Quantitative versus qualitative risk framing in patient decision aids for dysplastic nevi: A randomized A/B testing study - 19/05/26
Abstract |
Background |
Patient decision aids (PDAs) support shared decision-making by presenting treatment options clearly and objectively. However, little is known about how risk framing and diagnostic severity labels influence patient preferences in dermatology.
Objective |
Assess how PDA format (quantitative vs qualitative) and dysplastic nevus severity (mild, moderate, or severe) affect understanding, risk perception, confidence, and treatment intent.
Methods |
In this randomized A/B testing design, 600 US adults viewed a quantitative or qualitative PDA describing a mild, moderate, or severe dysplastic nevus scenario. Self-reported outcomes included understanding, treatment selection (excision vs monitoring), satisfaction, decision-making confidence, perceived melanoma risk, and concern. Analyses used nonparametric tests and logistic regression.
Results |
Quantitative PDAs improved self-reported understanding (median 80 vs 72; P = .008) and confidence ( P = .003) and lowered perceived melanoma risk for monitoring ( P = .003) and excision ( P < .001), but did not change excision intent (52% vs 53%; odds ratio 1.04, 95% CI 0.75-1.43; P = .818). Dysplastic nevus severity significantly increased excision intent (31% mild, 41% moderate, 72% severe; P < .001), without affecting understanding.
Conclusion |
Quantitative PDAs enhance comprehension, yet diagnostic severity labels predominantly drive treatment intent. Approximately one-third of participants diverged from expert recommendations despite high comprehension, underscoring that individual values drive treatment choices.
Le texte complet de cet article est disponible en PDF.Key words : atypical nevi, comprehension, dysplastic nevi, framing effect, melanoma risk, patient decision aids, risk communication, risk perception, shared decision-making
Abbreviations used : DN, OR, PDA, Ql, Qn, SDM
Plan
| Authors Roland-McGowan and Ose contributed equally to the work. |
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| Funding sources: This work was supported by a Medical Student Research Grant from the Melanoma Research Foundation (Award ID 1028856 ), the National Center for Advancing Translational Sciences of the National Institutes of Health Award ( UL1TR002369 ), and a Dermatology Foundation Diversity Research Supplement Award (Fall 2024 Cycle) to Ms Roland-McGowan, both of which directly supported the conduct of this project. Dr Yu is supported by a VA Career Development Award ( 1IK2CX002642-01A1 ), a U.S. Department of Defense CDMRP Award ( W81XWH-21-1-0818 ), and a Kuni Foundation Cancer Discovery Grant. |
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| Patient consent: Not applicable. |
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| IRB approval status: Reviewed and approved by OHSU IRB; approval # 00027888. |
Vol 94 - N° 6
P. 1697-1704 - juin 2026 Retour au numéro
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