Research Collection. Medical Risk Communication and Decision Making: Results of Eye Tracking Studies. Doctoral Thesis. ETH Library
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1 Research Collection Doctoral Thesis Medical Risk Communication and Decision Making: Results of Eye Tracking Studies Author(s): Kreuzmair, Christina Publication Date: 2015 Permanent Link: This page was generated automatically upon download from the ETH Zurich Research Collection. For more information please consult the Terms of use. ETH Library
2 DISS. ETH NO MEDICAL RISK COMMUNICATION AND DECISION MAKING: RESULTS OF EYE TRACKING STUDIES A thesis submitted to attain the degree of DOCTOR OF SCIENCES of ETH ZURICH (Dr. sc. ETH Zurich) presented by CHRISTINA MARIA KREUZMAIR Dipl.-Psych. Univ., Ludwig Maximilian University of Munich born July 26 th, 1987 in Landshut, Germany accepted on the recommendation of Prof. Dr. Michael Siegrist Dr. Carmen Keller Prof. Dr. Wolfgang Gaissmaier 2015
3 iii Summary The understanding of numerical risk and benefit information in the medical context is the most important precondition for patients to make informed decisions in accordance with their preferences and values. Physicians are challenged with the communication of medical risk information to patients in easily understandable ways as the understanding of numerical information is determined by people s numerical abilities. To address difficulties in understanding numerical medical risk information that are especially experienced by low numerates, graphical formats have been recommended for medical risk communication. Pictographs in particular should be used since high and particularly low numerates benefit from this graphical risk communication format in risk comprehension and decision making. However, it is not clarified why this format is comprehended better than other graphical formats and can help to prevent patients from being biased by other factors. Therefore, in several eye tracking studies this thesis investigates the information processing strategies underlying medical risk communications with pictographs in dependence of numeracy. The introducing Chapter I gives a general overview of the topics medical risk communication, numeracy, risk communication formats, information processing approaches, and eye tracking. In Chapters II to IV the information processing of numerical and pictorial medical risk information is covered. The intuitive focus of high and low numerates on numerical and graphical risk information is investigated. Furthermore, the processing strategies of pictographs and the effect of different icon types in pictographs are examined in dependence of numeracy. Results suggest that the pictograph is a beneficial format for medical risk communication with high and especially low numerates. This format attracts especially low numerates attention in the first, intuitive phase of numerical information processing and allows them to process it further (Chapter II). Moreover, the pictograph allows both high and low numerates to use their default processing strategies for getting the gist (Chapter III) and it is shown that the concreteness of icons in pictographs has advantages for medical risk communication (Chapter IV). To conclude, the studies conducted within this thesis provide evidence that pictographs are useful for medical risk communication with high and especially low numerates as both can draw affective meaning from them. As the results of the presented studies are based on hypothetical medical scenarios, the emotional arousal of hypothetical medical scenarios is investigated with the help of pupil dilation (Chapter V). The results show that even simple hypothetical medical scenarios evoke emotional arousal and therefore, the results have enough predictive accuracy to be generalized to real life situations. In the final chapter (Chapter VI), the central findings of the presented studies are discussed in light of
4 iv possible limitations, suggestions for future research perspectives, and risk communication practice. The findings of this thesis aim to help physicians to improve and tailor medical risk communication by addressing the specific information processing strategies of high and low numerates for enabling them to make an informed decision according to their preferences and values.
5 v Zusammenfassung Das Verständnis numerischer Risiko- und Nutzeninformation ist die wichtigste Voraussetzung für Patienten, um fundierte Entscheidungen im medizinischen Kontext in Übereinstimmung mit ihren Präferenzen und Werten treffen zu können. Ärzten ist daher empfohlen, medizinische Risikoinformation in leicht verständlicher Weise zu kommunizieren. Da die numerischen Fähigkeiten (Numeracy) für das Verständnis numerischer Informationen ausschlaggebend sind, können vor allem bei Personen mit geringer Numeracy Schwierigkeiten im Verständnis von numerischen Informationen auftreten. Um solche Verständnisprobleme zu verringern, werden verschiedene graphische Formate für die medizinische Risikokommunikation vorgeschlagen. Insbesondere Piktogramme sollten eingesetzt werden, da sowohl Personen mit hoher als auch geringer Numeracy von diesem graphischen Format bei Risikoeinschätzungen und Entscheidungsfindungen profitieren können. Es ist jedoch zu klären, warum Piktogramme besser als andere graphische Formate verstanden werden und wie sie verarbeitet werden. Im Rahmen dieser Dissertation werden daher in mehreren Eye-Tracker Studien die Strategien zur Verarbeitung medizinischer Risikokommunikation in Piktogrammen in Abhängigkeit der Numeracy untersucht. Das einleitende Kapitel I gibt einen Überblick über die Themen medizinische Risikokommunikation, Numeracy, Risikokommunikationsformate, Theorien der Informationsverarbeitung und Eye-Tracking. In den Kapiteln II bis IV wird die Informationsverarbeitung von numerischer und graphischer medizinischer Risikokommunikation behandelt. Der intuitive Fokus von Personen mit hoher und geringer Numeracy auf numerische und graphische Risikoinformation wird untersucht. Zudem wird erforscht, mit welchen Strategien Piktogramme in Abhängigkeit der Numeracy verarbeitet werden und welche Icon-Typen (z. B. einfache Kästchen oder bildliche männliche und weibliche Symbole) in Piktogrammen verwendet werden sollten. Die Ergebnisse der Studien legen nahe, dass Piktogramme ein nützliches Format für die medizinische Risikokommunikation für Personen mit hoher, aber insbesondere auch für Personen mit geringer Numeracy, sind. In der ersten, intuitiven Phase der numerischen Informationsverarbeitung lenkt dieses Format besonders die Aufmerksamkeit von Personen mit geringer Numeracy auf sich und ermöglicht es diesen, die graphisch dargestellten numerischen Informationen weiter zu verarbeiten (Kapitel II). Darüber hinaus bieten Piktogramme die Möglichkeit, dass Personen unabhängig von ihrer Numeracy ihre präferierten Verarbeitungsstrategien verwenden können, um die dargestellte numerische Risikoinformation zu verarbeiten (Kapitel III). Zudem konnte gezeigt werden, dass bildliche Icons in Piktogrammen (z. B. männliche und weibliche Symbole) Vorteile für
6 vi die medizinische Risikokommunikation bieten (Kapitel IV). Die Studien, die im Rahmen dieser Dissertation durchgeführt worden sind, zeigen, dass Piktogramme für die medizinische Risikokommunikation mit Personen von hoher und besonders auch von geringer Numeracy verwendet werden sollten, weil sie unabhängig von der Numeracy verstanden werden. Des Weiteren wird die emotionale Erregung durch hypothetische medizinische Szenarien mittels Pupillenerweiterung untersucht, da die Ergebnisse der vorgestellten Studien auf solchen basieren (Kapitel V). Die Ergebnisse zeigen, dass bereits einfache hypothetische medizinische Szenarien emotionale Erregungen hervorrufen können und diese deshalb ausreichend prädiktive Genauigkeit für reelle Situationen haben. Im abschliessenden Kapitel (Kapitel VI) werden die zentralen Erkenntnisse der vorgestellten Studien in Hinblick auf mögliche Einschränkungen, Anregungen für zukünftige Forschungsperspektiven und die Praxisanwendung in der medizinischen Risikokommunikation diskutiert. Die Ergebnisse dieser Dissertation ermöglichen es Ärzten medizinische Risikokommunikation zu verbessern und anzupassen. Dabei sollten die spezifischen Verarbeitungsstrategien von Personen mit hoher und geringer Numeracy berücksichtigt werden, um Personen fundierte Entscheidungen in Übereinstimmung mit den eigenen Präferenzen und Werten zu ermöglichen.
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