Communicating Risk in Imaging: A Scoping Review of Risk Presentation in Patient Decision Aids

Abstract

Best practices exist for communicating medical information to patients, however there is less emphasis on methods to communicate risks, especially in medical imaging. We conducted a scoping review of patient decision aids in medical imaging and characterized the presentation methods of imaging risks. Embase, Medline, CINAHL, and PsychINFO were searched to identify studies involving patient decision aids utilized in diagnostic imaging that communicated the risks. Study characteristics included the number and types of risks included, as well as the presentation type and how the probability of risks were communicated. The final study included 46 articles encompassing 27 distinct patient decision aids. Mammography was the most common imaging scenario (22/46), lung cancer screening (18/46), traumatic brain injury (5/46), and urolithiasis (1/46). All patient decision aids included risks associated with imaging, however the number of risk types varied from 2 to 9 (mean: 4, SD: 2). We identified 12 risks across the 27 decision aids, however no single study included all risks. Overall, most risks (65%) were communicated with text, and the presentation mode varied by type of risk. False positive risks were most commonly communicated using a visual format while radiation risk was most commonly communicated using text format. There was no consistent manner of communicating risk to patients and visual methods such as icon arrays were not consistently used. The variability of both included risks and the risk presentation modes in the PDAs may affect decision-making, especially in patients and caregivers with lower health literacy and numeracy.