Can the Results of Laboratory Based Message Framing Experiments  Help Teach Us How to Support Patient Decision Making?

Richard W. Martin, MD, MA1, Patience J. Gallagher, B.S.2 and Donald J. Tellinghuisen, PhD2

(1) Michigan State University, Grand Rapids, MI, 

(2) Calvin College, Grand Rapids, MI

Purpose:   To explore the validity of generalizing the results from first year psychology students in message framing laboratory experiments to patient decision aid design.

Method:    90 first year psychology students and 90 rheumatoid arthritis (RA) patients participated in a prospective randomized, single blind, factorial experimental design evaluating the effect of four information formats on: satisfaction with risk communication and verbatim and gist recall of a hypothetical drug’s ability to slow the rate of progression of structural joint damage (SJD). The study was conducted in 2 different settings using similar experimental procedures. College students enrolled in an introductory psychology class were evaluated in a traditional experimental laboratory setting.  Patients were evaluated in a conference room adjacent to the clinic waiting room following a routinely scheduled clinic visit.

Result:   Demographics of students and patients were respectively:  Mean age 19.4 years (18-25) vs. 61.7 years (18-86), female gender 50.5 vs. 60.0%, minority ethnicity 1.1 vs. 5.4%.  Less than high school graduate 0 vs. 10.0%, low or marginal health literacy N/A vs. 4.4%.  Patients had a mean duration of disease of 9.6 year (range < 1 -30) and previous had used a mean of 3 disease modifying drugs (range 1-8). A two-way ANOVA performed on mean satisfaction with risk communication scores did not disclose a significant effect of participant type [F (1, 174) = .109, p = .742, p2 = .001)].  Participants across conditions overestimated the rate of progression by 19 percentage points (M response of 34.4%, SD 29.7).  The two-way ANOVA of mean verbatim recall indicated a significant effect of information format, F (3, 174) =2.774, p<0.023, p2 = .053. The main effect of participant type however was not significant, F (1, 174) = .003, p = .955, p2 > .001.

Conclusion:   Graphic elements improved the understanding of disease progression in participants unfamiliar with the disease as well as in RA patients.  Our results indicate that testing decision aid components with non-patients may provide data generalizable to patient populations from more convenient samples than patients.  We demonstrate that it is not only feasible to conduct message framing experiments with patients in a clinical setting, but that they were very interested in contributing to the development of medication patient decision aids.

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