Background. The communication of probabilistic outcomes is an essential aspect of shared medical decision making.Methods. The authors conducted a qualitative study using focus groups to evaluate the response of women to various formats used in the communication of breast cancer risk.Findings. Graphic discrete frequency formats using highlighted human figures had greater salience than continuous probability formats using bar graphs. Potential biases in the estimation of risk magnitude were associated with the use of highlighted human figures versus bar graphs and the denominator size in graphics using highlighted human figures. The presentation of uncertainty associated with risk estimates caused some to loose trust in the information, whereas others were accepting of uncertainty in scientific data.Conclusion. The qualitative study identified new constructs with regard to how patients process probabilistic information. Further research in the clinical setting is needed to provide a theoretical justification for the format used when presenting risk information to patients.
Barrett-Connor E.Hormone replacement therapy. Br Med J. 1998;15:457.
2.
O’Connor AM, Tugwell P, Wells GA, et al.A decision aid for women considering hormone therapy after menopause: decision support framework and evaluation. Patient Educ Counseling. 1998;33:267-279.
3.
American College of Physicians Position Statement. Screening for prostate cancer. Ann Intern Med. 1997;126:394-406.
4.
Mazur DJ, Hickam DH. Paitent’s preferences for risk disclosure and role in decision making for invasive medical procedures. J Gen Intern Med. 1997;12:114-117.
5.
Wragg JA, Robinson EJ, Lilford RJ. Information presentation and decisions to enter clinical trials: a hypothetical trial of hormone replacement therapy. Soc Sci Med. 2000;51:453-462.
6.
O’Connor AM, Fiset V, DeGrasse C, et al.Decision aids for patients considering options affecting cancer outcomes: evidence of efficacy and policy implications. Monogr Natl Cancer Inst. 1999;25:67-80.
7.
Kahneman D, Slovic P, Tversky A, editors. Judgment under uncertainty: heuristics and biases. Cambridge, UK: Cambridge University Press; 1982.
8.
Fischhoff B, Bostrom A, Quadrel MJ. Risk perception and communication. Annu Rev Public Health. 1993;14:183-203.
9.
Weinstein ND. What does it mean to understand risk? Evaluating risk comprehension. JNCI Monogr. 1999;25:15-20.
10.
McNeil BJ, Pauker SG, Sox HC, Tversky A.On the elicitation of preferences for alternative therapies. N Engl J Med. 1982;306:1259-1262.
11.
Wilson DK, Kaplan RM, Schneiderman LJ. Framing of decisions and selections of alternatives in health care. Soc Behav. 1987;2:51-59.
12.
Gurm HS, Litaker DG. Framing procedural risks to patients: is 99% safe the same risk of 1 in 100?Acad Med. 2000;75:840-842.
13.
Kahneman D, Tversky A.Choices, values, and frames. Am Psychol. 1984;39:341-350.
14.
Banks SM, Salovey P, Greener S, et al.The effects of message framing on mammography utilization. Health Psychol. 1995;14:178-184.
15.
Forrow L, Taylor WC, Arnold RM. Absolutely relative: how research results are summarized can affect treatment decisions. Am J Med. 1992;92:121-124.
16.
Malenka DJ, Baron JA, Johansen S, Wahrenberger JW, Ross JM. The framing effect of relative and absolute risk. J Gen Intern Med. 1993;8:543-548.
17.
Hux JE, Naylor CD. Communicating the benefits of chronic preventive therapy: does the format of efficacy data determine patients’ acceptance of treatment?Med Decis Making. 1995;15:152-157.
18.
Nikolajevic-Sarunac J, Henry DA, O’Connell DL, Robertson J.Effect of information framing on the intentions of family physicians to prescribe long-term hormone replacement therapy. J Gen Intern Med. 1999;14:591-598.
19.
Pinker S.A theory of graph comprehension. Occasional paper no. 15; Center for Cognitive Sciences, Massachusetts Institute of Technology; 1982.
20.
Tufte ER. The visual display of quantitative information. Cheshire, CT: Graphics Press; 1983.
21.
Cleveland WS, McGill R.Graphical perceptions: theory, experimentation, and application to the development of graphic methods. J Am Stat Assoc. 1984;70:531-554.
22.
Kosslyn SM. Understanding charts and graphs. Appl Cogn Psychol. 1989;3:185-226.
23.
Lipkus IM, Hollands JG. The visual communication of risk. J Natl Cancer Inst Monogr. 1999;25:149-163.
24.
Kaplan RM, Hammel B, Schimmel LE. Patient information processing and the decision to accept treatment. J Soc Behav Pers. 1985;1:113-120.
25.
Mazur DJ, Hickam DH. Patients’ and physicians’ interpretations of graphic data displays. Med Decis Making. 1993;13:59-63.
26.
Weinstein ND, Sandman PM, Hallman WK. Testing a visual display to explain small probabilities. Risk Analysis. 1994;14:895-896.
27.
Baty BJ, Venne VL, McDonald J, et al.BRCA1 testing: genetic counseling protocol development and counseling issues. J Genet Counseling. 1997;6:223-244.
28.
Stone EF, Yates JF, Parker AM. Effects of numerical and graphical displays on professed risk-taking behavior. J Exp Psychol Appl. 1997;3:243-256.
29.
Feldman-Stewart D, Kocovski N, McConnell BA, Brundage MD, Mackillop WJ. Perception of quantitative information for treatment decisions. Med Decis Making. 2000;20:228-238.
30.
Pope C, Mays N.Reaching the parts other methods cannot reach: an introduction to qualitative methods in health and health services research. Br Med J. 1995;311:42-45.
31.
Huston P, Rowan M.Qualitative studies: their role in medical research. Can Fam Physician. 1998;44:2453-2458.
32.
Sofaer S.Qualitative methods: what are they and why use them?Health Serv Res. 1999;34:1101-1118.
33.
Morgan DL. Focus groups as qualitative research. 2nd ed.Thousand Oaks, CA: Sage Publications; 1997. (Qualitative research methods; vol 16).
34.
Sim J.Collecting and analyzing qualitative data: issues raised by the focus group. J Adv Nurs. 1998;28:345-352.
35.
Krueger RA, Casey MA. Focus groups: a practical guide for applied research. Thousand Oaks, CA: Sage Publications; 2000.
36.
Mays N, Pope C.Rigour and qualitative research. Br Med J. 1995;311:109-111.
37.
Rowan M, Huston P.Qualitative research articles: information for authors and peer reviewers. Can Med Assoc J. 1997;157:1442-1446.
38.
Edwards A, Matthews E, Pill R, Bloor M.Communication about risk: the responses of primary care professionals to standardizing the “language of risk” and communication tools. Fam Pract. 1998;15:301-307.
39.
Elwyn G, Edwards A, Gwyn R, Grol R.Towards a feasible model for shared decision making: focus group study with general practice registrars. Br Med J. 1999;319:753-756.
40.
Gail MH, Brinton LA, Byar DP, et al.Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. J Natl Cancer Inst. 1989;81:1879-1886.
41.
Tesch R.Qualitative research: analysis types and software tools. New York, NY: Falmer Press; 1992.
42.
Weinstein ND. Optimistic biases about personal risks. Science. 1989;246:1232-1233.
43.
Reyna VF, Brainerd CJ. The origins of probability judgment: a review of data and theories. In: Wright G, Ayton P, editors. Subjective probability. West Sussex, UK: John Wiley & Sons; 1994. p. 239-272.
44.
Gigerenzer G, Hoffrage U.How to improve Bayesian reasoning without instruction: frequency formats. Psychol Rev. 1995;102:684-704.
45.
Gigerenzer G.The psychology of good judgment: frequency formats and simple algorithms. Med Decis Making. 1996;3:273-280.
46.
Hoffrage U, Gigerenzer G.Using natural frequencies to improve diagnostic inferences. Acad Med. 1998;73:538-540.
47.
Grimes DA, Snively GR. Patients’ understanding of medical risks: implications for genetic counseling. Obstet Gynecol. 1999;93:910-914.
48.
Woloshin S, Schwartz LM, Byram S, Fischhoff B, Welch HG. A new scale for assessing perceptions of chance: a validation study. Med Decis Making. 2000;20:298-307.
49.
Yamagishi K.Effects of response range in frequency judgments of common versus uncommon events. Percept Motor Skills. 1996;82:1371-1376.
50.
Yamagishi K.When a 12.86% mortality is more dangerous than 24.14%: implications for risk communication. Appl Cogn Psychol. 1997;11:495-506.
51.
Viscusi WK. Smoking risk perceptions in smoking: making the risky decision. New York, NY: Oxford University Press; 1992.
52.
Sedlmeier P, Gigerenzer G.Intuitions about sample size: the empirical law of large numbers. J Behav Decis Making. 1997;10:33-51.
Johnson BB, Slovic P.Presenting uncertainty in health risk assessment: initial studies of its effects on risk perception and trust. Risk Analysis. 1995;15:485-494.
55.
Fern EF. The use of focus groups for idea generation: the effects of group size, acquaintanceship, and moderator on response quantity and quality. J Marketing Res. 1982;19:1-13.
56.
Wright D.Boys’ thoughts and talk about sex in a working class locality of Glasgow. Sociol Rev. 1994;42:702-737.
57.
Exley C, Sim J, Reid NG, Jackson S, West N.Attitudes and beliefs within the Sikh community regarding organ donation: a pilot study. Soc Sci Med. 1996;43:23-28.
58.
Johnson BB. Ethical issues in risk communication: continuing the discussion. Risk Analysis. 1999;19:335-348.
59.
Grady D, Rubin SM, Petitti DB, et al.Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Intern Med. 1992;117:1016-1037.
