{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T13:33:48Z","timestamp":1774445628675,"version":"3.50.1"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,8,25]],"date-time":"2021-08-25T00:00:00Z","timestamp":1629849600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,8,25]],"date-time":"2021-08-25T00:00:00Z","timestamp":1629849600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Inform Decis Mak"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Understanding prognostic information can help patients know what may happen to their health over time and make informed decisions. However, communicating prognostic information well can be challenging.<\/jats:p><\/jats:sec><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To conduct a systematic review to identify and synthesize research that has evaluated visual presentations that communicate quantitative prognostic information to patients or the public.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data sources<\/jats:title><jats:p>MEDLINE, EMBASE, CINAHL,<jats:bold>PsycINFO<\/jats:bold>, ERIC and the Cochrane Central Register of Controlled Trials (CENTRAL) (from inception to December 2020), and forward and backward citation search.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study selection<\/jats:title><jats:p>Two authors independently screened search results and assessed eligibility. To be eligible, studies required a quantitative design and comparison of at least one visual presentation with another presentation of quantitative prognostic information. The primary outcome was comprehension of the presented information. Secondary outcomes were preferences for or satisfaction with the presentations viewed, and behavioral intentions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data extraction<\/jats:title><jats:p>Two authors independently assessed risk of bias and extracted data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data synthesis<\/jats:title><jats:p>Eleven studies (all randomized trials) were identified. We grouped studies according to the presentation type evaluated. Bar graph versus pictograph (3 studies): no difference in comprehension between the groups. Survival vs mortality curves (2 studies): no difference in one study; higher comprehension in survival curve group in another study. Tabular format versus pictograph (4 studies): 2 studies reported similar comprehension between groups; 2 found higher comprehension in pictograph groups. Tabular versus free text (3 studies): 2 studies found no difference between groups; 1 found higher comprehension in a tabular group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Limitations<\/jats:title><jats:p>Heterogeneity in the visual presentations and outcome measures, precluding meta-analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>No visual presentation appears to be consistently superior to communicate quantitative prognostic information.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s12911-021-01612-9","type":"journal-article","created":{"date-parts":[[2021,8,25]],"date-time":"2021-08-25T12:03:49Z","timestamp":1629893029000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Effect of different visual presentations on the comprehension of prognostic information: a systematic review"],"prefix":"10.1186","volume":"21","author":[{"given":"Eman","family":"Abukmail","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mina","family":"Bakhit","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chris","family":"Del Mar","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tammy","family":"Hoffmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,8,25]]},"reference":[{"issue":"5","key":"1612_CR1","doi-asserted-by":"publisher","first-page":"681","DOI":"10.1016\/S0277-9536(96)00221-3","volume":"44","author":"C Charles","year":"1997","unstructured":"Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Soc Sci Med. 1997;44(5):681\u201392.","journal-title":"Soc Sci Med"},{"issue":"13","key":"1612_CR2","doi-asserted-by":"publisher","first-page":"1295","DOI":"10.1001\/jama.2014.10186","volume":"312","author":"TC Hoffmann","year":"2014","unstructured":"Hoffmann TC, Montori VM, Del Mar C. The connection between evidence-based medicine and shared decision making. JAMA. 2014;312(13):1295\u20136.","journal-title":"JAMA"},{"issue":"3","key":"1612_CR3","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1007\/s10549-016-4082-7","volume":"161","author":"ST Hawley","year":"2017","unstructured":"Hawley ST, Janz NK, Griffith KA, Jagsi R, Friese CR, Kurian AW, et al. Recurrence risk perception and quality of life following treatment of breast cancer. Breast Cancer Res Treat. 2017;161(3):557\u201365.","journal-title":"Breast Cancer Res Treat"},{"key":"1612_CR4","doi-asserted-by":"crossref","unstructured":"Janssens AC, de Boer JB, van Doorn PA, van ver Ploeg HM, van ver Meche FG, Passchier J, et al. Expectations of wheelchair-dependency in recently diagnosed patients with multiple sclerosis and their partners. Eur J Neurol. 2003;10(3):287\u201393.","DOI":"10.1046\/j.1468-1331.2003.00583.x"},{"issue":"4","key":"1612_CR5","doi-asserted-by":"publisher","first-page":"749","DOI":"10.1002\/ijc.30123","volume":"139","author":"F Kendel","year":"2016","unstructured":"Kendel F, Helbig L, Neumann K, Herden J, Stephan C, Schrader M, et al. Patients\u2019 perceptions of mortality risk for localized prostate cancer vary markedly depending on their treatment strategy. Int J Cancer. 2016;139(4):749\u201353.","journal-title":"Int J Cancer"},{"key":"1612_CR6","doi-asserted-by":"crossref","unstructured":"Paladino J, Lakin JR, Sanders JJ. Communication strategies for sharing prognostic information with patients: beyond survival statistics. JAMA. 2019.","DOI":"10.1001\/jama.2019.11533"},{"key":"1612_CR7","doi-asserted-by":"crossref","unstructured":"Sisk BA, Dobrozsi S, Mack JW. Teamwork in prognostic communication: addressing bottlenecks and barriers. Pediatr Blood Cancer. 2020;67(5):e28192.","DOI":"10.1002\/pbc.28192"},{"key":"1612_CR8","doi-asserted-by":"crossref","unstructured":"van der Wal MHL, Hjelmfors L, Stromberg A, Jaarsma T. Cardiologists' attitudes on communication about prognosis with heart failure patients. ESC Heart Fail. 2020.","DOI":"10.1002\/ehf2.12672"},{"issue":"4","key":"1612_CR9","doi-asserted-by":"publisher","first-page":"270","DOI":"10.7326\/M14-0295","volume":"161","author":"DA Zipkin","year":"2014","unstructured":"Zipkin DA, Umscheid CA, Keating NL, Allen E, Aung K, Beyth R, et al. Evidence-based risk communication: a systematic review. Ann Intern Med. 2014;161(4):270\u201380.","journal-title":"Ann Intern Med"},{"issue":"6","key":"1612_CR10","doi-asserted-by":"publisher","first-page":"608","DOI":"10.1197\/jamia.M2115","volume":"13","author":"JS Ancker","year":"2006","unstructured":"Ancker JS, Senathirajah Y, Kukafka R, Starren JB. Design features of graphs in health risk communication: a systematic review. J Am Med Inform Assoc. 2006;13(6):608\u201318.","journal-title":"J Am Med Inform Assoc"},{"issue":"4","key":"1612_CR11","doi-asserted-by":"publisher","first-page":"582","DOI":"10.1177\/0018720817690634","volume":"59","author":"R Garcia-Retamero","year":"2017","unstructured":"Garcia-Retamero R, Cokely ET. Designing visual aids that promote risk literacy: a systematic review of health research and evidence-based design heuristics. Hum Factors. 2017;59(4):582\u2013627.","journal-title":"Hum Factors"},{"key":"1612_CR12","doi-asserted-by":"crossref","unstructured":"Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.","DOI":"10.1136\/bmj.d5928"},{"key":"1612_CR13","doi-asserted-by":"crossref","unstructured":"Akl EA, Oxman AD, Herrin J, Vist GE, Terrenato I, Sperati F, et al. Using alternative statistical formats for presenting risks and risk reductions. Cochrane Database Syst Rev. 2011(3):CD006776.","DOI":"10.1002\/14651858.CD006776.pub2"},{"key":"1612_CR14","doi-asserted-by":"crossref","unstructured":"Akl EA, Oxman AD, Herrin J, Vist GE, Terrenato I, Sperati F, et al. Framing of health information messages. Cochrane Database Syst Rev. 2011(12):CD006777.","DOI":"10.1002\/14651858.CD006777.pub2"},{"issue":"1","key":"1612_CR15","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1177\/0272989X0202200108","volume":"22","author":"K Armstrong","year":"2002","unstructured":"Armstrong K, Schwartz JS, Fitzgerald G, Putt M, Ubel PA. Effect of framing as gain versus loss on understanding and hypothetical treatment choices: survival and mortality curves. Med Decis Making. 2002;22(1):76\u201383.","journal-title":"Med Decis Making"},{"key":"1612_CR16","doi-asserted-by":"crossref","unstructured":"Brick C, McDowell M, Freeman ALJ. Risk communication in tables versus text: a registered report randomized trial on 'fact boxes'. R Soc Open Sci. 2020;7(3):190876.","DOI":"10.1098\/rsos.190876"},{"issue":"1","key":"1612_CR17","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1177\/0272989X14551639","volume":"35","author":"DA Hamstra","year":"2015","unstructured":"Hamstra DA, Johnson SB, Daignault S, Zikmund-Fisher BJ, Taylor JM, Larkin K, et al. The impact of numeracy on verbatim knowledge of the longitudinal risk for prostate cancer recurrence following radiation therapy. Med Decis Mak. 2015;35(1):27\u201336.","journal-title":"Med Decis Mak"},{"issue":"4","key":"1612_CR18","doi-asserted-by":"publisher","first-page":"797","DOI":"10.1111\/hex.12522","volume":"20","author":"J Kasper","year":"2017","unstructured":"Kasper J, van de Roemer A, Pottgen J, Rahn A, Backhus I, Bay Y, et al. A new graphical format to communicate treatment effects to patients\u2014a web-based randomized controlled trial. Health Expect. 2017;20(4):797\u2013804.","journal-title":"Health Expect"},{"issue":"7","key":"1612_CR19","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1177\/0272989X15587676","volume":"35","author":"D Petrova","year":"2015","unstructured":"Petrova D, Garcia-Retamero R, Cokely ET. Understanding the harms and benefits of cancer screening: a model of factors that shape informed decision making. Med Decis Mak. 2015;35(7):847\u201358.","journal-title":"Med Decis Mak"},{"issue":"1","key":"1612_CR20","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1177\/0272989X18818166","volume":"39","author":"M McDowell","year":"2019","unstructured":"McDowell M, Gigerenzer G, Wegwarth O, Rebitschek FG. Effect of tabular and icon fact box formats on comprehension of benefits and harms of prostate cancer screening: a randomized trial. Med Decis Mak. 2019;39(1):41\u201356.","journal-title":"Med Decis Mak"},{"issue":"12","key":"1612_CR21","doi-asserted-by":"publisher","first-page":"3382","DOI":"10.1002\/cncr.23959","volume":"113","author":"BJ Zikmund-Fisher","year":"2008","unstructured":"Zikmund-Fisher BJ, Fagerlin A, Ubel PA. Improving understanding of adjuvant therapy options by using simpler risk graphics. Cancer. 2008;113(12):3382\u201390.","journal-title":"Cancer"},{"issue":"1","key":"1612_CR22","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1016\/j.pec.2006.10.013","volume":"66","author":"BJ Zikmund-Fisher","year":"2007","unstructured":"Zikmund-Fisher BJ, Fagerlin A, Ubel PA. Mortality versus survival graphs: improving temporal consistency in perceptions of treatment effectiveness. Patient Educ Couns. 2007;66(1):100\u20137.","journal-title":"Patient Educ Couns"},{"issue":"6","key":"1612_CR23","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1177\/0272989X10364244","volume":"30","author":"BJ Zikmund-Fisher","year":"2010","unstructured":"Zikmund-Fisher BJ, Fagerlin A, Ubel PA. A demonstration of \u201cless can be more\u201d in risk graphics. Med Decis Mak. 2010;30(6):661\u201371.","journal-title":"Med Decis Mak"},{"key":"1612_CR24","doi-asserted-by":"crossref","unstructured":"Garcia-Retamero R, Okan Y, Cokely ET. Using visual aids to improve communication of risks about health: a review. ScientificWorldJournal. 2012;2012:562637.","DOI":"10.1100\/2012\/562637"},{"key":"1612_CR25","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1093\/oxfordjournals.jncimonographs.a024191","volume":"25","author":"IM Lipkus","year":"1999","unstructured":"Lipkus IM, Hollands JG. The visual communication of risk. J Natl Cancer Inst Monogr. 1999;25:149\u201363.","journal-title":"J Natl Cancer Inst Monogr"},{"issue":"Suppl 2","key":"1612_CR26","doi-asserted-by":"publisher","first-page":"S7","DOI":"10.1186\/1472-6947-13-S2-S7","volume":"13","author":"LJ Trevena","year":"2013","unstructured":"Trevena LJ, Zikmund-Fisher BJ, Edwards A, Gaissmaier W, Galesic M, Han PK, et al. Presenting quantitative information about decision outcomes: a risk communication primer for patient decision aid developers. BMC Med Inform Decis Mak. 2013;13(Suppl 2):S7.","journal-title":"BMC Med Inform Decis Mak"},{"issue":"7341","key":"1612_CR27","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1136\/bmj.324.7341.827","volume":"324","author":"A Edwards","year":"2002","unstructured":"Edwards A, Elwyn G, Mulley A. Explaining risks: turning numerical data into meaningful pictures. BMJ. 2002;324(7341):827\u201330.","journal-title":"BMJ"},{"issue":"5","key":"1612_CR28","doi-asserted-by":"publisher","first-page":"696","DOI":"10.1177\/0272989X07307271","volume":"27","author":"IM Lipkus","year":"2007","unstructured":"Lipkus IM. Numeric, verbal, and visual formats of conveying health risks: suggested best practices and future recommendations. Med Decis Mak. 2007;27(5):696\u2013713.","journal-title":"Med Decis Mak"},{"issue":"3","key":"1612_CR29","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1016\/S0738-3991(03)00051-X","volume":"50","author":"CE Wills","year":"2003","unstructured":"Wills CE, Holmes-Rovner M. Patient comprehension of information for shared treatment decision making: state of the art and future directions. Patient Educ Couns. 2003;50(3):285\u201390.","journal-title":"Patient Educ Couns"},{"key":"1612_CR30","unstructured":"Fischhoff B, Brewer N, Downs J. Communicating risks and benefits: an evidence based user's guide. MD: US Department of Health and Human Services, Food and Drug Administration (FDA) Silver Spring; 2011."},{"issue":"597","key":"1612_CR31","doi-asserted-by":"publisher","first-page":"213","DOI":"10.3399\/bjgp12X636236","volume":"62","author":"G Naik","year":"2012","unstructured":"Naik G, Ahmed H, Edwards AG. Communicating risk to patients and the public. Br J Gen Pract. 2012;62(597):213\u20136.","journal-title":"Br J Gen Pract"},{"issue":"6","key":"1612_CR32","doi-asserted-by":"publisher","first-page":"792","DOI":"10.1177\/0272989X12451057","volume":"32","author":"T Rakow","year":"2012","unstructured":"Rakow T, Wright RJ, Bull C, Spiegelhalter DJ. Simple and multistate survival curves: can people learn to use them? Med Decis Mak. 2012;32(6):792\u2013804.","journal-title":"Med Decis Mak"},{"issue":"3","key":"1612_CR33","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1111\/j.1539-6924.2005.00626.x","volume":"25","author":"BJ Zikmund-Fisher","year":"2005","unstructured":"Zikmund-Fisher BJ, Fagerlin A, Ubel PA. What\u2019s time got to do with it? Inattention to duration in interpretation of survival graphs. Risk Anal. 2005;25(3):589\u201395.","journal-title":"Risk Anal"},{"issue":"1","key":"1612_CR34","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1177\/0272989X9301300108","volume":"13","author":"DJ Mazur","year":"1993","unstructured":"Mazur DJ, Hickam DH. Patients\u2019 and physicians\u2019 interpretations of graphic data displays. Med Decis Mak. 1993;13(1):59\u201363.","journal-title":"Med Decis Mak"},{"issue":"5","key":"1612_CR35","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1007\/BF02599425","volume":"5","author":"DJ Mazur","year":"1990","unstructured":"Mazur DJ, Hickam DH. Interpretation of graphic data by patients in a general medicine clinic. J Gen Intern Med. 1990;5(5):402\u20135.","journal-title":"J Gen Intern Med"},{"issue":"2","key":"1612_CR36","first-page":"101","volume":"162","author":"DJ Mazur","year":"1996","unstructured":"Mazur DJ, Hickam DH. Five-year survival curves: how much data are enough for patient-physician decision making in general surgery? Eur J Surg. 1996;162(2):101\u20134.","journal-title":"Eur J Surg"},{"issue":"3","key":"1612_CR37","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1111\/j.1532-5415.1993.tb06696.x","volume":"41","author":"DJ Mazur","year":"1993","unstructured":"Mazur DJ, Merz JF. How the manner of presentation of data influences older patients in determining their treatment preferences. J Am Geriatr Soc. 1993;41(3):223\u20138.","journal-title":"J Am Geriatr Soc"}],"container-title":["BMC Medical Informatics and Decision Making"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12911-021-01612-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12911-021-01612-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12911-021-01612-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,7]],"date-time":"2023-11-07T21:18:49Z","timestamp":1699391929000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmedinformdecismak.biomedcentral.com\/articles\/10.1186\/s12911-021-01612-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,25]]},"references-count":37,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1612"],"URL":"https:\/\/doi.org\/10.1186\/s12911-021-01612-9","relation":{},"ISSN":["1472-6947"],"issn-type":[{"value":"1472-6947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,25]]},"assertion":[{"value":"24 March 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 August 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 August 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"249"}}