Seeing Is Believing: For Patients, Make Data Visual and Graphic

Upper Nyack, New York-based CreakyJoints, part of the nonprofit Global Healthy Living Foundation which provides multiple educational resources to patients and their families free of charge, announced the publication of “The Impact of Information Presentation Format on Preference for Total Knee Replacement Surgery,” which appears in the March 19, 2019 edition of Arthritis Care & Research.

Co-author Liana Fraenkel, M.D., M.P.H., Yale School of Medicine, explained how they recruited participants for this unusual study to OTW, “Our study included participants recruited via email from the CreakyJoints member database and Facebook page, who were then randomized into four groups. All groups reviewed the ‘numeric option,’ which explained the risks and benefits of joint surgery using language and numbers, only.”

The researchers, then, designed a test of how patients receive, process and remember the information that their doctors present to them. Here are the three pieces of raw information that Dr. Fraenkel and her colleagues presented to the study participants.

1. Most patients (about 42 in 50) do great. They have significant pain relief and are very satisfied with the surgery. These patients would have the surgery again without hesitation.
2. Some patients (about 7 in 50) don’t do as well as they expected. They continue to have a fair amount of pain and are not very satisfied with the surgery. They don’t think they would have this surgery again if they had bad arthritis in their other knee.
3. A few patients (about 1 in 50) have a serious complication after the surgery (such as an infection in the replaced knee). These patients regret having had the surgery.

Then, Fraenkel and her team changed the visual formats of the three factoids for three of the four groups, to wit:

• Group one: These patients only reviewed the numeric option.
• Group two: These patients read the numeric option and reviewed an icon array. The icon array depicted people who do great in blue, people who do not do as well as expected in orange, and people who have a serious complication in black.
• Group three: After reading the numeric option, group three reviewed a set of randomly sorted stock images of real people looking happy (42), sad (7), or with a complication (1).
• Group four: Following the numeric option, these patients viewed a donut-shaped figure with blue, orange, and black sections sized to represent the corresponding number of people who do great, do not do as well as expected, or have a serious complication, respectively. The spinner was programmed to rotate with a limited-range, randomly generated, initial speed after being clicked on by the participant. A constant damping factor was applied, and the spinner gradually reached a minimum speed. When the spin was completed, the participant could spin again.

According to Dr. Fraenkel, “Our study found that all patients who viewed visual information—the icon array, the images or the spinner—had a greater preference for total knee replacement than people who read the numeric option only.”

“Further, people in groups two, three and four, particularly those in group two who viewed the icon array, had more knowledge (remembered more) about the risk for different outcomes.”

“Ultimately, patients make the decision about whether and when to have surgery. But focus groups have demonstrated that patients don’t realize that they are in a position to evaluate specific aspects of joint replacement surgery such as markers of a surgeon’s success (such as readmission rates following arthroplasty), the rationale for using one device over another, or the relative risk and benefit for surgery success.”

“If we can build tools and provide education that helps patients weigh their options, then we’re providing better, more patient-centered health care.”