Zikmund Fisher - Columbia Public Health · 2018. 5. 10. · Zikmund-Fisher BJ, Scherer AM, Witteman...
Transcript of Zikmund Fisher - Columbia Public Health · 2018. 5. 10. · Zikmund-Fisher BJ, Scherer AM, Witteman...
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Creating Visual Context for Hard-to-Evaluate Data
Brian J. Zikmund-Fisher, PhD
University of Michigan Department of Health Behavior & Health Education
Department of Internal Medicine Center for Bioethics & Social Sciences in Medicine
Health Informatics Program @bzikmundfisher
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Evaluability of Risk Information
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Imagine Robert
Your 10-year risk of cardiovascular disease is:
11.22%
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“Am I at high risk,
or not?”
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Evaluability of Laboratory Test Results
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Can Patients Use This?
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What Is Out of Range?
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“Am I at risk,
or not?”
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Problem #1: Numbers
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Problem #2: Lack of Meaning
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So now what? What can we do to help?
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Step 1: Visual information
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Robert’s Risk
Created at iconarray.com
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Tables
Zikmund-Fisher BJ, et al. Graphics help patients distinguish between urgent and non-urgent deviations in laboratory test results. Journal of the American Medical Informatics Association 2017;24(3):520-528.
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Table vs. Number Line
Zikmund-Fisher BJ, et al. Graphics help patients distinguish between urgent and non-urgent deviations in laboratory test results. Journal of the American Medical Informatics Association 2017;24(3):520-528.
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Lines with More Meaning
Zikmund-Fisher BJ, et al. Graphics help patients distinguish between urgent and non-urgent deviations in laboratory test results. Journal of the American Medical Informatics Association 2017;24(3):520-528.
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Near-Normal Results vs. Extreme Results
Near-Normal
Extreme
Zikmund-Fisher BJ, et al. Graphics help patients distinguish between urgent and non-urgent deviations in laboratory test results. Journal of the American Medical Informatics Association 2017;24(3):520-528.
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Step 2: Gist-full information
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Fuzzy Trace Theory (Brainerd and Reyna, 1995)
Verbatim memory
Gist
What the heck is “gist”?
vs
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Know Your “Commander’s
Intent”
Heath & Heath, Made to Stick, 2007
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Cancer Screening Test Decisions
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Colorectal Cancer Screening
… at age 50
… vs. at age 75 (with multiple comorbidities)
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Benefits vs. Harms
Image from study materials for “Promoting Veteran-Centered Colorectal Cancer Screening” (I01 HX001278-01); SD Saini, PI.
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Gist Processing
Image from study materials for “Promoting Veteran-Centered Colorectal Cancer Screening” (I01 HX001278-01); SD Saini, PI.
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Test Results for Diagnosed Patients
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Goals for Test Results
Scherer AM, Witteman HO, Solomon J, Fagerlin A, Exe NL, Zikmund-Fisher BJ. Improving understanding of test results by substituting (not adding) goal ranges. Poster presentation to the Society for Medical Decision Making, Vancouver, BC, Canada, October 23, 2016.
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Goals for Test Results
Scherer AM, Witteman HO, Solomon J, Fagerlin A, Exe NL, Zikmund-Fisher BJ. Improving understanding of test results by substituting (not adding) goal ranges. Poster presentation to the Society for Medical Decision Making, Vancouver, BC, Canada, October 23, 2016.
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Goals for Test Results
Scherer AM, Witteman HO, Solomon J, Fagerlin A, Exe NL, Zikmund-Fisher BJ. Improving understanding of test results by substituting (not adding) goal ranges. Poster presentation to the Society for Medical Decision Making, Vancouver, BC, Canada, October 23, 2016.
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Test Results for Monitoring
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Harms
Alanine Aminotransferase (ALT):
80 IU/L
Standard Range: 10-40
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Showing the Possible Range
Zikmund-Fisher BJ, Scherer AM, Witteman HO, Solomon J, Exe NL, Fagerlin A. Providing harm anchors in visual displays of test results can mitigate patient perceptions of urgency about near-normal values. Journal of Medical Internet Research, 2018.
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Harm Anchors
“Many doctors are not concerned until here”
Zikmund-Fisher BJ, Scherer AM, Witteman HO, Solomon J, Exe NL, Fagerlin A. Providing harm anchors in visual displays of test results can mitigate patient perceptions of urgency about near-normal values. Journal of Medical Internet Research, 2018.
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Increased Sensitivity with Harm Anchors
1
2
3
4
5
6
Near Value Extreme Value
Per
ceiv
ed A
larm
Simple Harm Anchor
Zikmund-Fisher BJ, Scherer AM, Witteman HO, Solomon J, Exe NL, Fagerlin A. Providing harm anchors in visual displays of test results can mitigate patient perceptions of urgency about near-normal values. Journal of Medical Internet Research, 2018.
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“We need to design for the way people ARE,
not the way we wish they were”
- Holly O. Witteman
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People only process or remember
one thing
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Use context to create ONE message
based on THEIR needs
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