The Effect of Format on Parents' Understanding of the Risks and Benefits of Clinical Research: A Comparison Between Text, Tables, and Graphics

There is a paucity of information regarding the optimal method of presenting risk/benefit information to parents of pediatric research subjects. This study, therefore, was designed to examine the effect of different message formats on parents' understanding of research risks and benefits. An Internet-administered survey was completed by 4,685 parents who were randomized to receive risk/benefit information about a study of pediatric postoperative pain control presented in different message formats (text, tables, and pictographs). Survey questions assessed participants' gist and verbatim understanding of the information and their perceptions of the risks and benefits. Pictographs were associated with significantly (p < .05) greater likelihood of adequate gist and verbatim understanding compared with text and tables regardless of the participants' numeracy. Parents who received the information in pictograph format perceived the risks to be lower and the benefits to be higher compared with the other formats (p < .001). Furthermore, compared with text and tables, pictographs were perceived as more “effective,” “helpful,” and “trustworthy” in presenting risk/benefit information. These results underscore the difficulties associated with presenting risk/benefit information for clinical research but suggest a simple method for enhancing parents' informed understanding of the relevant statistics.

[1]  David K. Simkin,et al.  An Information-Processing Analysis of Graph Perception , 1987 .

[2]  A. O'Connor,et al.  Effects of framing and level of probability on patients' preferences for cancer chemotherapy. , 1989, Journal of clinical epidemiology.

[3]  E. Susman,et al.  Participation in biomedical research: the consent process as viewed by children, adolescents, young adults, and physicians. , 1992, Jornal de Pediatria.

[4]  R M Arnold,et al.  Absolutely relative: how research results are summarized can affect treatment decisions. , 1992, The American journal of medicine.

[5]  Improvement,et al.  Adult literacy in America : a first look at the results of the National Adult Literacy Survey , 1993 .

[6]  J. Merz,et al.  How the Manner of Presentation of Data Influences Older Patients in Determining Their Treatment Preferences , 1993, Journal of the American Geriatrics Society.

[7]  Eric R. Stone,et al.  Effects of numerical and graphical displays on professed risk-taking behavior. , 1997 .

[8]  Lisa M. Schwartz,et al.  The Role of Numeracy in Understanding the Benefit of Screening Mammography , 1997, Annals of Internal Medicine.

[9]  Ian Spence,et al.  Judging Proportion with Graphs: The Summation Model , 1998 .

[10]  J. Ward,et al.  How risks of breast cancer and benefits of screening are communicated to women: analysis of 58 pamphlets , 1998, BMJ.

[11]  J. G. Hollands,et al.  The visual communication of risk. , 1999, Journal of the National Cancer Institute. Monographs.

[12]  Lisa M. Schwartz,et al.  How can we help people make sense of medical data? , 1999, Effective clinical practice : ECP.

[13]  P. Slovic,et al.  Violence Risk Assessment and Risk Communication: The Effects of Using Actual Cases, Providing Instruction, and Employing Probability Versus Frequency Formats , 2000, Law and human behavior.

[14]  C. McHorney,et al.  Frequency or Probability? A Qualitative Study of Risk Communication Formats Used in Health Care , 2001, Medical decision making : an international journal of the Society for Medical Decision Making.

[15]  B. Rimer,et al.  General Performance on a Numeracy Scale among Highly Educated Samples , 2001, Medical decision making : an international journal of the Society for Medical Decision Making.

[16]  Michael Theil,et al.  The role of translations of verbal into numerical probability expressions in risk management: a meta-analysis , 2002 .

[17]  G. Elwyn,et al.  One hundred years ago: Should milk be boiled? , 2002, BMJ : British Medical Journal.

[18]  Peter Tugwell,et al.  A randomized trial of a computerized versus an audio-booklet decision aid for women considering post-menopausal hormone replacement therapy. , 2002, Patient education and counseling.

[19]  Terri Voepel-Lewis,et al.  Priorities for disclosure of the elements of informed consent for research: a comparison between parents and investigators , 2002, Paediatric anaesthesia.

[20]  Terri Voepel-Lewis,et al.  Participation of Children in Clinical Research: Factors that Influence a Parent's Decision to Consent , 2003, Anesthesiology.

[21]  Terri Voepel-Lewis,et al.  Do They Understand? (Part I): Parental Consent for Children Participating in Clinical Anesthesia and Surgery Research , 2003, Anesthesiology.

[22]  J. Paling.  Strategies to help patients understand risks , 2003, BMJ : British Medical Journal.

[23]  J. Burkell,et al.  What are the chances? Evaluating risk and benefit information in consumer health materials. , 2004, Journal of the Medical Library Association : JMLA.

[24]  A. Stiggelbout,et al.  Different formats for communicating surgical risks to patients and the effect on choice of treatment. , 2004, Patient education and counseling.

[25]  D Feldman-Stewart,et al.  Communicating quality of life information to cancer patients: a study of six presentation formats. , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[26]  Erika A. Waters,et al.  Formats for Improving Risk Communication in Medical Tradeoff Decisions , 2006, Journal of health communication.

[27]  M. Schapira,et al.  The Influence of Graphic Format on Breast Cancer Risk Communication , 2006, Journal of health communication.

[28]  P. Ubel,et al.  Measuring Numeracy without a Math Test: Development of the Subjective Numeracy Scale , 2007, Medical decision making : an international journal of the Society for Medical Decision Making.

[29]  P. Ubel,et al.  Validation of the Subjective Numeracy Scale: Effects of Low Numeracy on Comprehension of Risk Communications and Utility Elicitations , 2007, Medical decision making : an international journal of the Society for Medical Decision Making.

[30]  John A. Baron,et al.  The framing effect of relative and absolute risk , 1993, Journal of General Internal Medicine.

[31]  Melanie Price,et al.  Communicating risk information: the influence of graphical display format on quantitative information perception-Accuracy, comprehension and preferences. , 2007, Patient education and counseling.

[32]  C. K. Mertz,et al.  Less Is More in Presenting Quality Information to Consumers , 2007, Medical care research and review : MCRR.

[33]  M. Brundage,et al.  Further Insight into the Perception of Quantitative Information: Judgments of Gist in Treatment Decisions , 2007, Medical decision making : an international journal of the Society for Medical Decision Making.

[34]  P. Ubel,et al.  The impact of the format of graphical presentation on health-related knowledge and treatment choices. , 2008, Patient education and counseling.

[35]  Angela Fagerlin,et al.  Alternate Methods of Framing Information About Medication Side Effects: Incremental Risk Versus Total Risk of Occurrence , 2008, Journal of health communication.