Current Challenges When Using Numbers in Patient Decision Aids: Advanced Concepts
Current Challenges When Using Numbers in Patient Decision Aids: Advanced Concepts
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DOI：
10.1177/0272989x21996342
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发表时间：
2021-03-04
影响因子：
3.6
通讯作者：
Zikmund-Fisher, Brian J.
中科院分区：
文献类型：
--
作者：
Trevena, Lyndal J.;Bonner, Carissa;Zikmund-Fisher, Brian J.
决策辅助开发人员必须以最小化偏见和促进对特定决策中可用选项的理解的方式传达复杂的任务特定数字信息。虽然我们的同伴论文总结了基本问题，但本文侧重于在患者决策辅助中呈现数字信息的更复杂，特定于任务的方面。方法作为国际患者决策辅助标准第三次证据更新的一部分，我们召集了一个由9名国际专家组成的专家小组，他们根据自己的专业知识和对文献的有针对性的搜索，以2至3人为一组，修订和扩展了2013年审查中涵盖的主题，以更新证据。然后，整个小组审查并提供了额外的修订，就最终版本达成了共识。结果10个主题中有5个涉及更复杂的特定任务问题。我们发现了使用独立事件率和/或增量绝对风险差异作为测试和筛选结果效应大小的有力证据。简单的视觉格式可以帮助减少常见的判断偏差，提高理解能力，但如果设计不当，可能会产生误导。图形素养可以调节视觉格式的有效性，因此应该在工具设计中考虑。支持纳入个性化和交互式风险评估的证据较少。更复杂的数字信息。例如决策选择的利弊大小，可以通过使用增量绝对风险差异以及考虑目标用户图形素养的精心设计的视觉格式来更好地理解。由于个性化和/或互动式风险评估的复杂性和可及性可能影响其在临床实践中的可行性，因此何时以及如何使用个性化和/或互动式风险评估需要更多的研究。
BackgroundDecision aid developers have to convey complex task-specific numeric information in a way that minimizes bias and promotes understanding of the options available within a particular decision. Whereas our companion paper summarizes fundamental issues, this article focuses on more complex, task-specific aspects of presenting numeric information in patient decision aids.MethodsAs part of the International Patient Decision Aids Standards third evidence update, we gathered an expert panel of 9 international experts who revised and expanded the topics covered in the 2013 review working in groups of 2 to 3 to update the evidence, based on their expertise and targeted searches of the literature. The full panel then reviewed and provided additional revisions, reaching consensus on the final version.ResultsFive of the 10 topics addressed more complex task-specific issues. We found strong evidence for using independent event rates and/or incremental absolute risk differences for the effect size of test and screening outcomes. Simple visual formats can help to reduce common judgment biases and enhance comprehension but can be misleading if not well designed. Graph literacy can moderate the effectiveness of visual formats and hence should be considered in tool design. There is less evidence supporting the inclusion of personalized and interactive risk estimates.DiscussionMore complex numeric information. such as the size of the benefits and harms for decision options, can be better understood by using incremental absolute risk differences alongside well-designed visual formats that consider the graph literacy of the intended audience. More research is needed into when and how to use personalized and/or interactive risk estimates because their complexity and accessibility may affect their feasibility in clinical practice.