VA Health Services Research & Development Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
Med Decis Making. 2010 Nov-Dec;30(6):661-71. doi: 10.1177/0272989X10364244. Epub 2010 Apr 7.
Online tools such as Adjuvant! provide tailored estimates of the possible outcomes of adjuvant therapy options available to breast cancer patients. The graphical format typically displays 4 outcomes simultaneously: survival, mortality due to cancer, other-cause mortality, and incremental survival due to adjuvant treatment.
To test whether simpler formats that present only baseline and incremental survival would improve comprehension of the relevant risk statistics and/or affect treatment intentions.
. Randomized experimental manipulation of risk graphics shown included in Internet-administered survey vignettes about adjuvant therapy decisions for breast cancer patients with ER + tumors.
Demographically diverse, stratified random samples of women ages 40 to 74 y recruited from an Internet research panel.
Participants were randomized to view either pictographs (icon arrays) that displayed all 4 possible outcomes or pictographs that showed only survival outcomes.
Comprehension of key statistics, task completion times, graph evaluation ratings, and perceived interest in adjuvant chemotherapy.
In the primary study (N = 832), participants who viewed survival-only pictographs had better accuracy when reporting the total chance of survival with both chemotherapy and hormonal therapy (63% v. 50%, P < 0.001), higher graph evaluation ratings (x = 7.98 v. 7.67, P = 0.04), and less interest in adding chemotherapy to hormonal therapy (43% v. 50%, P = 0.04; adjusted odds ratio [OR] = 0.68, P = 0.008). A replication study (N = 714) confirmed that participants who viewed survival-only graphs had higher graph evaluation ratings (x = 8.06 v. 7.72, P = 0.04) and reduced interest in chemotherapy (OR=0.67,P=0.03).
Studies used general public samples; actual patients may process risk information differently.
Taking a ''less is more'' approach by omitting redundant mortality outcome statistics can be an effective method of risk communication and may be preferable when using visual formats such as pictographs.
在线工具，如 Adjuvant！，为乳腺癌患者提供了各种辅助治疗方案可能结果的定制化评估。图形格式通常同时显示 4 种结果：生存、癌症相关死亡率、其他原因死亡率和辅助治疗带来的增量生存。
测试更简单的格式，仅呈现基线和增量生存，是否会提高对相关风险统计数据的理解，或者是否会影响治疗意向。
在关于乳腺癌患者 ER+肿瘤辅助治疗决策的互联网调查小案例中，对在线呈现的风险图形进行随机实验操作。
从互联网研究小组中招募了年龄在 40 岁至 74 岁之间的、具有不同人口统计学特征的分层随机女性样本。
参与者被随机分配观看显示所有 4 种可能结果的图表（图标数组）或仅显示生存结果的图表。
关键统计数据的理解、任务完成时间、图表评估评分和对辅助化疗的兴趣。
在主要研究（N=832）中，观看仅生存图表的参与者在报告化疗和激素治疗的总生存机会时更准确（63%比 50%，P<0.001），对图表的评估评分更高（x=7.98 比 7.67，P=0.04），对将化疗添加到激素治疗中的兴趣降低（43%比 50%，P=0.04；调整后的优势比[OR]为 0.68，P=0.008）。一项复制研究（N=714）证实，观看仅生存图表的参与者对图表的评估评分更高（x=8.06 比 7.72，P=0.04），对化疗的兴趣降低（OR=0.67，P=0.03）。
研究使用了普通公众样本；实际患者可能会以不同的方式处理风险信息。
通过省略冗余的死亡率统计数据，采用“少即是多”的方法是一种有效的风险沟通方法，在使用图表等视觉格式时可能更可取。
