Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Oct;45(7):794-810.
doi: 10.1177/0272989X251346811. Epub 2025 Jul 7.

Evidence on Methods for Communicating Health-Related Probabilities: Comparing the Making Numbers Meaningful Systematic Review to the 2021 IPDAS Evidence Paper Recommendations

Brian J Zikmund-Fisher  1 , Natalie C Benda  2 , Jessica S Ancker  3
Affiliations

Evidence on Methods for Communicating Health-Related Probabilities: Comparing the Making Numbers Meaningful Systematic Review to the 2021 IPDAS Evidence Paper Recommendations

Brian J Zikmund-Fisher et al. Med Decis Making. 2025 Oct.

Abstract

PurposeTo summarize the degree to which evidence from our recent Making Numbers Meaningful (MNM) systematic review of the effects of data presentation format on communication of health numbers supports recommendations from the 2021 International Patient Decision Aids Standards (IPDAS) Collaboration papers on presenting probabilities.MethodsThe MNM review generated 1,119 distinct findings (derived from 316 papers) related to communication of probabilities to patients or other lay audiences, classifying each finding by its relation to audience task, type of stimulus (data and data presentation format), and up to 10 distinct sets of outcomes: identification and/or recall, contrast, categorization, computation, probability perceptions and/or feelings, effectiveness perceptions and/or feelings, behavioral intentions or behavior, trust, preference, and discrimination. Here, we summarize the findings related to each of the 35 IPDAS paper recommendations.ResultsStrong evidence exists to support several IPDAS recommendations, including those related to the use of part-to-whole graphical formats (e.g., icon arrays) and avoidance of verbal probability terms, 1-in-X formats, and relative risk formats to prevent amplification of probability perceptions, effectiveness perceptions, and/or behavioral intentions as well as the use of consistent denominators to improve computation outcomes. However, the evidence base appears weaker and less complete for other IPDAS recommendations (e.g., recommendations regarding numerical estimates in context and evaluative labels). The IPDAS papers and the MNM review agree that both communication of uncertainty and use of interactive formats need further research.ConclusionsThe idea that no one visual or numerical format is optimal for every probability communication situation is both an IPDAS panel recommendation and foundational to the MNM project's design. Although no MNM evidence contradicts IPDAS recommendations, the evidence base needed to support many common probability communication recommendations remains incomplete.HighlightsThe Making Numbers Meaningful (MNM) systematic review of the literature on communicating health numbers provides mixed support for the recommendations of the 2021 International Patient Decision Aids Standards (IPDAS) evidence papers on presenting probabilities in patient decision aids.Both the IPDAS papers and the MNM project agree that no single visual or numerical format is optimal for every probability communication situation.The MNM review provides strong evidentiary support for IPDAS recommendations in favor of using part-to-whole graphical formats (e.g., icon arrays) and consistent denominators.The MNM review also supports the IPDAS cautions against verbal probability terms and 1-in-X formats as well as its concerns about the potential biasing effects of relative risk formats and framing.MNM evidence is weaker related to IPDAS recommendations about placing numerical estimates in context and use of evaluative labels.

Keywords: Risk; data visualization; health communication; patient education as topic.

PubMed Disclaimer

Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Funding for this article was provided by a grant from the National Library of Medicine (R01 LM012964). The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report.

References

    1. Stacey D, Lewis KB, Smith M, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2024;1(1):CD001431. DOI: 10.1002/14651858.CD001431.pub6 - DOI - PMC - PubMed
    1. O’Connor A, Llewellyn-Thomas H, Stacey D. IPDAS Collaboration Background Document. International Patient Decision Aids Standards Collaboration; 2005. Available from: http://ipdasohrica/IPDAS_Backgroundpdf.
    1. Trevena L, Zikmund-Fisher BJ, Edwards A, et al. Presenting probabilities (Chapter C). In: Volk R, Llewellyn-Thomas HA, eds. 2012 Update of the International Patient Decision Aids Standards (IPDAS) Collaboration Background Document. IPDAS; 2012. http://ipdas.ohri.ca/resources.html.
    1. Trevena LJ, Zikmund-Fisher BJ, Edwards A, et al. Presenting quantitative information about decision outcomes: a risk communication primer for patient decision aid developers. BMC Med Inform Decis Mak. 2013;13(suppl 2):S7. DOI: 10.1186/1472-6947-13-s2-s7 - DOI - PMC - PubMed
    1. Bonner C, Trevena LJ, Gaissmaier W, et al. Current best practice for presenting probabilities in patient decision aids: fundamental principles. Med Decis Making. 2021;41(7):821–33. DOI: 10.1177/0272989x21996328 - DOI - PubMed

LinkOut - more resources