Interactive Visual Displays for Interpreting the Results of Clinical Trials: Formative Evaluation With Case Vignettes

Sensitivity of two Australian melanoma risk tools to identify high-risk individuals among people presenting with their first primary melanoma

AIMS

Regular skin examinations for early detection of melanoma are recommended for high-risk individuals, but there is minimal consensus regarding what constitutes 'high-risk'. Melanoma risk prediction models may guide this. We compared two online melanoma risk prediction tools: Victorian Melanoma Service (VMS) and Melanoma Institute Australia (MIA) risk tools; to assess classification differences of patients at high-risk of a first primary melanoma.

METHODS

Risk factor data for 357 patients presenting with their first primary melanoma were entered into both risk tools. Predicted risks were recorded: 5-year absolute risk (VMS tool and MIA tool); 10-year, lifetime, and relative risk estimates (MIA tool). Sensitivities for each tool were calculated using the same high-risk thresholds. The MIA risk tool showed greater sensitivity on comparison of 5-year absolute risks (90% MIA vs 78% VMS). Patients had significantly higher odds of being classified as high or very-high risk using the MIA risk tool overall, and for each patient subgroup. Using either tool, patients of male gender or with synchronous multiple first primary melanomas were more likely to be correctly classified as high- or very-high risk using 5-year absolute risk thresholds; but tumour invasiveness was unrelated to risk. Classification differed when using the MIA risk categories based on relative risk.

CONCLUSIONS

Both melanoma risk prediction tools had high sensitivity for identifying individuals at high-risk and could be used for optimising prevention campaigns. The choice of which risk tool, measure, and threshold for risk stratification depends on the intended purpose of risk prediction, and ideally requires information on specificity.

Provider Preferences for Patient-Generated Health Data Displays in Pediatric Asthma: A Participatory Design Approach

Objective  There is a lack of evidence on how to best integrate patient-generated health data (PGHD) into electronic health record (EHR) systems in a way that supports provider needs, preferences, and workflows. The purpose of this study was to investigate provider preferences for the graphical display of pediatric asthma PGHD to support decisions and information needs in the outpatient setting.

Methods  In December 2019, we conducted a formative evaluation of information display prototypes using an iterative, participatory design process. Using multiple types of PGHD, we created two case-based vignettes for pediatric asthma and designed accompanying displays to support treatment decisions. Semi-structured interviews and questionnaires with six participants were used to evaluate the display usability and determine provider preferences.

Results  We identified provider preferences for display features, such as the use of color to indicate different levels of abnormality, the use of patterns to trend PGHD over time, and the display of environmental data. Preferences for display content included the amount of information and the relationship between data elements.

Conclusion  Overall, provider preferences for PGHD include a desire for greater detail, additional sources, and visual integration with relevant EHR data. In the design of PGHD displays, it appears that the visual synthesis of multiple PGHD elements facilitates the interpretation of the PGHD. Clinicians likely need more information to make treatment decisions when PGHD displays are introduced into practice. Future work should include the development of interactive interface displays with full integration of PGHD into EHR systems.