Effect of different visual presentations on the comprehension of prognostic information: a systematic review

Abstract

Background: 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. Purpose: 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. Data sources: MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC and the Cochrane Central Register of Controlled Trials (CENTRAL) (from inception to December 2020), and forward and backward citation search. Study selection: 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. Data extraction: Two authors independently assessed risk of bias and extracted data. Data synthesis: 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. Limitations: Heterogeneity in the visual presentations and outcome measures, precluding meta-analysis. Conclusions: No visual presentation appears to be consistently superior to communicate quantitative prognostic information.