Comprehension and preferences for graphical representations of quality of life after prostate cancer treatment.

Abstract

76 Background: Integration of quality of life (QoL) measurement into clinical prostate cancer (PCa) practice may enhance patients’ communication with clinicians, improve satisfaction with care, and affect the delivery of secondary therapies. A necessary step to achieve these benefits is illustrating QoL in ways patients can understand and use. Through a patient-partnered project, we developed graphical representations of prostate cancer QoL (dashboards) and compared patients’ comprehension and preferences among four alternative formats: table, bar chart, line graph, and pictograph. Methods: We conducted interviews with PCa patients and assessed health literacy, subjective numeracy, and graphic literacy with validated instruments (REALM, Subjective Numeracy Scale, Graphic Literacy Scale). We then presented patients the 4 candidate dashboards counterbalanced for format order, and assessed participants’ comprehension, helpfulness rating, and rank order preferences. Results: Our study included 29 PCa patients, with mean age 71 years (range 53-90). Patients were mostly white (86%) and had at least a college degree (76%). Most had localized PCa (90%) and 55% were treated within the last 5 years; 9 patients had undergone more than one type of treatment. Patients’ health literacy (mean score 6.9±0.26 out of 7), numeracy (mean score 4.3±0.94 out of 6), and graphic literacy (mean score 11.4±1.4 out of 13) was high. Comprehension did not vary by dashboard format (p=0.39), ranging from 84% correct for line graph to 91% correct for bar chart. The pictograph exhibited lower helpfulness ratings (p=0.001). Preference elicitation strongly favored the bar chart (p=0.004), ranked 1st by 52% of patients, and disfavored pictograph, ranked 4th by 69% of patients. Conclusions: Among a high literacy and numeracy sample of PCa patients, comprehension and preference ranking strongly favored bar charts for QoL dashboards. Pictographs, known to benefit low literacy patients, were not preferred despite good comprehension. Inclusion of lower literacy patients may yield different results. Future work will determine if clinical integration of QoL dashboards is associated with improved health outcomes.