Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany.
Media and Communication Science, University of Erfurt, Erfurt, Germany.
J Med Internet Res. 2020 Aug 10;22(8):e15899. doi: 10.2196/15899.
Uncertainty is integral to evidence-informed decision making and is of particular importance for preference-sensitive decisions. Communicating uncertainty to patients and the public has long been identified as a goal in the informed and shared decision-making movement. Despite this, there is little quantitative research on how uncertainty in health information is perceived by readers.
The aim of this study was to examine the impact of different uncertainty descriptions regarding the evidence for a treatment effect in a written research summary for the public.
We developed 8 versions of a research summary on a fictitious drug for tinnitus with varying degrees (Q1), sources (Q2), and magnitudes of uncertainty (Q3). We recruited 2099 members of the German public from a web-based research panel. Of these, 1727 fulfilled the inclusion criteria and were randomly presented with one of these research summaries. Randomization was conducted by using a centralized computer with a random number generator. Web-based recruitment and data collection were fully automated. Participants were not aware of the purpose of the study and alternative presentations. We measured the following outcomes: perception of the treatment effectiveness (primary), certainty in the judgement of treatment effectiveness, perception of the body of evidence, text quality, and intended decision. The outcomes were self-assessed.
For the primary outcome, we did not find a global effect for Q1 and Q2 (P=.25 and P=.73), but we found a global effect for Q3 (P=.048). Pairwise comparisons showed a weaker perception of treatment effectiveness for the research summary with 3 sources of uncertainty compared to the version with 2 sources of uncertainty (P=.04). Specifically, the proportion of the participants in the group with 3 sources of uncertainty that perceived the drug as possibly beneficial was 9% lower than that of the participants in the group with 2 sources of uncertainty (92/195, 47.2% vs 111/197, 56.3%, respectively). The proportion of the participants in the group with 3 sources of uncertainty that considered the drug to be of unclear benefit was 8% higher than that of the participants in the group with 2 sources of uncertainty (72/195, 36.9% vs 57/197, 28.9%, respectively). However, there was no significant difference compared to the version with 1 source of uncertainty (P=.31). We did not find any meaningful differences between the research summaries for the secondary outcomes.
Communicating even a large magnitude of uncertainty for a treatment effect had little impact on the perceived effectiveness. Efforts to improve public understanding of research are needed to improve the understanding of evidence-based health information.
German Clinical Trials Register DRKS00015911, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015911.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/13425.
不确定性是循证决策不可或缺的一部分，对于偏好敏感的决策尤为重要。向患者和公众传达不确定性一直是知情和共享决策运动的目标。尽管如此，对于读者如何感知健康信息中的不确定性，几乎没有进行定量研究。
本研究旨在考察在为公众编写的研究摘要中，不同程度（Q1）、来源（Q2）和不确定性大小（Q3）的治疗效果证据的不确定性描述对公众的影响。
我们针对一种虚构的耳鸣药物，开发了 8 个版本的研究摘要，其中不确定性程度（Q1）、来源（Q2）和大小（Q3）各不相同。我们从一个基于网络的研究小组中招募了 1727 名德国公众，其中 1727 名符合纳入标准，并随机展示了其中一个研究摘要。随机化是通过使用带有随机数生成器的中央计算机进行的。基于网络的招募和数据收集是完全自动化的。参与者不知道研究的目的和替代方案。我们测量了以下结果：治疗效果的感知（主要结果）、对治疗效果判断的确定性、对证据体的感知、文本质量和预期决策。结果是自我评估的。
对于主要结果，我们没有发现 Q1 和 Q2 的全局效应（P=.25 和 P=.73），但我们发现 Q3 的全局效应（P=.048）。两两比较显示，与有 2 个来源的不确定性的研究摘要相比，有 3 个来源的不确定性的研究摘要对治疗效果的感知较弱（P=.04）。具体来说，在有 3 个不确定性来源的组中，认为药物可能有益的参与者比例比有 2 个不确定性来源的组低 9%（92/195，47.2%与 111/197，56.3%，分别）。在有 3 个不确定性来源的组中，认为药物益处不明确的参与者比例比有 2 个不确定性来源的组高 8%（72/195，36.9%与 57/197，28.9%，分别）。然而，与有 1 个不确定性来源的组相比，差异无统计学意义（P=.31）。我们没有发现次要结果的研究摘要之间存在任何有意义的差异。
即使传达治疗效果的不确定性幅度较大，对感知效果的影响也很小。需要努力提高公众对研究的理解，以提高对循证健康信息的理解。
德国临床试验注册处 DRKS00015911，https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015911。
国际注册报告标识符（IRRID）：RR2-10.2196/13425。
