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Version of Record online: 14 NOV 2008
Published 2008 by the American Cancer Society
Volume 113, Issue 12, pages 3382–3390, 15 December 2008
How to Cite
Zikmund-Fisher, B. J., Fagerlin, A. and Ubel, P. A. (2008), Improving understanding of adjuvant therapy options by using simpler risk graphics. Cancer, 113: 3382–3390. doi: 10.1002/cncr.23959
Presented at the Annual Meeting of the Society for Medical Decision Making, Philadelphia, Pennsylvania, October 20, 2008.
The funding agreements ensured the authors' independence in designing the study, interpreting the data, and publishing the report.
The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.
The authors would like to acknowledge Ellen Peters, Isaac Lipkus, and Mick Couper for helpful discussions and comments; Rosemarie Pitsch for her project management; and Bob Burbach and Aaron Pearlman for creating the risk graphics and for programming, testing, and implementing the survey.
This article is a US Government work and, as such, is in the public domain in the United States of America.
- Issue online: 4 DEC 2008
- Version of Record online: 14 NOV 2008
- Manuscript Accepted: 16 JUL 2008
- Manuscript Revised: 8 JUL 2008
- Manuscript Received: 2 APR 2008
- National Institutes for Health. Grant Numbers: R01 CA87595, P50 CA101451
- American Cancer Society. Grant Number: MRSG-06-130-01-CPPB
- Merit Review Entry Program early career award from the Department of Veterans Affairs
- decision aids;
- patient education;
- audiovisual aids
To help oncologists and breast cancer patients make informed decisions about adjuvant therapies, online tools such as Adjuvant! provide tailored estimates of mortality and recurrence risks. However, the graphical format used to display these results (a set of 4 horizontal stacked bars) may be suboptimal. The authors tested whether using simpler formats would improve comprehension of the relevant risk statistics.
A total of 1619 women, aged 40-74 years, completed an Internet-administered survey vignette about adjuvant therapy decisions for a patient with an estrogen receptor-positive tumor. Participants were randomized to view 1 of 4 risk graphics, a base version that mirrored the Adjuvant! format, an alternate graph that showed only 2 options (those that included hormonal therapy), a graph that used a pictograph format, or a graph that included both changes. Outcome measures included comprehension of key statistics, time required to complete the task, and graph-perception ratings.
The simplifying format changes significantly improved comprehension, especially when both changes were implemented together. Compared with participants who viewed the base 4-option bar graph, respondents who, instead, viewed a 2-option pictograph version were more accurate when they reported the incremental risk reduction achievable from adding chemotherapy to hormonal therapy (77% vs 51%; P< .001), answered that question more quickly (median time, 28 seconds vs 42 seconds; P< .001), and liked the graph more (mean, 7.67 vs 6.88; P< .001).
Although most patients will only view risk calculators such as Adjuvant! in consultation with their clinicians, simplifying design graphics could significantly improve patients' comprehension of statistics essential for informed decision making about adjuvant therapies. Cancer 2008. Published 2008 by the American Cancer Society.