Improving bone mineral density reporting to patients with an illustration of personal fracture risk.
BACKGROUND
To determine patients' preferences for, and understanding of, FRAX® fracture risk conveyed through illustrations.


METHODS
Drawing on examples from published studies, four illustrations of fracture risk were designed and tested for patient preference, ease of understanding, and perceived risk. We enrolled a convenience sample of adults aged 50 and older at two medical clinics located in the Midwestern and Southern United States. In-person structured interviews were conducted to elicit patient ranking of preference, ease of understanding, and perceived risk for each illustration.


RESULTS
Most subjects (n = 142) were female (64%), Caucasian (76%) and college educated (78%). Of the four risk depictions, a plurality of participants (37%) listed a bar graph as most preferred. Subjects felt this illustration used the stoplight color system to display risk levels well and was the most "clear," "clean," and "easy to read". The majority of subjects (52%) rated the pictogram as the most difficult to understand as this format does not allow people to quickly ascertain their individual risk category.


CONCLUSIONS
Communicating risk to patients with illustrations can be done effectively with clearly designed illustrations responsive to patient preference.


BACKGROUND
ClinicalTrials.gov Identifier: NCT01507662.
Division of General Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA. stephanie-edmonds@uiowa.edu.|College of Nursing, University of Iowa, Iowa City, IA, USA. stephanie-edmonds@uiowa.edu.
Stephanie W
SW
Edmonds
Faculty of Medicine, University of Toronto, Toronto, ON, Canada. peter.cram@uhn.ca.|University Health Network and Mount Sinai Hospital, Toronto, ON, Canada. peter.cram@uhn.ca.
Peter
P
Cram
Division of General Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA. xin-lu@uiowa.edu.
Xin
X
Lu
Kaiser Permanente Georgia, Atlanta, GA, USA. droblin@gsu.edu.|School of Public Health, Georgia State University, Atlanta, GA, USA. droblin@gsu.edu.
Douglas W
DW
Roblin
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA. ncwright@uab.edu.
Nicole C
NC
Wright
Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA. ksaag@uab.edu.
Kenneth G
KG
Saag
Department of Veterans Affairs, Center for Comprehensive Access & Delivery Research and Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA. samantha.solimeo@va.gov.
Samantha L
SL
Solimeo
D000368:Aged; D015519:Bone Density; D032882:Comprehension; D005260:Female; D050723:Fractures, Bone; D006801:Humans; D008297:Male; D008488:Medical Illustration; D008875:Middle Aged; D057240:Patient Preference / Q000523:psychology*; D016032:Randomized Controlled Trials as Topic; D012306:Risk