Do visual aids influenced patients' risk perceptions for rare and very rare risks?

OBJECTIVE: To examine whether visual aids (a graphic representation and/or conceptual illustrations) influence patients' risk perceptions for rare and very rare risks. METHODS: Participants were randomized to a scenario which varied by probability of infection (2% or 0.2%) and visual aid: numbers only, numbers + graphic representation, numbers + conceptual illustrations, or numbers + graphic representation + conceptual illustrations. Risk perceptions and likelihood of starting the medication were examined across the four formats, separately, in participants with and without a college education. RESULTS: Adding a graphic representation and/or conceptual illustrations did not affect risk perceptions among those with a higher level of education. Adding both a graphic representation + conceptual illustrations decreased risk perceptions and increased likelihood of starting the medication among participants randomized to the 2%, but not 0.2% scenario, among participants with lower levels of education. CONCLUSION: Adding a graphic representation + conceptual illustrations to numbers may influence perceptions for rare, but not very rare, risks among patients with lower education. PRACTICE IMPLICATIONS: Clinicians should be aware of the differential effects of visual aids developed to facilitate risk communication. Patients with higher levels of education may be less responsive to visual aids than those with lower education.

Influence of Explanatory Images on Risk Perceptions and Treatment Preference.

OBJECTIVE: The aim of this study was to examine whether providing patients with a series of balance scales (BS), depicting a reciprocal relationship between achieving disease control and increasing the risk of infection, influences treatment preference. METHODS: Participants were randomized to receive a description of a medication in which risk of infection was relayed using 1 of 4 formats, including numbers only, numbers + icon array (IA), numbers + BS, or numbers + IA + BS (i.e., combination). We compared the likelihood of starting the medication across the 4 formats, and evaluated whether the influence of risk formats varied by numeracy and gist risk appraisals. RESULTS: The mean ± SE likelihood of starting the medication was higher among participants randomized to the combination format (3.85 ± 0.09) compared to those who viewed the BS (3.56 ± 0.09; P = 0.0222) or numbers-only formats (3.51 ± 0.09; P = 0.0069). Viewing an IA alone was associated with a lower likelihood of starting the medication among participants lower in numeracy and endorsing a risk-avoidant noncompensatory gist risk appraisal. Conversely, viewing an IA (with or without the BS) was associated with a greater likelihood of starting the medication among patients with higher numeracy and compensatory risk appraisals. CONCLUSION: Adding explanatory images to IAs increases patient likelihood to take a medication in those with low numeracy and a noncompensatory gist risk appraisal. Explanatory images may be a feasible approach to improve willingness to try medication among subjects who are especially risk averse and believe that any risk is unacceptable.

"What does it mean?": uncertainties in understanding results of chromosomal microarray testing.

PURPOSE: The increased sensitivity of chromosomal microarray (CMA) technology as compared with traditional cytogenetic analysis allows for improved detection of genomic alterations. However, there is potential for uncertainty in the interpretation of test results in some cases. This paper explores how families understand and make meaning of CMA test results, and identifies the needs of families undergoing CMA testing. METHODS: We conducted semistructured interviews with parents of 25 pediatric outpatients with CMA test results indicating either a pathogenic alteration or a variant of unknown significance (VUS). Interviews were analyzed qualitatively. RESULTS: Three domains of understanding were identified: comprehension of results, interpretations of scientific uncertainty, and personal meaning for the child and family. Incomplete comprehension of test results and scientific uncertainty were prominent themes for families receiving results in both the VUS and pathogenic categories. Receiving results from non-geneticists and by telephone, long waits to see a geneticist, and misleading Internet searches all contributed to misunderstandings. CONCLUSION: Differentiating domains of understanding allows for the identification of uncertainties that can be reduced or managed in order to improve understanding of CMA results. Using this framework, we suggest interventions to promote clarity and address the informational needs of families undergoing CMA testing.