Effect of different visual presentations on the comprehension of prognostic information: a systematic review

Exploring individuals' perceptions and acceptability of a 'wait and see' approach for managing self-limiting illnesses: A qualitative study

OBJECTIVE

To explore individuals' perceptions and acceptability of a 'wait and see' approach, and phrases to describe this, for managing self-limiting illnesses (those that typically resolve spontaneously).

METHODS

Semi-structured interviews with a purposive sample of 30 Australians. Two researchers independently conducted a thematic analysis of interview transcripts, and all authors agreed on final themes.

RESULTS

Four themes emerged: Interpretation of what 'wait and see' meant varied and encompassed whether individuals had already sought medical care; Individuals' experiences and circumstances influenced the acceptability of a 'wait and see' approach; Symptom management was perceived as the most reassuring phrase to describe this approach; Individuals highly valued clear communication about a 'wait and see' approach and wanted a collaborative and action-oriented plan for the waiting period.

CONCLUSION

Individuals generally accepted a 'wait and see' approach, although less so for some illnesses and in some circumstances. They wanted it at least presented as an option when appropriate, with 'symptom management' as the preferred terminology. Clear communication and collaborative decision-making were valued.

PRACTICE IMPLICATIONS

When 'wait and see' is a reasonable option, clinicians should communicate this to patients, support them in decision-making, and provide a plan for the waiting period if the option is chosen.

Effect of different visual presentations on the public's comprehension of prognostic information using acute and chronic condition scenarios: two online randomised controlled trials

OBJECTIVES

To assess the effectiveness of bar graph, pictograph and line graph compared with text-only, and to each other, for communicating prognosis to the public.

DESIGN

Two online four-arm parallel-group randomised controlled trials. Statistical significance was set at p<0.016 to allow for three-primary comparisons.

PARTICIPANTS AND SETTING

Two Australian samples were recruited from members registered at Dynata online survey company. In trial A: 470 participants were randomised to one of the four arms, 417 were included in the analysis. In trial B: 499 were randomised and 433 were analysed.

INTERVENTIONS

In each trial four visual presentations were tested: bar graph, pictograph, line graph and text-only. Trial A communicated prognostic information about an acute condition (acute otitis media) and trial B about a chronic condition (lateral epicondylitis). Both conditions are typically managed in primary care where 'wait and see' is a legitimate option.

MAIN OUTCOME

Comprehension of information (scored 0-6).

SECONDARY OUTCOMES

Decision intention, presentation satisfaction and preferences.

RESULTS

In both trials, the mean comprehension score was 3.7 for the text-only group. None of the visual presentations were superior to text-only. In trial A, the adjusted mean difference (MD) compared with text-only was: 0.19 (95% CI -0.16 to 0.55) for bar graph, 0.4 (0.04 to 0.76) for pictograph and 0.06 (-0.32 to 0.44) for line graph. In trial B, the adjusted MD was: 0.1 (-0.27 to 0.47) for bar graph), 0.38 (0.01 to 0.74) for pictograph and 0.1 (-0.27 to 0.48) for line graph. Pairwise comparisons between the three graphs showed all were clinically equivalent (95% CIs between -1.0 and 1.0). In both trials, bar graph was the most preferred presentation (chosen by 32.9% of trial A participants and 35.6% in trial B).

CONCLUSIONS

Any of the four visual presentations tested may be suitable to use when discussing quantitative prognostic information.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry (ACTRN12621001305819).