Identifying patient preferences for communicating risk estimates: a descriptive pilot study

Abstract

Background: Patients increasingly seek more active involvement in health care decisions, but little is known about how to communicate complex risk information to patients. The objective of this study was to elicit patient preferences for the presentation and framing of complex risk information.

Method: To accomplish this, eight focus group discussions and 15 one-on-one interviews were conducted, where women were presented with risk data in a variety of different graphical formats, metrics, and time horizons. Risk data were based on a hypothetical woman's risk for coronary heart disease, hip fracture, and breast cancer, with and without hormone replacement therapy. Participants' preferences were assessed using likert scales, ranking, and abstractions of focus group discussions.

Results: Forty peri- and postmenopausal women were recruited through hospital fliers (n = 25) and a community health fair (n = 15). Mean age was 51 years, 50% were non-Caucasian, and all had completed high school. Bar graphs were preferred by 83% of participants over line graphs, thermometer graphs, 100 representative faces, and survival curves. Lifetime risk estimates were preferred over 10 or 20-year horizons, and absolute risks were preferred over relative risks and number needed to treat.

Conclusion: Although there are many different formats for presenting and framing risk information, simple bar charts depicting absolute lifetime risk were rated and ranked highest overall for patient preferences for format.

Figure 1

Graphical Displays of Risk Estimates: Bar Graph and Line Graph

Figure 2

Graphical Displays of Risk Estimates: Thermometer Graph, 100 Faces, and Survival Curves

Figure 3

Risk Displays on Multiple Disease Outcomes Over Different Time Horizons, Set A: Each graph shows the risk for one disease over multiple time horizons with and without HRT (1. Coronary Heart Disease, 2. Hip Fracture, 3. Breast Cancer).

Figure 4

Risk Displays on Multiple Disease Outcomes Over Different Time Horizons, Set B: Each graph shows the risk for three diseases over one time horizon with and without HRT (4. Ten-year estimates, 5. Twenty-year estimates, 6. Lifetime estimates).

Figure 5

Ranking of Graphical Formats Containing Risk Information