Improving understanding of adjuvant therapy options by using simpler risk graphics

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Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.