Quantitative versus qualitative risk framing in patient decision aids for dysplastic nevi: A randomized A/B testing...

Area of Science:

• Dermatology
• Medical Decision Making
• Health Communication

Background:

• Patient decision aids (PDAs) are crucial for shared decision-making in healthcare.
• The impact of risk framing and diagnostic severity in PDAs for dermatological conditions is not well understood.

Purpose of the Study:

• To evaluate how patient decision aid (PDA) format (quantitative vs. qualitative) and dysplastic nevus severity influence patient understanding, risk perception, confidence, and treatment intentions.
• To assess the interplay between PDA design and diagnostic information in shaping patient preferences for dermatological treatments.

Main Methods:

• A randomized A/B testing design involved 600 US adults viewing either a quantitative or qualitative PDA for mild, moderate, or severe dysplastic nevus scenarios.
• Outcomes measured included understanding, treatment selection (excision vs. monitoring), satisfaction, decision-making confidence, perceived melanoma risk, and concern.
• Statistical analyses employed nonparametric tests and logistic regression to compare outcomes between PDA formats and severity levels.

Main Results:

• Quantitative PDAs significantly enhanced patient understanding and confidence while reducing perceived melanoma risk for both monitoring and excision options.
• Dysplastic nevus severity was a strong predictor of treatment intent, with higher severity leading to increased likelihood of choosing excision (31% mild, 41% moderate, 72% severe).
• Despite improved comprehension with quantitative PDAs, treatment intent did not significantly differ between formats, and severity, not format, predominantly drove treatment decisions.

Conclusions:

• Quantitative patient decision aids effectively improve comprehension and risk perception in dermatological treatment choices.
• Diagnostic severity labels play a more significant role than PDA format in determining patient treatment intent for dysplastic nevi.
• A notable proportion of patients deviated from expert recommendations, highlighting the critical influence of individual values on treatment decisions, even when understanding is high.