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呈现药物副作用信息的不同方式:发生的增量风险与总风险。

Alternate methods of framing information about medication side effects: incremental risk versus total risk of occurrence.

作者信息

Zikmund-Fisher Brian J, Fagerlin Angela, Roberts Todd R, Derry Holly A, Ubel Peter A

机构信息

VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan 48109-5429, USA.

出版信息

J Health Commun. 2008 Mar;13(2):107-24. doi: 10.1080/10810730701854011.

Abstract

Communications of treatment risk, such as medication package inserts, commonly report total rates of adverse reactions (e.g., 4% get heartburn with placebo, 9% with medication). This approach, however, requires mental arithmetic to distinguish the incremental risk caused by medication (here, 5%) from the total post-treatment risk. In two Internet-administered survey experiments (N = 2,012 and 1,393), we tested whether explicitly reporting the incremental risk and framing it as the "additional risk" of complications influenced people's impressions of adverse event risks. Study 1 compared side-by-side displays of total risks against sequential presentations that highlighted the incremental risk, using both text and graphical formats. Results showed that incremental risk formats significantly lowered participants' worry about complications and reduced biases caused by varying the risk denominator. Study 2 unpacked this factor and showed that its effect on both perceived likelihood and worry derives primarily from the incremental risk framing rather than from sequential presentation. Explicitly reporting incremental risk statistics appears to facilitate recognition of how much risk already exists at baseline. Presenting adverse reaction risks in this manner may improve patient comprehension of the effects of treatment decisions and support effective risk communication.

摘要

诸如药品包装说明书之类的治疗风险信息通常会报告不良反应的总发生率(例如,服用安慰剂时4%的人出现胃灼热,服用药物时为9%)。然而,这种方法需要心算才能将药物引起的增量风险(此处为5%)与治疗后的总风险区分开来。在两项通过互联网进行的调查实验中(N分别为2012人和1393人),我们测试了明确报告增量风险并将其表述为并发症的“额外风险”是否会影响人们对不良事件风险的认知。研究1使用文本和图形格式,将总风险的并列展示与突出增量风险的顺序展示进行了比较。结果表明,增量风险格式显著降低了参与者对并发症的担忧,并减少了因风险分母变化而导致的偏差。研究2剖析了这一因素,并表明其对感知可能性和担忧的影响主要源于增量风险框架,而非顺序展示。明确报告增量风险统计数据似乎有助于人们认识到基线时已经存在的风险程度。以这种方式呈现不良反应风险可能会提高患者对治疗决策效果的理解,并支持有效的风险沟通。

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