UTILIZATION OF CONTINUOUS “SPINNERS” TO COMMUNICATE RISK

Purpose: To examine the effect of spinners, donut-shaped figures divided into red and white regions (representing proportions of a population) with an arrow attached to the center, on risk understanding and medication selection, compared to numerical format and icon arrays.

Methods: Subjects were enrolled from waiting rooms and asked to imagine they suffered from uncontrolled chronic back pain for the last 2 months. Two equally effective medications, each with a serious but rare side effect (pneumonia requiring hospitalization for a week), and a common side effect (nausea/vomiting) were described. Pill A had a slightly higher pneumonia risk (0.6 vs. 0.2%), but a lower nausea/vomiting incidence (10 vs. 20%) compared to Pill B. Subjects were randomized to one of three risk presentation formats: numeric only (frequencies and percentages), numeric with icon arrays (1000 icons, with affected persons highlighted in red) or numeric with spinners. Subjects selected which pill had greater risk of stomach upset, hospitalization, and any side effect. A knowledge score was calculated as the sum of correct answers. Subjects also indicated their preferred pill and rated how much they liked the format. ANOVA and chi-squared analyses were used to compare groups, and multivariate linear and logistic regression were used to assess adjusted differences between groups.

Results: 151 subjects (56% female, mean age 41.7 ± 15.3 years) were enrolled. Unadjusted results are presented in the Table. In a multivariate model including age, gender, race, ethnicity, objective numeracy, and education level, knowledge scores were higher among subjects randomized to the icon arrays (b = 0.54, p= 0.001) and spinners (b = 0.33, p= 0.044 ) than the numeric only group. In an adjusted logistic regression model, subjects shown icon arrays were no more likely to prefer Pill A (OR = 1.56, p = 0.33), while those shown spinners were 3.96 (p = 0.006) times as likely, compared to the numeric group. Icon arrays (b = 0.62, p = 0.03) and spinners (b = 0.91, p = 0.002) were preferred over the numeric format.

Conclusions: Compared to the numeric format, spinners and icon arrays increased risk knowledge and were preferred by subjects. The spinner also influenced preference. Future research will explore the use of spinners to improve risk communication for patients facing difficult decisions.