Literature review of visual representation of the results of benefit-risk assessments of medicinal products
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paper_title: Graphical Perception: Theory, Experimentation, and Application to the Development of Graphical Methods

paper_content:

Abstract The subject of graphical methods for data analysis and for data presentation needs a scientific foundation. In this article we take a few steps in the direction of establishing such a foundation. Our approach is based on graphical perception—the visual decoding of information encoded on graphs—and it includes both theory and experimentation to test the theory. The theory deals with a small but important piece of the whole process of graphical perception. The first part is an identification of a set of elementary perceptual tasks that are carried out when people extract quantitative information from graphs. The second part is an ordering of the tasks on the basis of how accurately people perform them. Elements of the theory are tested by experimentation in which subjects record their judgments of the quantitative information on graphs. The experiments validate these elements but also suggest that the set of elementary tasks should be expanded. The theory provides a guideline for graph construction...
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paper_title: Balancing benefit and risk of medicines: a systematic review and classification of available methodologies

paper_content:

BACKGROUND ::: The need for formal and structured approaches for benefit-risk assessment of medicines is increasing, as is the complexity of the scientific questions addressed before making decisions on the benefit-risk balance of medicines. We systematically collected, appraised and classified available benefit-risk methodologies to facilitate and inform their future use. ::: ::: ::: METHODS ::: A systematic review of publications identified benefit-risk assessment methodologies. Methodologies were appraised on their fundamental principles, features, graphical representations, assessability and accessibility. We created a taxonomy of methodologies to facilitate understanding and choice. ::: ::: ::: RESULTS ::: We identified 49 methodologies, critically appraised and classified them into four categories: frameworks, metrics, estimation techniques and utility survey techniques. Eight frameworks describe qualitative steps in benefit-risk assessment and eight quantify benefit-risk balance. Nine metric indices include threshold indices to measure either benefit or risk; health indices measure quality-of-life over time; and trade-off indices integrate benefits and risks. Six estimation techniques support benefit-risk modelling and evidence synthesis. Four utility survey techniques elicit robust value preferences from relevant stakeholders to the benefit-risk decisions. ::: ::: ::: CONCLUSIONS ::: Methodologies to help benefit-risk assessments of medicines are diverse and each is associated with different limitations and strengths. There is not a 'one-size-fits-all' method, and a combination of methods may be needed for each benefit-risk assessment. The taxonomy introduced herein may guide choice of adequate methodologies. Finally, we recommend 13 of 49 methodologies for further appraisal for use in the real-life benefit-risk assessment of medicines.
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paper_title: Graphical Perception: Theory, Experimentation, and Application to the Development of Graphical Methods

paper_content:

Abstract The subject of graphical methods for data analysis and for data presentation needs a scientific foundation. In this article we take a few steps in the direction of establishing such a foundation. Our approach is based on graphical perception—the visual decoding of information encoded on graphs—and it includes both theory and experimentation to test the theory. The theory deals with a small but important piece of the whole process of graphical perception. The first part is an identification of a set of elementary perceptual tasks that are carried out when people extract quantitative information from graphs. The second part is an ordering of the tasks on the basis of how accurately people perform them. Elements of the theory are tested by experimentation in which subjects record their judgments of the quantitative information on graphs. The experiments validate these elements but also suggest that the set of elementary tasks should be expanded. The theory provides a guideline for graph construction...
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paper_title: Helping Patients Decide: Ten Steps to Better Risk Communication

paper_content:

With increasing frequency, patients are being asked to make complex decisions about cancer screening, prevention, and treatment. These decisions are fraught with emotion and cognitive difficulty simultaneously. Many Americans have low numeracy skills making the cognitive demands even greater whenever, as is often the case, patients are presented with risk statistics and asked to make comparisons between the risks and benefits of multiple options and to make informed medical decisions. In this commentary, we highlight 10 methods that have been empirically shown to improve patients' understanding of risk and benefit information and/or their decision making. The methods range from presenting absolute risks using frequencies (rather than presenting relative risks) to using a risk format that clarifies how treatment changes risks from preexisting baseline levels to using plain language. We then provide recommendations for how health-care providers and health educators can best to communicate this complex medical information to patients, including using plain language, pictographs, and absolute risks instead of relative risks.
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paper_title: Graph Literacy: A Cross-Cultural Comparison

paper_content:

BACKGROUND ::: Visual displays are often used to communicate important medical information to patients. However, even the simplest graphs are not understood by everyone. ::: ::: ::: OBJECTIVE ::: To develop and test a scale to measure health-related graph literacy and investigate the level of graph literacy in the United States and Germany. ::: ::: ::: DESIGN ::: Experimental and questionnaire studies. Setting. Computerized studies in the laboratory and on probabilistic national samples in the United States and Germany. Participants. Nationally representative samples of people 25 to 69 years of age in Germany (n = 495) and the United States (n = 492). Laboratory pretest on 60 younger and 60 older people. Measurements. Psychometric properties of the scale (i.e., reliability, validity, discriminability) and level of graph literacy in the two countries. ::: ::: ::: RESULTS ::: The new graph literacy scale predicted which patients can benefit from visual aids and had promising measurement properties. Participants in both countries completed approximately 9 of 13 items correctly (in Germany, x¯ = 9.4, s = 2.6; in the United States, x¯ = 9.3, s = 2.9). Approximately one third of the population in both countries had both low graph literacy and low numeracy skills. Limitations. The authors focused on basic graph literacy only. They used a computerized scale; comparability with paper-and-pencil versions should be checked. ::: ::: ::: CONCLUSIONS ::: The new graph literacy scale seems to be a suitable tool for assessing whether patients understand common graphical formats and shows that not everyone profits from standard visual displays. Research is needed on communication formats that can overcome the barriers of both low numeracy and graph literacy.
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paper_title: The impact of the format of graphical presentation on health-related knowledge and treatment choices.

paper_content:

OBJECTIVE ::: To evaluate the ability of six graph formats to impart knowledge about treatment risks/benefits to low and high numeracy individuals. ::: ::: ::: METHODS ::: Participants were randomized to receive numerical information about the risks and benefits of a hypothetical medical treatment in one of six graph formats. Each described the benefits of taking one of two drugs, as well as the risks of experiencing side effects. Main outcome variables were verbatim (specific numerical) and gist (general impression) knowledge. Participants were also asked to rate their perceptions of the graphical format and to choose a treatment. ::: ::: ::: RESULTS ::: 2412 participants completed the survey. Viewing a pictograph was associated with adequate levels of both types of knowledge, especially for lower numeracy individuals. Viewing tables was associated with a higher likelihood of having adequate verbatim knowledge vs. other formats (p<0.001) but lower likelihood of having adequate gist knowledge (p<0.05). All formats were positively received, but pictograph was trusted by both high and low numeracy respondents. Verbatim and gist knowledge were significantly (p<0.01) associated with making a medically superior treatment choice. ::: ::: ::: CONCLUSION ::: Pictographs are the best format for communicating probabilistic information to patients in shared decision making environments, particularly among lower numeracy individuals. ::: ::: ::: PRACTICE IMPLICATIONS ::: Providers can consider using pictographs to communicate risk and benefit information to patients of different numeracy levels.
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paper_title: The Visual Communication of Risk

paper_content:

This paper 1) provides reasons why graphics should be effective aids to communicate risk; 2) reviews the use of visuals, especially graphical displays, to communicate risk; 3) discusses issues to consider when designing graphs to communicate risk; and 4) provides suggestions for future research. Key articles and materials were obtained from MEDLINE(R) and PsychInfo(R) databases, from reference article citations, and from discussion with experts in risk communication. Research has been devoted primarily to communicating risk magnitudes. Among the various graphical displays, the risk ladder appears to be a promising tool for communicating absolute and relative risks. Preliminary evidence suggests that people understand risk information presented in histograms and pie charts. Areas that need further attention include 1) applying theoretical models to the visual communication of risk, 2) testing which graphical displays can be applied best to different risk communication tasks (e.g., which graphs best convey absolute or relative risks), 3) communicating risk uncertainty, and 4) testing whether the lay public's perceptions and understanding of risk varies by graphical format and whether the addition of graphical displays improves comprehension substantially beyond numerical or narrative translations of risk and, if so, by how much. There is a need to ascertain the extent to which graphics and other visuals enhance the public's understanding of disease risk to facilitate decision-making and behavioral change processes. Nine suggestions are provided to help achieve these ends.
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paper_title: The effect of format on parents' understanding of the risks and benefits of clinical research: a comparison between text, tables, and graphics.

paper_content:

There is a paucity of information regarding the optimal method of presenting risk/benefit information to parents of pediatric research subjects. This study, therefore, was designed to examine the effect of different message formats on parents' understanding of research risks and benefits. An Internet-administered survey was completed by 4,685 parents who were randomized to receive risk/benefit information about a study of pediatric postoperative pain control presented in different message formats (text, tables, and pictographs). Survey questions assessed participants' gist and verbatim understanding of the information and their perceptions of the risks and benefits. Pictographs were associated with significantly (p < .05) greater likelihood of adequate gist and verbatim understanding compared with text and tables regardless of the participants' numeracy. Parents who received the information in pictograph format perceived the risks to be lower and the benefits to be higher compared with the other formats (p < .001). Furthermore, compared with text and tables, pictographs were perceived as more "effective," "helpful," and "trustworthy" in presenting risk/benefit information. These results underscore the difficulties associated with presenting risk/benefit information for clinical research but suggest a simple method for enhancing parents' informed understanding of the relevant statistics.
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paper_title: Graphical Perception: Theory, Experimentation, and Application to the Development of Graphical Methods

paper_content:

Abstract The subject of graphical methods for data analysis and for data presentation needs a scientific foundation. In this article we take a few steps in the direction of establishing such a foundation. Our approach is based on graphical perception—the visual decoding of information encoded on graphs—and it includes both theory and experimentation to test the theory. The theory deals with a small but important piece of the whole process of graphical perception. The first part is an identification of a set of elementary perceptual tasks that are carried out when people extract quantitative information from graphs. The second part is an ordering of the tasks on the basis of how accurately people perform them. Elements of the theory are tested by experimentation in which subjects record their judgments of the quantitative information on graphs. The experiments validate these elements but also suggest that the set of elementary tasks should be expanded. The theory provides a guideline for graph construction...
---
paper_title: Graphical Perception: Theory, Experimentation, and Application to the Development of Graphical Methods

paper_content:

Abstract The subject of graphical methods for data analysis and for data presentation needs a scientific foundation. In this article we take a few steps in the direction of establishing such a foundation. Our approach is based on graphical perception—the visual decoding of information encoded on graphs—and it includes both theory and experimentation to test the theory. The theory deals with a small but important piece of the whole process of graphical perception. The first part is an identification of a set of elementary perceptual tasks that are carried out when people extract quantitative information from graphs. The second part is an ordering of the tasks on the basis of how accurately people perform them. Elements of the theory are tested by experimentation in which subjects record their judgments of the quantitative information on graphs. The experiments validate these elements but also suggest that the set of elementary tasks should be expanded. The theory provides a guideline for graph construction...
---
paper_title: Graph Literacy: A Cross-Cultural Comparison

paper_content:

BACKGROUND ::: Visual displays are often used to communicate important medical information to patients. However, even the simplest graphs are not understood by everyone. ::: ::: ::: OBJECTIVE ::: To develop and test a scale to measure health-related graph literacy and investigate the level of graph literacy in the United States and Germany. ::: ::: ::: DESIGN ::: Experimental and questionnaire studies. Setting. Computerized studies in the laboratory and on probabilistic national samples in the United States and Germany. Participants. Nationally representative samples of people 25 to 69 years of age in Germany (n = 495) and the United States (n = 492). Laboratory pretest on 60 younger and 60 older people. Measurements. Psychometric properties of the scale (i.e., reliability, validity, discriminability) and level of graph literacy in the two countries. ::: ::: ::: RESULTS ::: The new graph literacy scale predicted which patients can benefit from visual aids and had promising measurement properties. Participants in both countries completed approximately 9 of 13 items correctly (in Germany, x¯ = 9.4, s = 2.6; in the United States, x¯ = 9.3, s = 2.9). Approximately one third of the population in both countries had both low graph literacy and low numeracy skills. Limitations. The authors focused on basic graph literacy only. They used a computerized scale; comparability with paper-and-pencil versions should be checked. ::: ::: ::: CONCLUSIONS ::: The new graph literacy scale seems to be a suitable tool for assessing whether patients understand common graphical formats and shows that not everyone profits from standard visual displays. Research is needed on communication formats that can overcome the barriers of both low numeracy and graph literacy.
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paper_title: Frequency or Probability? A Qualitative Study of Risk Communication Formats Used in Health Care

paper_content:

Background. The communication of probabilistic outcomes is an essential aspect of shared medical decision making.Methods. The authors conducted a qualitative study using focus groups to evaluate the response of women to various formats used in the communication of breast cancer risk.Findings. Graphic discrete frequency formats using highlighted human figures had greater salience than continuous probability formats using bar graphs. Potential biases in the estimation of risk magnitude were associated with the use of highlighted human figures versus bar graphs and the denominator size in graphics using highlighted human figures. The presentation of uncertainty associated with risk estimates caused some to loose trust in the information, whereas others were accepting of uncertainty in scientific data.Conclusion. The qualitative study identified new constructs with regard to how patients process probabilistic information. Further research in the clinical setting is needed to provide a theoretical justificatio...
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paper_title: Individual Differences in Graph Literacy: Overcoming Denominator Neglect in Risk Comprehension

paper_content:

Graph literacy is an often neglected skill that influences decision making performance. We conducted an experiment to investigate whether individual differences in graph literacy affect the extent to which people benefit from visual aids (icon arrays) designed to reduce a common judgment bias (i.e., denominator neglect—a focus on numerators in ratios while neglecting denominators). Results indicated that icon arrays more often increased risk comprehension accuracy and confidence among participants with high graph literacy as compared with those with low graph literacy. Results held regardless of how the health message was framed (chances of dying versus chances of surviving). Findings contribute to our understanding of the ways in which individual differences in cognitive abilities interact with the comprehension of different risk representation formats. Theoretical, methodological, and prescriptive implications of the results are discussed (e.g., the effective communication of quantitative medical data). Copyright © 2011 John Wiley & Sons, Ltd.
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paper_title: A Longitudinal Model and Graphic for Benefit-risk Analysis, with Case Study

paper_content:

A novel method for simultaneously visualizing benefit and risk over time is presented. The underlying model represents a subject's benefit-risk state at a given time as one of five discrete clinical states, one being premature study withdrawal. The new graphic uses colors to represent each subject's changing state over the course of the clinical trial. The user can grasp how a treatment affects subjects in aggregate, then further examine how individuals are affected. It is possible to tell whether the beneficial and harmful outcomes are correlated. The method is particularly appropriate for treatments that provide only symptomatic relief. An approved drug for chronic pain is presented as a worked example.
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paper_title: Explaining risks: turning numerical data into meaningful pictures

paper_content:

The way in which information is presented affects both how health professionals introduce it and how patients use it ::: ::: The “information age” has profound implications for the way we work. The volume of information derives from biomedical and clinical evaluative sciences and is increasingly available to clinicians and patients through the world wide web.1 We need to process information, derive knowledge, and disseminate the knowledge into clinical practice. This is particularly challenging for doctors in the context of the consultation. Information often highlights uncertainties, including collective professional uncertainty, which we address with more and better research; individual professional uncertainty, which we address with professional education and support for decisions; and stochastic uncertainty (the irreducible element of chance), which we address with effective risk communication about the harms and benefits of different options for treatment or care. ::: ::: In this article we discuss whether the shift towards a greater use of information in consultations is helpful and summarise the current literature on risk communication. We also explore how information can be used without losing the benefits that are traditionally associated with the art, rather than the science, of medicine. ::: ::: #### Summary points ::: ::: Patients often desire more information than is currently provided ::: ::: Communicating about risks should be a two way process in which professionals and patients exchange information and opinions about those risks ::: ::: Professionals need to support patients in making choices by turning raw data into information that is more helpful to the discussions than the data ::: ::: “Framing” manipulations of information, such as using information about relative risk in isolation of base rates, to achieve professionally determined goals should be avoided ::: ::: “Decision aids” can be useful as they often include visual presentations of risk information and relate the information to more familiar risks RETURN TO TEXT ::: ::: This paper draws on systematic reviews and other key literature in the …
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paper_title: Effective visualization of integrated knowledge and data to enable informed decisions in drug development and translational medicine

paper_content:

Integrative understanding of preclinical and clinical data is imperative to enable informed decisions and reduce the attrition rate during drug development. The volume and variety of data generated during drug development have increased tremendously. A new information model and visualization tool was developed to effectively utilize all available data and current knowledge. The Knowledge Plot integrates preclinical, clinical, efficacy and safety data by adding two concepts: knowledge from the different disciplines and protein binding.Internal and public available data were gathered and processed to allow flexible and interactive visualizations. The exposure was expressed as the unbound concentration of the compound and the treatment effect was normalized and scaled by including expert opinion on what a biologically meaningful treatment effect would be.The Knowledge Plot has been applied both retrospectively and prospectively in project teams in a number of different therapeutic areas, resulting in closer collaboration between multiple disciplines discussing both preclinical and clinical data. The Plot allows head to head comparisons of compounds and was used to support Candidate Drug selections and differentiation from comparators and competitors, back translation of clinical data, understanding the predictability of preclinical models and assays, reviewing drift in primary endpoints over the years, and evaluate or benchmark compounds in due diligence comparing multiple attributes.The Knowledge Plot concept allows flexible integration and visualization of relevant data for interpretation in order to enable scientific and informed decision-making in various stages of drug development. The concept can be used for communication, decision-making, knowledge management, and as a forward and back translational tool, that will result in an improved understanding of the competitive edge for a particular project or disease area portfolio. In addition, it also builds up a knowledge and translational continuum, which in turn will reduce the attrition rate and costs of clinical development by identifying poor candidates early.
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paper_title: Communicating contraceptive effectiveness: A randomized controlled trial to inform a World Health Organization family planning handbook

paper_content:

Objective The objective of the study was to compare 3 different approaches for increasing clients' understanding of contraceptive effectiveness. Study design We randomized 900 reproductive-age women in India and Jamaica to 1 of 3 charts presenting pregnancy risk. Results The most important reason for choosing a contraceptive was how well it prevents pregnancy (54%) followed by few side effects (17%). At baseline, knowledge about contraceptive effectiveness was poor. About half knew oral contraceptive pills are more effective than condoms (46%) and intrauterine devices are more effective than injectables (50%). All 3 charts improved knowledge significantly (P .05). The chart ranking contraceptive methods on a continuum was judged slightly easier to understand than the other 2 charts. Conclusion Only with accurate understanding of pregnancy risk can clients make informed choices. Our results have already informed a global handbook for family planning providers to use the chart ranking contraceptive methods on a continuum.
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paper_title: The impact of the format of graphical presentation on health-related knowledge and treatment choices.

paper_content:

OBJECTIVE ::: To evaluate the ability of six graph formats to impart knowledge about treatment risks/benefits to low and high numeracy individuals. ::: ::: ::: METHODS ::: Participants were randomized to receive numerical information about the risks and benefits of a hypothetical medical treatment in one of six graph formats. Each described the benefits of taking one of two drugs, as well as the risks of experiencing side effects. Main outcome variables were verbatim (specific numerical) and gist (general impression) knowledge. Participants were also asked to rate their perceptions of the graphical format and to choose a treatment. ::: ::: ::: RESULTS ::: 2412 participants completed the survey. Viewing a pictograph was associated with adequate levels of both types of knowledge, especially for lower numeracy individuals. Viewing tables was associated with a higher likelihood of having adequate verbatim knowledge vs. other formats (p<0.001) but lower likelihood of having adequate gist knowledge (p<0.05). All formats were positively received, but pictograph was trusted by both high and low numeracy respondents. Verbatim and gist knowledge were significantly (p<0.01) associated with making a medically superior treatment choice. ::: ::: ::: CONCLUSION ::: Pictographs are the best format for communicating probabilistic information to patients in shared decision making environments, particularly among lower numeracy individuals. ::: ::: ::: PRACTICE IMPLICATIONS ::: Providers can consider using pictographs to communicate risk and benefit information to patients of different numeracy levels.
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paper_title: Graph Design for the Eye and Mind

paper_content:

1. Looking with the Eye and Mind 2. Choosing a Graph Format 3. Creating the Framework, Labels, and Title 4. Creating the Pie Graphs, Divided-Bar Charts, and Visual Tables 5. Creating Bar-Graph Variants 6. Creating Line-Graph Variants and Scatterplots 7. Creating color, filling, and optional components 8. How People Lie with Graphs 9. Beyond the Graph Appendix 1: Elementary Statistics for Graphs Appendix 2: Analyzing Graphics Programs Appendix 3: Summary of Psychological Principles References Sources of Data and Figures
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paper_title: Formats for Improving Risk Communication in Medical Tradeoff Decisions

paper_content:

ABSTRACT To make treatment decisions, patients should consider not only a treatment option's potential consequences but also the probability of those consequences. Many laypeople, however, have difficulty using probability information. This Internet-based study (2,601 participants) examined a hypothetical medical tradeoff situation in which a treatment would decrease one risk but increase another. Accuracy was assessed in terms of the ability to determine correctly whether the treatment would increase or decrease the total risk. For these tradeoff problems, accuracy was greater when the following occurred: (1) the amount of cognitive effort required to evaluate the tradeoff was reduced; (2) probability information was presented as a graphical display rather than as text only; and (3) information was presented as percentages rather than as frequencies (n in 100). These findings provide suggestions of ways to present risk probabilities that may help patients understand their treatment options.
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paper_title: Influence of framing and graphic format on comprehension of risk information among American Indian tribal college students.

paper_content:

We evaluated methods for presenting risk information by administering six versions of an anonymous survey to 489 American Indian tribal college students. All surveys presented identical numeric information, but framing varied. Half expressed prevention benefits as relative risk reduction, half as absolute risk reduction. One third of surveys used text to describe prevention benefits; one third used text plus bar graph; one third used text plus modified bar graph incorporating a culturally tailored image. The odds ratio (OR) for correct risk interpretation for absolute risk framing vs. relative risk framing was 1.40 (95 % CI = 1.01, 1.93). The OR for correct interpretation of text plus bar graph vs. text only was 2.16 (95 % CI = 1.46, 3.19); OR for text plus culturally tailored bar graph vs. text only was 1.72 (95 % CI = 1.14, 2.60). Risk information including a bar graph was better understood than text-only information; a culturally tailored graph was no more effective than a standard graph.
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paper_title: The Visual Communication of Risk

paper_content:

This paper 1) provides reasons why graphics should be effective aids to communicate risk; 2) reviews the use of visuals, especially graphical displays, to communicate risk; 3) discusses issues to consider when designing graphs to communicate risk; and 4) provides suggestions for future research. Key articles and materials were obtained from MEDLINE(R) and PsychInfo(R) databases, from reference article citations, and from discussion with experts in risk communication. Research has been devoted primarily to communicating risk magnitudes. Among the various graphical displays, the risk ladder appears to be a promising tool for communicating absolute and relative risks. Preliminary evidence suggests that people understand risk information presented in histograms and pie charts. Areas that need further attention include 1) applying theoretical models to the visual communication of risk, 2) testing which graphical displays can be applied best to different risk communication tasks (e.g., which graphs best convey absolute or relative risks), 3) communicating risk uncertainty, and 4) testing whether the lay public's perceptions and understanding of risk varies by graphical format and whether the addition of graphical displays improves comprehension substantially beyond numerical or narrative translations of risk and, if so, by how much. There is a need to ascertain the extent to which graphics and other visuals enhance the public's understanding of disease risk to facilitate decision-making and behavioral change processes. Nine suggestions are provided to help achieve these ends.
---
paper_title: Graphical Perception: Theory, Experimentation, and Application to the Development of Graphical Methods

paper_content:

Abstract The subject of graphical methods for data analysis and for data presentation needs a scientific foundation. In this article we take a few steps in the direction of establishing such a foundation. Our approach is based on graphical perception—the visual decoding of information encoded on graphs—and it includes both theory and experimentation to test the theory. The theory deals with a small but important piece of the whole process of graphical perception. The first part is an identification of a set of elementary perceptual tasks that are carried out when people extract quantitative information from graphs. The second part is an ordering of the tasks on the basis of how accurately people perform them. Elements of the theory are tested by experimentation in which subjects record their judgments of the quantitative information on graphs. The experiments validate these elements but also suggest that the set of elementary tasks should be expanded. The theory provides a guideline for graph construction...
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paper_title: Review article: explaining risks of inflammatory bowel disease therapy to patients.

paper_content:

BACKGROUND ::: Medical treatment for inflammatory bowel disease (IBD) has advanced significantly over the past decade, but it is important to communicate effectively the balance of benefits and risks of therapy to patients to facilitate informed medical decisions. ::: ::: ::: AIM ::: To review the available data describing the risk of side effects of IBD medications and to describe effective methods for communicating risk. ::: ::: ::: METHODS ::: To identify relevant articles for this review, a PubMed search was conducted using relevant key words and phrases. In addition, reference lists from identified manuscripts were searched and recent abstracts from National meetings were reviewed. ::: ::: ::: RESULTS ::: The steroid-sparing medications used for the treatment of IBD all carry risks of both common and rare adverse events. Trade-offs need to be made between the risks of these medications vs. the risks of poorly treated disease and corticosteroids. There has been significant research on how best to present risk data to patients, which is summarized in this review. ::: ::: ::: CONCLUSIONS ::: To ensure that our patients understand their choices and feel comfortable with their treatment, we need to communicate risk data to patients clearly. Patients comprehend absolute numbers better than relative risk, and when available, pictorial representations of data are preferred over solely presenting numerical outcomes.
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paper_title: Individual Differences in Graph Literacy: Overcoming Denominator Neglect in Risk Comprehension

paper_content:

Graph literacy is an often neglected skill that influences decision making performance. We conducted an experiment to investigate whether individual differences in graph literacy affect the extent to which people benefit from visual aids (icon arrays) designed to reduce a common judgment bias (i.e., denominator neglect—a focus on numerators in ratios while neglecting denominators). Results indicated that icon arrays more often increased risk comprehension accuracy and confidence among participants with high graph literacy as compared with those with low graph literacy. Results held regardless of how the health message was framed (chances of dying versus chances of surviving). Findings contribute to our understanding of the ways in which individual differences in cognitive abilities interact with the comprehension of different risk representation formats. Theoretical, methodological, and prescriptive implications of the results are discussed (e.g., the effective communication of quantitative medical data). Copyright © 2011 John Wiley & Sons, Ltd.
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paper_title: Helping doctors and patients make sense of health statistics

paper_content:

Many doctors, patients, journalists, and politicians alike do not understand what health statistics mean or draw wrong conclusions without noticing. Collective statistical illiteracy refers to the widespread inability to understand the meaning of numbers. For instance, many citizens are unaware that higher survival rates with cancer screening do not imply longer life, or that the statement that mammography screening reduces the risk of dying from breast cancer by 25% in fact means that 1 less woman out of 1,000 will die of the disease. We provide evidence that statistical illiteracy (a) is common to patients, journalists, and physicians; (b) is created by nontransparent framing of information that is sometimes an unintentional result of lack of understanding but can also be a result of intentional efforts to manipulate or persuade people; and (c) can have serious consequences for health.The causes of statistical illiteracy should not be attributed to cognitive biases alone, but to the emotional nature of ...
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paper_title: What are the chances? Evaluating risk and benefit information in consumer health materials.

paper_content:

Much consumer health information addresses issues of disease risk or treatment risks and benefits, addressing questions such as "How effective is this treatment?" or "What is the likelihood that this test will give a false positive result?" Insofar as it addresses outcome likelihood, this information is essentially quantitative in nature, which is of critical importance, because quantitative information tends to be difficult to understand and therefore inaccessible to consumers. Information professionals typically examine reading level to determine the accessibility of consumer health information, but this measure does not adequately reflect the difficulty of quantitative information, including materials addressing issues of risk and benefit. As a result, different methods must be used to evaluate this type of consumer health material. There are no standard guidelines or assessment tools for this task, but research in cognitive psychology provides insight into the best ways to present risk and benefit information to promote understanding and minimize interpretation bias. This paper offers an interdisciplinary bridge that brings these results to the attention of information professionals, who can then use them to evaluate consumer health materials addressing risks and benefits.
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paper_title: The Visual Communication of Risk

paper_content:

This paper 1) provides reasons why graphics should be effective aids to communicate risk; 2) reviews the use of visuals, especially graphical displays, to communicate risk; 3) discusses issues to consider when designing graphs to communicate risk; and 4) provides suggestions for future research. Key articles and materials were obtained from MEDLINE(R) and PsychInfo(R) databases, from reference article citations, and from discussion with experts in risk communication. Research has been devoted primarily to communicating risk magnitudes. Among the various graphical displays, the risk ladder appears to be a promising tool for communicating absolute and relative risks. Preliminary evidence suggests that people understand risk information presented in histograms and pie charts. Areas that need further attention include 1) applying theoretical models to the visual communication of risk, 2) testing which graphical displays can be applied best to different risk communication tasks (e.g., which graphs best convey absolute or relative risks), 3) communicating risk uncertainty, and 4) testing whether the lay public's perceptions and understanding of risk varies by graphical format and whether the addition of graphical displays improves comprehension substantially beyond numerical or narrative translations of risk and, if so, by how much. There is a need to ascertain the extent to which graphics and other visuals enhance the public's understanding of disease risk to facilitate decision-making and behavioral change processes. Nine suggestions are provided to help achieve these ends.
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Title: Literature review of visual representation of the results of benefit-risk assessments of medicinal products

Section 1: Abstract
Description 1: Summarize the primary objectives, methods, results, and conclusions of the paper.

Section 2: Background
Description 2: Provide context for the review, including the objectives of the PROTECT Benefit-risk group and the significance of visual representation in benefit-risk assessment.

Section 3: Methods
Description 3: Describe the approach of the systematic review, including literature search strategy, inclusion criteria, and data extraction process.

Section 4: Results
Description 4: Discuss the findings of the review, including the variety of visual formats identified, their classifications, and their respective strengths and weaknesses.

Section 5: Discussion
Description 5: Analyze the implications of the findings, emphasizing the absence of a universally superior visual format and the importance of context-specific visual creation.

Section 6: Recommendations
Description 6: Present recommendations on creating effective visual displays for benefit-risk communication, focusing on audience-visual compatibility and specific visual formats to explore.

Section 7: Conclusions
Description 7: Summarize the main insights and final recommendations derived from the review.

Section 8: Supplemental Materials
Description 8: Reference additional detailed descriptions and tables used to support the appraisals and recommendations in the paper.