An experimental evaluation of patient decision aid design to communicate the effects of medications on the rate of progression of structural joint damage in rheumatoid arthritis

Patient Educ Couns. 2012 Mar;86(3):329-34. doi: 10.1016/j.pec.2011.06.001. Epub 2011 Jul 12.


Objective: To explore how effectively information presentation formats used in a patient decision aid communicated the ability of a disease modifying anti-rheumatic drug to slow the rate of progression of rheumatoid arthritis related structural joint damage (SJD).

Methods: 91 first year psychology students and 91 RA patients participated in a prospective randomized, single blind, factorial experimental design evaluating the effect of four information formats on: satisfaction with risk communication, verbatim and gist recall of a hypothetical anti-rheumatic drug's ability to slow the rate of progression of SJD.

Results: Both groups underestimated the hypothetical drug's ability to slow SJD. Formats that supported the narrative statement with a reinforcing graphic element resulted in recall closer to the true value. Comparison of the results from testing of RA patients and college students were remarkably similar across formats.

Conclusion: Rate of progression as communicated by narrative statement plus a graphic element (i.e. speedometer metaphor or pictograph) aided recall better than a narrative statement alone. Our results suggest that testing decision aid components with non-patients may provide data generalizable to patient populations.

Practice implications: Graphics must be used carefully in patient decision aids as they can enhance recall, but may also introduce unintended recall bias.

Publication types

  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antirheumatic Agents / administration & dosage*
  • Arthritis, Rheumatoid / drug therapy*
  • Choice Behavior*
  • Communication*
  • Decision Support Techniques*
  • Disease Progression
  • Dose-Response Relationship, Drug
  • Factor Analysis, Statistical
  • Female
  • Humans
  • Male
  • Memory, Short-Term
  • Middle Aged
  • Prospective Studies
  • Single-Blind Method
  • Young Adult


  • Antirheumatic Agents