title: Evaluation of risk communication in a mammography patient decision aid.
abstract: We characterized patients' comprehension, memory, and impressions of risk communication messages in a patient decision aid (PtDA), Mammopad, and clarified perceived importance of numeric risk information in medical decision making.
  
  
  
  Participants were 75 women in their forties with average risk factors for breast cancer. We used mixed methods, comprising a risk estimation problem administered within a pretest-posttest design, and semi-structured qualitative interviews with a subsample of 21 women.
  
  
  
  Participants' positive predictive value estimates of screening mammography improved after using Mammopad. Although risk information was only briefly memorable, through content analysis, we identified themes describing why participants value quantitative risk information, and obstacles to understanding. We describe ways the most complicated graphic was incompletely comprehended.
  
  
  
  Comprehension of risk information following Mammopad use could be improved. Patients valued receiving numeric statistical information, particularly in pictograph format. Obstacles to understanding risk information, including potential for confusion between statistics, should be identified and mitigated in PtDA design.
  
  
  
  Using simple pictographs accompanied by text, PtDAs may enhance a shared decision-making discussion. PtDA designers and providers should be aware of benefits and limitations of graphical risk presentations. Incorporating comprehension checks could help identify and correct misapprehensions of graphically presented statistics.
authors.affiliation: Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, USA. Electronic address: kleinkr@ohsu.edu.
authors.forename: Krystal A
authors.initials: KA
authors.lastname: Klein
authors.affiliation: Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, USA. Electronic address: watsolin@ohsu.edu.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Watson
authors.affiliation: Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, USA. Electronic address: ash@ohsu.edu.
authors.forename: Joan S
authors.initials: JS
authors.lastname: Ash
authors.affiliation: Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, USA. Electronic address: edenk@ohsu.edu.
authors.forename: Karen B
authors.initials: KB
authors.lastname: Eden
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000517:prevention & control / Q000523:psychology; D003142:Communication; D032882:Comprehension; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008327:Mammography / Q000523:psychology*; D008875:Middle Aged; D018802:Patient-Centered Care; D011237:Predictive Value of Tests; D036301:Qualitative Research; D012306:Risk; D016387:Women's Health
keywords: Mammography; Patient decision aid; Risk communication; Women’s health