Perceived risk of tamoxifen side effects: A study of the use of absolute frequencies or frequency bands, with or without verbal descriptors

Knapp, Peter; Gardner, Peter; Raynor, David K.; Woolf, Elizabeth; McMillan, Brian

doi:10.1016/j.pec.2009.10.002

Cited by 28 publications

(32 citation statements)

References 17 publications

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“…Levels of variance on the risk estimates among the sample were high (see standard deviations in Tables and ), as noted in previous studies . Variance was higher in risk estimates from the combined verbal and numerical terms, although the differences were not tested statistically.…”

Section: Resultssupporting

confidence: 49%

“…However, empirical support for patients’ understanding of combined verbal and numerical expressions is lacking and a concern is that is the inclusion of the verbal term may ‘frame’ patients’ understanding of the risk expression, leading to overestimation . The recommended combined expression was evaluated in a previous, similar study and found some increased risk estimates by comparison with numerical frequency bands only . However, that study did not assess the full range of EMA risk expressions and also had a relatively small sample, which might have masked true effects.…”

Section: Introductionmentioning

confidence: 99%

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Combined verbal and numerical expressions increase perceived risk of medicine side‐effects: a randomized controlled trial of EMA recommendations

Knapp

Gardner

Woolf

2015

Health Expectations

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Section: Resultssupporting

confidence: 49%

Section: Introductionmentioning

confidence: 99%

Combined verbal and numerical expressions increase perceived risk of medicine side‐effects: a randomized controlled trial of EMA recommendations

Knapp

Gardner

Woolf

2015

Health Expectations

Self Cite

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“…three in 100 people will experience a side‐effect) has led to increased consumer satisfaction in comparison with verbal descriptor use and have on the whole supported more accurate consumer risk estimates compared with frequency bands (e.g. less than 1 in 100 people but more than 1 in 1000 people will experience a side‐effect) . However, consensus has not been reached on a superior numerical descriptor that promotes accurate consumer understanding.…”

Section: Introductionmentioning

confidence: 99%

Exploring consumer opinions on the presentation of side‐effects information in Australian Consumer Medicine Information leaflets

Tong

Raynor

Blalock

et al. 2014

Health Expectations

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BackgroundConsumer Medicine Information (CMI) is a brand‐specific and standardized source of written medicine information available in Australia for all prescription medicines. Side‐effect information is poorly presented in CMI and may not adequately address consumer information needs.ObjectiveTo explore consumer opinions on (i) the presentation of side‐effect information in existing Australian CMI leaflets and alternative study‐designed CMIs and (ii) side‐effect risk information and its impact on treatment decision making.DesignFuzzy trace, affect heuristic, frequency hypothesis and cognitive‐experiential theories were applied when revising existing CMI side‐effects sections. Together with good information design, functional linguistics and medicine information expertise, alternative ramipril and clopidogrel CMI versions were proposed. Focus groups were then conducted to address the study objectives.Participants and settingThree focus groups (n = 18) were conducted in Sydney, Australia. Mean consumer age was 58 years (range 50–65 years), with equal number of males and females.ResultsAll consumers preferred the alternative CMIs developed as part of the study, with unequivocal preference for the side‐effects presented in a simple tabular format, as it allowed quick and easy access to information. Consumer misunderstandings reflected literacy and numeracy issues inherent in consumer risk appraisal. Many preferred no numerical information and a large proportion preferred natural frequencies.ConclusionsOne single method of risk presentation in CMI is unable to cater for all consumers. Consumer misunderstandings are indicative of possible health literacy and numeracy factors that influence consumer risk appraisal, which should be explored further.

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“…This approach has been used successfully in previous research. [125][126][127] Findings broadly indicate that comprehension of the information is improved, particularly for people with low numeracy. 128 Furthermore, the same study suggested that evaluative categories can increase deliberative processing of the numerical information.…”

Section: Numerical Informationmentioning

confidence: 89%

Testing innovative strategies to reduce the social gradient in the uptake of bowel cancer screening: a programme of four qualitatively enhanced randomised controlled trials

Raine

Atkin

Wagner

et al. 2017

Programme Grants Appl Res

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Objective: To reduce socioeconomic inequalities in uptake of the NHS BCSP ’ s guaiac faecal occult blood test (gFOBt) without compromising uptake in any socioeconomic group. Design: Workstream 1 explored psychosocial determinants of non-uptake of gFOBt in focus groups and interviews. Workstream 2 developed and tested four theoretically based interventions: (1) ‘ gist ’ information, (2) a ‘ narrative ’ leaflet, (3) ‘ general practice endorsement ’ (GPE) and (4) an ‘ enhanced reminder ’ (ER). Workstream 3 comprised four national cluster randomised controlled trials (RCTs) of the cost-effectiveness of each intervention. Methods: Interventions were co-designed with user panels, user tested using interviews and focus groups, and piloted with postal questionnaires. RCTs compared ‘ usual care ’ (existing NHS BCSP invitations) with usual care plus each intervention. The four trials tested: (1) ‘ gist ’ leaflet ( n = 163,525), (2) ‘ narrative ’ leaflet ( n = 150,417), (3) GPE on the invitation letter ( n = 265,434) and (4) ER ( n = 168,480). Randomisation was based on day of mailing of the screening invitation. The Index of Multiple Deprivation (IMD) score associated with each individual ’ s home address was used as the marker of socioeconomic circumstances (SECs). Change in the socioeconomic gradient in uptake (interaction between treatment group and IMD quintile) was the primary outcome. Screening uptake was defined as the return of a gFOBt kit within 18 weeks of the invitation that led to a ‘ definitive ’ test result of either ‘ normal ’ (i.e. no further investigation required) or ‘ abnormal ’ (i.e. requiring referral for further testing). Difference in overall uptake was the secondary outcome. Results: The gist and narrative trials showed no effect on the SECs gradient or overall uptake (57.6% and 56.7%, respectively, compared with 57.3% and 58.5%, respectively, for usual care; all p -values > 0.05). GPE showed no effect on the gradient ( p = 0.5) but increased overall uptake [58.2% vs. 57.5% in usual care, odds ratio (OR) = 1.07, 95% confidence interval (CI) 1.04 to 1.10; p < 0.0001]. ER showed a significant interaction with SECs ( p = 0.005), with a stronger effect in the most deprived IMD quintile (14.1% vs. 13.3% in usual care, OR = 1.11, 95% CI 1.04 to 1.20; p = 0.003) than the least deprived (34.7% vs. 34.9% in usual care OR = 1.00, 95% CI 0.94 to 1.06; p = 0.98), and higher overall uptake (25.8% vs. 25.1% in usual care, OR = 1.07, 95% CI 1.03 to 1.11; p = 0.001). All interventions were inexpensive to provide. Limitations: In line with NHS policy, the gist and narrative leaflets supplemented rather than replaced existing NHS BCSP information. This may have undermined their effect. Conclusions: Enhanced reminder reduced the gradient and modestly increased overall uptake, whereas GPE increased overall uptake but did not reduce the gradient. Therefore, given their effectiveness and very low cost, the findings suggest that implementation of both by the NHS BCSP would be beneficial. The gist and narrative results hig...

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Perceived risk of tamoxifen side effects: A study of the use of absolute frequencies or frequency bands, with or without verbal descriptors

Cited by 28 publications

References 17 publications

Combined verbal and numerical expressions increase perceived risk of medicine side‐effects: a randomized controlled trial of EMA recommendations

Combined verbal and numerical expressions increase perceived risk of medicine side‐effects: a randomized controlled trial of EMA recommendations

Exploring consumer opinions on the presentation of side‐effects information in Australian Consumer Medicine Information leaflets

Testing innovative strategies to reduce the social gradient in the uptake of bowel cancer screening: a programme of four qualitatively enhanced randomised controlled trials

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