A comparative evaluation of risk communication formats in cancer prevention

描述（由申请人提供）：自采用知情同意原则以来，关于医疗干预对患者的可能风险和获益的有效沟通一直是医疗护理的组成部分。近年来，它已变得越来越重要，由于在医生与病人的关系，促进病人更积极地参与有关他们的护理决策，循证医学实践的兴起，并越来越重视预防措施，旨在减少未来的健康风险的公认模式的变化。关于医疗干预措施可能产生的结果的有效沟通也是改进将生物医学研究成果转化为实践的方法的一个重要组成部分。尽管它的重要性，有很大的差距，在我们的知识如何有效地传达有关不确定的未来事件的信息，病人和医生。本研究的具体目的是：1）提供目前推荐的数字和图形格式之间的初步估计差异，以向患者传达有关可能结局的信息，这些可能结局在临床重要可能性和后果的代表性范围内变化; 2）提供风险沟通格式的有效性与患者特征之间相互作用的初步估计，包括：计算能力、识字能力、教育水平、社会经济地位、年龄和种族/民族背景;以及3）制定分析框架，并收集有关关键参数的数据，用于计划和开展将彻底解决这些问题的后续R 01水平研究。患者人群将包括360例年龄至少为18岁的患者的人口统计学分层样本，这些患者是罗切斯特纽约三家门诊诊所的患者。将使用具有两个五水平受试者内因素的不完全析因设计。其中一个因素是目前推荐的五种风险沟通格式：垂直条形图、分组图标显示、风险量表、频率图和数字频率信息。另一个因素是疾病筛查项目的五个结果：疾病风险、死于疾病的风险、严重筛查副作用的风险、死于筛查副作用的风险和假阳性筛查结果的风险。每名受试者将被随机分配到25种可能组合中的5种组合中对风险信息做出响应，以便以某种组合的形式向他们展示每种风险结局和每种风险格式。为了便于设计未来的全面R 01级研究，本研究的数据将用于获得风险格式和受试者变量的初步估计，这些变量是关于以下结局的五种风险呈现格式之间的差异：a）理解，B）决策有用性，c）危险响应一致性，d）一致性，e）患者评价，以及f）沟通错误方向。我们还将确定这些结果与风险的性质或个体患者特征（包括人口统计学、教育、识字和算术）之间是否存在关联。公共卫生相关性：关于医疗干预措施可能的风险和益处的有效沟通对于确保提供始终如一的高质量医疗保健至关重要。尽管它的重要性，有很大的差距，在我们的知识如何有效地传达信息的不确定的未来结果的医疗保健决策的患者和医生。本项目将通过以下方式开始解决这些差距：a）比较目前推荐的五种风险沟通格式在一系列临床重要概率和结局中向患者传达风险信息的效果，以及B）确定患者特征（如人口统计学、算术和识字能力）是否影响健康风险沟通的有效性。

DESCRIPTION (provided by applicant): Effective communication about possible risks and benefits of medical interventions to patients has been an integral part of medical care since the doctrine of informed consent was adopted. In recent years, it has become increasingly more important due to changes in the accepted model of the doctor-patient relationship that promote more active involvement of patients in decisions about their care, the rise of evidence-based medical practice, and the increasing emphasis placed on preventive measures that are intended to reduce future health risks. Effective communication about the possible outcomes of medical interventions is also an essential component of methods for improving the translation of biomedical research findings into practice. Despite its importance, there are large gaps in our knowledge of how to effectively convey information about uncertain future events to patients and practitioners. The specific aims of this study are: 1) To provide initial estimates differences among currently recommended numeric and graphic formats in their ability to convey information to patients about possible outcomes that vary across a representative range of clinically important likelihoods and consequences; 2) To provide initial estimates of interactions between the effectiveness of the risk communication formats and patient characteristics including: numeracy, literacy, educational level, socio- economic status, age, and racial/ethnic background; and 3) To develop an analytic framework and to gather data about key parameters for use in planning and conducting a follow-up R01-level study that will thoroughly address these issues. The patient population will consist of demographically-stratified sample of 360 patients at least 18 years of age who are patients at three outpatient practices in Rochester New York. An incomplete factorial design with two five-level within-subject factors will be used. One factor will be five currently recommended risk communication formats: vertical bar charts, grouped icon displays, risk scales, frequency diagrams, and numeric frequency information. The other factor will be five outcomes of a disease screening program: risk of disease, risk of dying from disease, risk of a serious screening side effect, risk of dying from a screening side effect, and risk of a false positive screening test result. Each subject will be randomly assigned to respond to risk information in five of the possible 25 combinations such that they are presented with each risk outcome and each risk format in some combination. To facilitate the design of a future comprehensive R01-level study, data from this study will be used to gain initial estimates of risk format and subject variables on the differences among the five risk presentation formats on the following outcomes: a) comprehension, b) usefulness for decision making, c) hazard-response consistency, d) uniformity, e) patient evaluation, and f) direction of communication errors. We will also determine if there are associations between these outcomes and either the nature of the risk or individual patient characteristics including demographics, education, literacy, and numeracy. PUBLIC HEALTH RELEVANCE: Effective communication about possible risks and benefits of medical interventions is essential for ensuring the delivery of consistently high quality health care. Despite its importance, there are large gaps in our knowledge of how to effectively convey information about uncertain future outcomes of health care decisions to patients and practitioners. This project will begin to address these gaps by: a) comparing how well five currently recommended risk communication formats convey risk information to patients across a range of clinically important probabilities and outcomes, and b) determining whether patient characteristics such as demographics, numeracy, and literacy affect the effectiveness of health risk communications.