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Patient Educ Couns. 2019 Oct;102(10):1939-1944. doi: 10.1016/j.pec.2019.05.004. Epub 2019 May 9.

Presenting time-based risks of stroke and death for Patients facing carotid stenosis treatment options: Patients prefer pie charts over icon arrays.

Author information

1
The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Williamson Translational Building, One Medical Center Drive, Lebanon, NH, 03756, USA. Electronic address: Peter.Scalia@dartmouth.edu.
2
The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Williamson Translational Building, One Medical Center Drive, Lebanon, NH, 03756, USA; Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Williamson Translational Building, One Medical Center Drive, Lebanon, NH, 03756, USA. Electronic address: James.OMalley@dartmouth.edu.
3
The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Williamson Translational Building, One Medical Center Drive, Lebanon, NH, 03756, USA. Electronic address: Marie-Anne.Durand@dartmouth.edu.
4
The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Williamson Translational Building, One Medical Center Drive, Lebanon, NH, 03756, USA. Electronic address: Philip.P.Goodney@hitchcock.org.
5
The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Williamson Translational Building, One Medical Center Drive, Lebanon, NH, 03756, USA. Electronic address: glynelwyn@gmail.com.

Abstract

OBJECTIVE:

To user-test graphical display formats (icon arrays, pie, bar, and line charts) to identify preferred formats and metrics ('probability of death or stroke' or 'proportion of time lived without death or stroke') in order to display time-dependent risks of stroke or death for three carotid stenosis treatments: endarterectomy (surgery), stenting, and medical therapy.

METHODS:

Iterative cycles of semi-structured interviews with patients recruited from a Vascular Clinic.

RESULTS:

A total of 27 patients (mean age = 68; range: 50-85) were interviewed over four cycles. Patients strongly preferred the pie chart over icon arrays, and over bar or line graphs. The preference was based on patient recognition of the time-based increase in risk for stroke or death for treatment options. Patients preferred data presented as probabilities instead of the proportion of time lived. We did not assess patients' understanding.

CONCLUSION:

Patients preferred the pie chart formats and reported better realization that risks increase with time for each option and that tradeoffs exist when surgery has a higher short-term risk than medical therapy.

PRACTICE IMPLICATIONS:

There remains debate on how best to convey time-dependent risk information to patients, especially where low literacy and numeracy might exist.

KEYWORDS:

Carotid artery stenosis; Graphical Display format; Shared Decision making; Time-Dependent Risk information; Upfront versus long-term risk trade-off; Visualization Aid

PMID:
31101429
DOI:
10.1016/j.pec.2019.05.004
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