How can we display benefits and risks?

Why is there a need to represent benefits and risks visually?

Patients should be actively involved in choosing the best treatment for their medical condition(s). Different treatments might vary in how well they do (i.e. the benefits) and their side effects (i.e. the risks).

In order for patients to make decisions it is important that they understand the benefits and risks. To address this, we are looking at how information on benefits and risks can be communicated directly to patients and the public and how well they understand it.

Visual displays are a useful means of presenting health information. There are a wide variety of styles (see examples below) which may suit different communication needs. More information is needed about which formats can be most effective for different purposes and circumstances, and for the diverse needs and preferences of patients and members of the public.

The use of appropriate visual displays to communicate benefits and risks will likely provide more transparency and insight into the benefit-risk balance, and consequently better informed decision-making.

Which formats of display can be used?

There are a variety of display formats that can be used to communicate benefit-risk information: graphical/illustration and non-graphical. This section focusses on the use of graphical/illustration display formats. During our project, we learned that current use of visual displays in benefit-risk communication in regulatory setting is minimal. Texts and tables are used most commonly, but are still sparse. It is acceptable practice, but it is also insufficient and less efficient when compared to using other display formats. Different formats of visual displays can induce other visual perception advantages that may influence decisions.

When should visual displays be used?

Arguably, visual displays should be used throughout the entire benefit-risk assessment. See recommendations section.

1. 1. In the first stage of a benefit-risk assessment, outlines of the relevant benefits and risks can be made available without any numeric data, where one can focus on the format itself and specifically on the assessment criteria.
2. 2. In the second stage, data relevant to the benefit-risk assessment are can be shown explicitly, where one can appreciate, as well as scrutinise, the strength of the available evidence.
3. 3. In the third stage, a benefit-risk assessor or analyst could present visual displays related to the benefit-risk balance of the medicine in question (and also other treatment options). One can compare between options at this stage much easier than at the earlier stages because the efficacy and safety data have been summarised further.
4. 4. In the last stage, the uncertainty about the benefit-risk balance can be presented to demonstrate that any results are not always concrete, and that different people may experience different effects from the same medications.

Who will gain from displaying benefits and risks visually?

Who will gain from displaying benefits and risks visually? Displaying benefits and risks visually may provide an added-value to many people. Visual displays help to increase the transparency and the clarity of the problems, as well as the decisions to be made. Well-designed visual displays are time effective. They affect individual’s perception and comprehension in different ways, and may be driven by the emotions and feelings. The perceived benefit-risk balance is therefore better guided by past experience, knowledge and understanding. These allow decision-maker, such as a patient, to be in control and feel more confident when making decisions about medical treatments.

How did we measure preferences for visual display formats?

Other similar studies focus on how well patients and public understand the information on display. Often, the ability to correctly perceive numerical information from graphs (verbatim knowledge), and the ability to identify the essential point of the information presented (gist knowledge). Some studies also tested which visual displays were perceived as more “effective”, “helpful,” and “trustworthy” in presenting benefit-risk information.

We conducted an online survey to evaluate the preferences of visual formats from people who are obese or had been obese in the past, and healthcare professionals. We created hypothetical interventions where, for weight loss drugs, only one drug is superior in every aspect. By doing so, we would be able to tell whether participants correctly understood the visual displays. We also specifically asked participants to rate the visual displays using a 5-point rating system on whether a visual display is “effective”, “helpful” and “trustworthy” when presenting benefit-risk information.