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理解和偏好与妊娠期间风险沟通相关的问题:一项旨在促进提供者与患者之间沟通的调查。

Understanding and preferences regarding risk communication during pregnancy: a survey to facilitate provider communication with patients.

机构信息

Faculty of Science, McMaster University, Hamilton, Canada (Ms Ferguson).

Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada (Dr Shapiro).

出版信息

Am J Obstet Gynecol MFM. 2023 Jun;5(6):100929. doi: 10.1016/j.ajogmf.2023.100929. Epub 2023 Mar 15.


DOI:10.1016/j.ajogmf.2023.100929
PMID:36931434
Abstract

BACKGROUND: Clear communication of medical risk helps to ensure proper patient understanding of healthcare options and supports informed decision-making. Communication involving visual and written risk typically conveys risk more effectively than conversations alone between a patient and a clinician. However, perception of risk is context-dependent, and the efficacy of and preferences for commonly-used risk communication formats are not well-understood during pregnancy, which is a time of complex decision-making. We sought to address this knowledge gap. OBJECTIVE: This study aimed to assess pregnant and recently pregnant people's understanding and preferences for different risk communication formats. STUDY DESIGN: We conducted an open online REDCap survey of pregnant and recently pregnant people over a 1-month period in 2022. Study participants were aged 16 to 49 years, pregnant or recently pregnant, and able to provide informed consent in English. Data collected included demographics, measurements of accuracy of understanding including both gist accuracy (general understanding) and verbatim accuracy (numeric quantification), and preferences for risk communication formats including icon arrays, pie charts, bar graphs, and text. Descriptive analyses of the proportion of correctly answered questions were calculated. RESULTS: A total of 247 participants completed ≥1 item on accuracy and risk communication preferences, and 230 provided complete responses. Gist (general) understanding was accurate between 74% and 89% of the time for most graphical formats. Verbatim understanding (exact numeric quantification) was approximately 90% accurate for most formats. Respondents preferred that figures be used over circles to display risk in icon arrays, both for themselves and for infants, although figures generated more worry. However, participants substantially preferred pie charts over bar graphs (59%-70% vs 19%-25%). Respondents preferred risk to be expressed with a lower denominator of 200 rather than a higher denominator of 1000 (79% vs 13%, although the lower denominator generated more worry), and in terms of chance of survival rather than chance of death (50% vs 33%). CONCLUSION: In a survey of pregnant and recently pregnant people, most respondents preferred pie charts over other graph formats, and lower rather than higher denominators in text. Presentations of survival rather than death estimates were also preferred. Approximately 75% to 90% of respondents accurately understood risk presented with visual and written communication. For the remaining participants, for whom accurate understanding was challenging, new strategies need to be developed.

摘要

背景:清晰地传达医疗风险有助于确保患者正确理解医疗保健选项,并支持知情决策。包含视觉和书面风险的沟通通常比患者和临床医生之间的单独对话更有效地传达风险。然而,风险感知是上下文相关的,并且在妊娠期间,人们对常用风险沟通格式的效果和偏好了解甚少,妊娠期间是一个需要做出复杂决策的时期。我们旨在解决这一知识空白。

目的:本研究旨在评估孕妇和近期孕妇对不同风险沟通格式的理解和偏好。

研究设计:我们在 2022 年进行了一项为期 1 个月的针对孕妇和近期孕妇的开放式在线 REDCap 调查。研究参与者年龄在 16 至 49 岁之间,处于妊娠或近期妊娠状态,并且能够以英文提供知情同意。收集的数据包括人口统计学数据、理解准确性的测量,包括主旨准确性(一般理解)和逐字准确性(数字量化),以及对风险沟通格式的偏好,包括图标数组、饼图、柱状图和文本。计算了正确回答问题的比例的描述性分析。

结果:共有 247 名参与者完成了≥1 项关于准确性和风险沟通偏好的项目,其中 230 名提供了完整的回复。对于大多数图形格式,主旨(一般)理解的准确性在 74%至 89%之间。对于大多数格式,逐字理解(准确的数字量化)的准确性约为 90%。受访者希望使用数字而不是圆圈来显示图标数组中的风险,无论是对自己还是对婴儿,尽管数字会引起更多的担忧。然而,参与者更喜欢饼图而不是柱状图(59%-70%对 19%-25%)。受访者希望以较低的分母 200 而不是较高的分母 1000 来表示风险(79%对 13%,尽管较低的分母会引起更多的担忧),并且以生存机会而不是死亡机会来表示风险(50%对 33%)。

结论:在对孕妇和近期孕妇的调查中,大多数受访者更喜欢饼图而不是其他图形格式,并且更喜欢较低的分母而不是较高的分母。还更喜欢呈现生存而不是死亡的估计。大约 75%至 90%的受访者准确理解了带有视觉和书面沟通的风险。对于其余理解有困难的参与者,需要开发新的策略。

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