetical decisions about 2 treatment options for depression and anxiety. The treatments varied with respect to potential benefits and harms. Information was presented numerically or with an accompanying data visualization (an icon array) that is known to aid decision making. Results Decisional clarity was better with the icon arrays. Furthermore, the results showed that decisional clarity can be used to identify situations for which patients will be more likely to struggle making their decision. These included situations for which financial considerations were relevant to the decision and situations for which the probabilities of potential benefits were higher. Limitations The measure of decisional clarity and the situations identified as lacking clarity should be validated with a larger, more representative sample. Conclusions These findings demonstrate that decisional clarity can be used to both empirically evaluate the effectiveness of a decision aid as well as test factors that can cloud clarity and disrupt medical decision making. Implications Researchers and medical providers interested in developing decision aids for situations with equipoise can use decisional clarity as an objective measure to assess the effectiveness of their decision aid. Financial considerations and higher probabilities may also cloud judgments. Highlights An objective measure of decisional clarity is supported. Decisional clarity can be used to evaluate decision aids in the context of equipoise for which there is no objectively correct choice. Decisional clarity can also be used to identify scenarios for which patients are likely to struggle to make a medical decision.

Suggested Citation

  • Jessica K. Witt, 2022. "An Objective Measure of Decisional Clarity to Assess Decision Aid Effectiveness in Situations with Equipoise: A Randomized Trial," Medical Decision Making, , vol. 42(6), pages 822-831, August.
    • Handle: RePEc:sae:medema:v:42:y:2022:i:6:p:822-831
    DOI: 10.1177/0272989X221085489
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    References listed on IDEAS

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    1. Jessica K. Witt, 2020. "The Precision-Bias Distinction for Evaluating Visual Decision Aids for Risk Perception," Medical Decision Making, , vol. 40(6), pages 846-853, August.
    2. Rocio Garcia-Retamero & Mirta Galesic & Gerd Gigerenzer, 2010. "Do Icon Arrays Help Reduce Denominator Neglect?," Medical Decision Making, , vol. 30(6), pages 672-684, November.
    3. Cokely, Edward T. & Galesic, Mirta & Schulz, Eric & Ghazal, Saima & Garcia-Retamero, Rocio, 2012. "Measuring Risk Literacy: The Berlin Numeracy Test," Judgment and Decision Making, Cambridge University Press, vol. 7(1), pages 25-47, January.
    4. Edward T. Cokely & Mirta Galesic & Eric Schulz & Saima Ghazal & Rocio Garcia-Retamero, 2012. "Measuring risk literacy: The Berlin Numeracy Test," Judgment and Decision Making, Society for Judgment and Decision Making, vol. 7(1), pages 25-47, January.
    5. Brian J. Zikmund-Fisher & Holly O. Witteman & Mark Dickson & Andrea Fuhrel-Forbis & Valerie C. Kahn & Nicole L. Exe & Melissa Valerio & Lisa G. Holtzman & Laura D. Scherer & Angela Fagerlin, 2014. "Blocks, Ovals, or People? Icon Type Affects Risk Perceptions and Recall of Pictographs," Medical Decision Making, , vol. 34(4), pages 443-453, May.
    6. Shane Frederick, 2005. "Cognitive Reflection and Decision Making," Journal of Economic Perspectives, American Economic Association, vol. 19(4), pages 25-42, Fall.
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