Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Division of Molecular Pathology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands.
PLoS One. 2024 Sep 3;19(9):e0309668. doi: 10.1371/journal.pone.0309668. eCollection 2024.
If communicated adequately, numerical decision-relevant information can support informed and shared decision making. Visual formats are recommended, but which format supports patients depending on their health literacy (HL) levels for specific decisions is unclear.
The aim of this study is to investigate: 1) the effect of survival rates and side-effects presentation formats on comprehension and 'feeling informed'; 2) differential effects among women with higher/lower HL, with adjuvant systemic breast cancer therapy as case example.
Two online experiments among women from the Dutch population without a history of breast cancer were conducted. Experiment 1 had a 3 (survival rate format: text block-bar graph-icon array) x 2 (HL: low-high) between-subjects design. Experiment 2 had a 5 (side-effects format: no probability information-probability information in numbers with or without a visualisation-probability information in numbers with or without a visualisation accompanied by a description of the side-effects) x 2 (HL: low-high) design. Primary outcomes were comprehension and feeling informed (Experiment 2 only). Formats were previously designed in co-creation with patients.
In Experiment 1, presentation format did not affect gist or verbatim comprehension. Higher HL was associated with higher gist comprehension. Experiment 2 showed an interaction between presentation format and HL on 'feeling informed'. When provided with visualised probability information without a description of the side-effects, women with lower HL felt better informed than women with higher HL.
Visual formats did not enhance comprehension of survival rate information beyond a well-designed text block format. However, none of the formats could overcome HL differences. When designing decision-relevant information, visualisations might not necessarily provide an advantage over structured numerical information for both patients with lower and higher HL. However, a deeper understanding of presenting side-effect information is warranted.
如果沟通得当，数值决策相关信息可以支持知情决策和共同决策。推荐使用可视化格式，但哪种格式适合具有不同健康素养（HL）水平的患者做出特定决策尚不清楚。
本研究旨在调查：1）生存率和副作用呈现格式对理解和“感觉知情”的影响；2）以辅助全身乳腺癌治疗为例，在不同 HL 水平的女性中的差异影响。
在没有乳腺癌病史的荷兰人群中进行了两项在线女性实验。实验 1 采用 3（生存率格式：文本块-条形图-图标数组）x 2（HL：低-高）组间设计。实验 2 采用 5（副作用格式：无概率信息-带有或不带有可视化的数字概率信息-带有或不带有可视化的数字概率信息伴有副作用描述）x 2（HL：低-高）设计。主要结局是理解和感觉知情（实验 2 仅）。格式是与患者共同创作设计的。
在实验 1 中，呈现格式并未影响主旨或逐字理解。较高的 HL 与较高的主旨理解相关。实验 2 显示了呈现格式和 HL 之间的交互作用对“感觉知情”的影响。当提供没有副作用描述的可视化概率信息时，HL 较低的女性比 HL 较高的女性感觉更知情。
与精心设计的文本块格式相比，可视化格式并未增强生存率信息的理解。然而，没有一种格式可以克服 HL 差异。在设计决策相关信息时，对于 HL 较低和较高的患者，可视化可能不一定比结构化数字信息具有优势。然而，需要更深入地了解呈现副作用信息。
