Related Experiment Video
Updated: Jul 3, 2026

Highlighting and Reducing the Impact of Negative Aging Stereotypes During Older Adults' Cognitive Testing
Published on: January 24, 2020
Communicating side effect risks in a tamoxifen prophylaxis decision aid: the debiasing influence of pictographs
Brian J Zikmund-Fisher1, Peter A Ubel, Dylan M Smith
1VA Health Services Research & Development Center of Excellence, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. bzikmund@umich.edu
Objective:
To experimentally test whether using pictographs (image matrices), incremental risk formats, and varied risk denominators would influence perceptions and comprehension of side effect risks in an online decision aid about prophylactic use of tamoxifen to prevent primary breast cancers.
Methods:
We recruited 631 women with elevated breast cancer risk from two healthcare organizations. Participants saw tailored estimates of the risks of 5 side effects: endometrial cancer, blood clotting, cataracts, hormonal symptoms, and sexual problems. Presentation format was randomly varied in a three factor design: (A) risk information was displayed either in pictographs or numeric text; (B) presentations either reported total risks with and without tamoxifen or highlighted the incremental risk most relevant for decision making; and (C) risk estimates used 100 or 1000 person denominators. Primary outcome measures included risk perceptions and gist knowledge.
Results:
Incremental risk formats consistently lowered perceived risk of side effects but resulted in low knowledge when displayed by numeric text only. Adding pictographs, however, produced significantly higher comprehension levels.
Conclusions:
Pictographs make risk statistics easier to interpret, reducing biases associated with incremental risk presentations.
Practice Implications:
Including graphs in risk communications is essential to support an informed treatment decision-making process.
Related Concept Videos
Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast, controlled...
Framing Effects
Therapeutic Drug Monitoring: Affecting Factors
Pharmacovigilance
This process, termed pharmacovigilance, aims to detect, evaluate, and minimize harmful effects related to medication use. The data collection for pharmacovigilance depends on spontaneous reporting systems, where healthcare professionals or patients voluntarily report suspected ADRs.
In some cases, there...
Drug Toxicity: Risk factors
Antiplatelet Drugs: Prostaglandin Synthesis, P2Y12 and Glycoprotein IIb/IIIa Inhibitors
Prostaglandin synthesis inhibitors, exemplified by the widely known aspirin, wield their power by irreversibly acetylating...