title: A new graphical format to communicate treatment effects to patients-A web-based randomized controlled trial.
abstract: Patients making treatment decisions require understandable evidence-based information. However, evidence on graphical presentation of benefits and side-effects of medical treatments is not conclusive. The study evaluated a new space-saving format, CLARIFIG (clarifying risk figures), aiming to facilitate accuracy of comprehension.
  
  
  
  CLARIFIG displays groups of patients with and without treatment benefits as coloured sectors of a proportional bar graph representing in total 100 patients. Supplementary icons indicate the corresponding group's actual condition. The study used an application showing effects of immunotherapy intended to slow disease progression in multiple sclerosis (MS). In a four-arm web-based randomized controlled trial, CLARIFIG was compared to the reference standard, multifigure pictographs (MFP), regarding comprehension (primary outcome) and processing time. Both formats were presented as static and animated versions. People with MS were recruited through the website of the German MS society.
  
  
  
  Six hundred and eighty-two patients were randomized and analysed for the primary end point. There were no differences in comprehension rates (MFPstatic=46%, CLARIFIGstatic=44%; P=.59; MFPanimated=23%, CLARIFIGanimated=30%; P=.134). Processing time for CLARIFIG was shorter only in the animated version (MFPstatic=162 seconds, CLARIFIGstatic=155 seconds; P=.653; MFPanimated=286 seconds, CLARIFIGanimated=189 seconds; P≤.001). However, both animated versions caused more wrong answers and longer processing time than static presentation (MFPstaticvsanimated: P≤.001/.001, CLARIFIGstaticvsanimated: P=.027/.017).
  
  
  
  Comprehension of the new format is comparable to MFP. CLARIFIG has the potential to simplify presentation in more complex contexts such as comparison of several treatment options in patient decision aids, but further studies are needed.
authors.affiliation: Department of Health and Caring Sciences, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway.|Division of Internal Medicine, University Hospital of Northern Norway, Tromsø, Norway.|Unit of Health Sciences and Education, MIN Faculty, University of Hamburg, Hamburg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Kasper
authors.affiliation: Institute on Didactics in Medicine, Michelstadt, Germany.
authors.forename: Adrian
authors.initials: A
authors.lastname: van de Roemer
authors.affiliation: Department of Neurology, Institute for Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Jana
authors.initials: J
authors.lastname: Pöttgen
authors.affiliation: Unit of Health Sciences and Education, MIN Faculty, University of Hamburg, Hamburg, Germany.|Department of Neurology, Institute for Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Anne
authors.initials: A
authors.lastname: Rahn
authors.affiliation: Department of Neurology, Institute for Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Imke
authors.initials: I
authors.lastname: Backhus
authors.affiliation: Department of Neurology, Institute for Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Yasemin
authors.initials: Y
authors.lastname: Bay
authors.affiliation: Institute of Social Medicine and Epidemiology, University of Lübeck, Lübeck, Germany.
authors.forename: Sascha
authors.initials: S
authors.lastname: Köpke
authors.affiliation: Department of Neurology, Institute for Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Heesen
mesh_terms: D000328:Adult; D003142:Communication; D003196:Computer Graphics / Q000706:statistics & numerical data*; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D010353:Patient Education as Topic; D057240:Patient Preference; D018570:Risk Assessment
keywords: evidence based medicine; medical decision making; multiple sclerosis; patient education; patient preference