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.