title: Communicating patient-reported outcome scores using graphic formats: results from a mixed-methods evaluation.
abstract: BACKGROUND
  Patient-reported outcomes (PROs) promote patient-centered care by using PRO research results ("group-level data") to inform decision making and by monitoring individual patient's PROs ("individual-level data") to inform care. We investigated the interpretability of current PRO data presentation formats.
  
  
  METHODS
  This cross-sectional mixed-methods study randomized purposively sampled cancer patients and clinicians to evaluate six group-data or four individual-data formats. A self-directed exercise assessed participants' interpretation accuracy and ratings of ease-of-understanding and usefulness (0 = least to 10 = most) of each format. Semi-structured qualitative interviews explored helpful and confusing format attributes.
  
  
  RESULTS
  We reached thematic saturation with 50 patients (44 % < college graduate) and 20 clinicians. For group-level data, patients rated simple line graphs highest for ease-of-understanding and usefulness (median 8.0; 33 % selected for easiest to understand/most useful) and clinicians rated simple line graphs highest for ease-of-understanding and usefulness (median 9.0, 8.5) but most often selected line graphs with confidence limits or norms (30 % for each format for easiest to understand/most useful). Qualitative results support that clinicians value confidence intervals, norms, and p values, but patients find them confusing. For individual-level data, both patients and clinicians rated line graphs highest for ease-of-understanding (median 8.0 patients, 8.5 clinicians) and usefulness (median 8.0, 9.0) and selected them as easiest to understand (50, 70 %) and most useful (62, 80 %). The qualitative interviews supported highlighting scores requiring clinical attention and providing reference values.
  
  
  CONCLUSIONS
  This study has identified preferences and opportunities for improving on current formats for PRO presentation and will inform development of best practices for PRO presentation. Both patients and clinicians prefer line graphs across group-level data and individual-level data formats, but clinicians prefer greater detail (e.g., statistical details) for group-level data.
authors.affiliation: Queen's Cancer Research Institute, Queen's University, 10 Stuart St, Level 2, Kingston, ON, K7L 3N6, Canada. michael.brundage@krcc.on.ca.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Brundage
authors.affiliation: Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 1650 Orleans St, Baltimore, MD, 21287, USA.|Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA.
authors.forename: Katherine C
authors.initials: KC
authors.lastname: Smith
authors.affiliation: Division of General Internal Medicine, Johns Hopkins School of Medicine, 624 N. Broadway, Baltimore, MD, 21205, USA.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Little
authors.affiliation: Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 1650 Orleans St, Baltimore, MD, 21287, USA.
authors.forename: Elissa T
authors.initials: ET
authors.lastname: Bantug
authors.affiliation: Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 1650 Orleans St, Baltimore, MD, 21287, USA.|Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA.|Division of General Internal Medicine, Johns Hopkins School of Medicine, 624 N. Broadway, Baltimore, MD, 21205, USA.
authors.forename: Claire F
authors.initials: CF
authors.lastname: Snyder
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D018802:Patient-Centered Care / Q000706:statistics & numerical data*; D011788:Quality of Life
keywords: Clinical practice; Clinical trials; Communication; Patient-reported outcomes