 |
 |
|
|
|  PubMed
|
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
1 December 1997 | Volume 127 Issue 11 | Pages 966-972
Background: Quantitative information about risks and benefits may be meaningful only to patients who have some facility with basic probability and numerical concepts, a construct called numeracy.
Objective: To assess the relation between numeracy and the ability to make use of typical risk reduction expressions about the benefit of screening mammography.
Design: Randomized, cross-sectional survey
Setting: A simple random sample of 500 female veterans drawn from a New England registry.
Intervention: One of four questionnaires, which differed only in how the same information on average risk reduction with mammography was presented.
Measurements: Numeracy was scored as the total number of correct responses to three simple tasks. Participants estimated their risk for death from breast cancer with and without mammography. Accuracy was judged as each woman's ability to adjust her perceived risk in accordance with the risk reduction data presented.
Results: 61% of eligible women completed the questionnaire. The median age of these women was 68 years (range, 27 to 88 years), and 96% were high school graduates. Both accuracy in applying risk reduction information and numeracy were poor (one third of respondents thought that 1000 flips of a fair coin would result in <300 heads). Accuracy was strongly related to numeracy: The accuracy rate was 5.8% (95% CI, 0.8% to 10.7%) for a numeracy score of 0, 8.9% (CI, 2.5% to 15.3%) for a score of 1, 23.7% (CI, 13.9% to 33.5%) for a score of 2, and 40% (CI, 25.1% to 54.9%) for a score of 3.
Conclusions: Regardless of how information was presented, numeracy was strongly related to accurately gauging the benefit of mammography. More effective formats are needed to communicate quantitative information about risks and benefits.
Author and Article Information
From Department of Veterans Affairs Medical Center, White River Junction, Vermont; and Dartmouth Medical School, Hanover, New Hampshire.
ARTICLE
The Role of Numeracy in Understanding the Benefit of Screening Mammography
Disclaimer: The views expressed herein do not necessarily represent those of the Department of Veterans Affairs or the U.S. government.
Acknowledgments: The authors thank the study participants. They also thank Kathy Herbst for organizational help, Betty Acheson for assistance with the Women Veterans Registry, and Harold C. Sox, MD, for reviewing the manuscript.
Grant Support: Drs. Schwartz and Woioshin were supported by the Department of Veterans Affairs Fellowship Program in Ambulatory Care and by a New Investigator Award from the Department of Defense Breast Cancer Research Program (RP#950610). Dr. Welch was supported by a Department of Veterans Affairs Career Development Award in Health Services Research and Development.
Requests for Reprints: Lisa M. Schwartz, MD, MS, VA Outcomes Group (111B), Department of Veterans Affairs Medical Center, White River Junction, VT 05009.
Current Author Addresses: Drs. Schwartz, Woloshin, and Welch: VA Outcomes Group (111B), Department of Veterans Affairs Medical Center, White River Junction, VT 05009.
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  S. Woloshin, L. M. Schwartz, S. L. Casella, A. T. Kennedy, and R. J. Larson Press Releases by Academic Medical Centers: Not So Academic? Ann Intern Med, May 5, 2009; 150(9): 613 - 618. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Galesic, G. Gigerenzer, and N. Straubinger Natural Frequencies Help Older Adults and People with Low Numeracy to Evaluate Medical Screening Tests Med Decis Making, May 1, 2009; 29(3): 368 - 371. [Abstract] [PDF]
|
|
|
|
|
|
P. K. J. Han, W. M. P. Klein, T. C. Lehman, H. Massett, S. C. Lee, and A. N. Freedman Laypersons' Responses to the Communication of Uncertainty Regarding Cancer Risk Estimates Med Decis Making, May 1, 2009; 29(3): 391 - 403. [Abstract] [PDF]
|
|
|
|
|
|
L. M. Schwartz, S. Woloshin, and H. G. Welch Using a Drug Facts Box to Communicate Drug Benefits and Harms: Two Randomized Trials Ann Intern Med, April 21, 2009; 150(8): 516 - 527. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. L. Kilbridge, G. Fraser, M. Krahn, E. M. Nelson, M. Conaway, R. Bashore, A. Wolf, M. J. Barry, D. A. Gong, R. F. Nease Jr, et al. Lack of Comprehension of Common Prostate Cancer Terms in an Underserved Population J. Clin. Oncol., April 20, 2009; 27(12): 2015 - 2021. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. T. Brewer, J. P. Tzeng, S. E. Lillie, A. S. Edwards, J. M. Peppercorn, and B. K. Rimer Health Literacy and Cancer Risk Perception: Implications for Genomic Risk Communication Med Decis Making, March 1, 2009; 29(2): 157 - 166. [Abstract] [PDF]
|
|
|
|
 |
|
 K. Dear, L. Scott, S. Chambers, M. C. Corbett, and D. Taupin Perception of colorectal cancer risk does not enhance participation in screening Therapeutic Advances in Gastroenterology, November 1, 2008; 1(3): 157 - 167. [Abstract] [PDF]
|
|
|
|
|
|
K. Cavanaugh, M. M. Huizinga, K. A. Wallston, T. Gebretsadik, A. Shintani, D. Davis, R. P. Gregory, L. Fuchs, R. Malone, A. Cherrington, et al. Association of Numeracy and Diabetes Control Ann Intern Med, May 20, 2008; 148(10): 737 - 746. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Goodyear-Smith, B. Arroll, L. Chan, R. Jackson, S. Wells, and T. Kenealy Patients Prefer Pictures to Numbers to Express Cardiovascular Benefit From Treatment Ann. Fam. Med, May 1, 2008; 6(3): 213 - 217. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. S. Ancker and D. Kaufman Rethinking Health Numeracy: A Multidisciplinary Literature Review J. Am. Med. Inform. Assoc., November 1, 2007; 14(6): 713 - 721. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Fagerlin, B. J. Zikmund-Fisher, P. A. Ubel, A. Jankovic, H. A. Derry, and D. M. Smith Measuring Numeracy without a Math Test: Development of the Subjective Numeracy Scale Med Decis Making, October 1, 2007; 27(5): 672 - 680. [Abstract] [PDF]
|
|
|
|
|
|
B. J. Zikmund-Fisher, D. M. Smith, P. A. Ubel, and A. Fagerlin Validation of the Subjective Numeracy Scale: Effects of Low Numeracy on Comprehension of Risk Communications and Utility Elicitations Med Decis Making, October 1, 2007; 27(5): 663 - 671. [Abstract] [PDF]
|
|
|
|
|
|
L. M. Schwartz, S. Woloshin, and H. G. Welch The Drug Facts Box: Providing Consumers with Simple Tabular Data on Drug Benefit and Harm Med Decis Making, October 1, 2007; 27(5): 655 - 662. [Abstract] [PDF]
|
|
|
|
|
|
K. McCaffery, L. Irwig, and P. Bossuyt Patient Decision Aids to Support Clinical Decision Making: Evaluating the Decision or the Outcomes of the Decision Med Decis Making, October 1, 2007; 27(5): 619 - 625. [Abstract] [PDF]
|
|
|
|
|
|
A. E. Barnato, H. A. Llewellyn-Thomas, E. M. Peters, L. Siminoff, E. D. Collins, and M. J. Barry Communication and Decision Making in Cancer Care: Setting Research Priorities for Decision Support/Patients' Decision Aids Med Decis Making, October 1, 2007; 27(5): 626 - 634. [Abstract] [PDF]
|
|
|
|
|
|
P. F.M. Stalmeier, J. J. van Tol-Geerdink, E. N.J.Th. van Lin, E. Schimmel, H. Huizenga, W. A.J. van Daal, and J.-W. Leer Doctors' and Patients' Preferences for Participation and Treatment in Curative Prostate Cancer Radiotherapy J. Clin. Oncol., July 20, 2007; 25(21): 3096 - 3100. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Peters, J. Hibbard, P. Slovic, and N. Dieckmann Numeracy Skill And The Communication, Comprehension, And Use Of Risk-Benefit Information Health Aff., May 1, 2007; 26(3): 741 - 748. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Armstrong, E. Moye, S. Williams, J. A. Berlin, and E. E. Reynolds Screening Mammography in Women 40 to 49 Years of Age: A Systematic Review for the American College of Physicians Ann Intern Med, April 3, 2007; 146(7): 516 - 526. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. K.J. Han, S. C. Kobrin, W. M.P. Klein, W. W. Davis, M. Stefanek, and S. H. Taplin Perceived Ambiguity about Screening Mammography Recommendations: Association with Future Mammography Uptake and Perceptions Cancer Epidemiol. Biomarkers Prev., March 1, 2007; 16(3): 458 - 466. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. R. Arkes, V. A. Shaffer, and M. A. Medow Patients Derogate Physicians Who Use a Computer-Assisted Diagnostic Aid Med Decis Making, March 1, 2007; 27(2): 189 - 202. [Abstract] [PDF]
|
|
|
|
|
|
S. Woloshin, L. M. Schwartz, and H. G. Welch The Effectiveness of a Primer to Help People Understand Risk: Two Randomized Trials in Distinct Populations Ann Intern Med, February 20, 2007; 146(4): 256 - 265. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. E. Lillie, N. T. Brewer, S. C. O'Neill, E. F. Morrill, E. C. Dees, L. A. Carey, and B. K. Rimer Retention and Use of Breast Cancer Recurrence Risk Information from Genomic Tests: The Role of Health Literacy Cancer Epidemiol. Biomarkers Prev., February 1, 2007; 16(2): 249 - 255. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. M Schwartz, S. Woloshin, E. L Dvorin, and H G. Welch Ratio measures in leading medical journals: structured review of accessibility of underlying absolute risks BMJ, December 16, 2006; 333(7581): 1248 - 1248. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. S. Ancker, Y. Senathirajah, R. Kukafka, and J. B. Starren Design Features of Graphs in Health Risk Communication: A Systematic Review J. Am. Med. Inform. Assoc., November 1, 2006; 13(6): 608 - 618. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. J. van Tol-Geerdink, P. F.M. Stalmeier, E. N.J.T. van Lin, E. C. Schimmel, H. Huizenga, W. A.J. van Daal, and J.-W. Leer Do Patients With Localized Prostate Cancer Treatment Really Want More Aggressive Treatment? J. Clin. Oncol., October 1, 2006; 24(28): 4581 - 4586. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Armstrong, B. Weber, P. A. Ubel, N. Peters, J. Holmes, and J. S. Schwartz Individualized Survival Curves Improve Satisfaction With Cancer Risk Management Decisions in Women With BRCA1/2 Mutations J. Clin. Oncol., December 20, 2005; 23(36): 9319 - 9328. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Hay, E. Shuk, G. Cruz, and J. Ostroff Thinking Through Cancer Risk: Characterizing Smokers' Process of Risk Determination Qual Health Res, October 1, 2005; 15(8): 1074 - 1085. [Abstract] [PDF]
|
|
|
|
|
|
S. H. Woolf, E. C.Y. Chan, R. Harris, S. L. Sheridan, C. H. Braddock III, R. M. Kaplan, A. Krist, A. M. O'Connor, and S. Tunis Promoting Informed Choice: Transforming Health Care To Dispense Knowledge for Decision Making Ann Intern Med, August 16, 2005; 143(4): 293 - 300. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Fagerlin, C. Wang, and P. A. Ubel Reducing the Influence of Anecdotal Reasoning on People's Health Care Decisions: Is a Picture Worth a Thousand Statistics? Med Decis Making, July 1, 2005; 25(4): 398 - 405. [Abstract] [PDF]
|
|
|
|
 |
|
 L. Nekhlyudov, R. Li, and S. W. Fletcher Information and Involvement Preferences of Women in Their 40s Before Their First Screening Mammogram Arch Intern Med, June 27, 2005; 165(12): 1370 - 1374. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. A. Halvorsen and I. S. Kristiansen Decisions on Drug Therapies by Numbers Needed to Treat: A Randomized Trial Arch Intern Med, May 23, 2005; 165(10): 1140 - 1146. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. M. Schwartz, S. Woloshin, and H. G. Welch Can Patients Interpret Health Information? An Assessment of the Medical Data Interpretation Test Med Decis Making, May 1, 2005; 25(3): 290 - 300. [Abstract] [PDF]
|
|
|
|
 |
|
 J T King Jr, H Yonas, M B Horowitz, A B Kassam, and M S Roberts A failure to communicate: patients with cerebral aneurysms and vascular neurosurgeons J. Neurol. Neurosurg. Psychiatry, April 1, 2005; 76(4): 550 - 554. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. G. Elmore, K. Armstrong, C. D. Lehman, and S. W. Fletcher Screening for Breast Cancer JAMA, March 9, 2005; 293(10): 1245 - 1256. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Segnan, C. Senore, B. Andreoni, A. Arrigoni, L. Bisanti, A. Cardelli, G. Castiglione, C. Crosta, R. DiPlacido, A. Ferrari, et al. Randomized Trial of Different Screening Strategies for Colorectal Cancer: Patient Response and Detection Rates J Natl Cancer Inst, March 2, 2005; 97(5): 347 - 357. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. R. Berger Slippery Slopes to Apprehension:: Rationality and Graphical Depictions of Increasingly Threatening Trends Communication Research, February 1, 2005; 32(1): 3 - 28. [Abstract] [PDF]
|
|
|
|
|
|
A. Fagerlin, D. Rovner, S. Stableford, C. Jentoft, J. T. Wei, and M. Holmes-Rovner Patient Education Materials about the Treatment of Early-Stage Prostate Cancer: A Critical Review Ann Intern Med, May 4, 2004; 140(9): 721 - 728. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. R. Tait, T. Voepel-Lewis, and S. Malviya Factors That Influence Parents' Assessments of the Risks and Benefits of Research Involving Their Children Pediatrics, April 1, 2004; 113(4): 727 - 732. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E A Lobb, P N Butow, B Meiser, A Barratt, C Gaff, M A Young, J Kirk, M Gattas, M Gleeson, and K Tucker Women's preferences and consultants' communication of risk in consultations about familial breast cancer: impact on patient outcomes J. Med. Genet., May 1, 2003; 40(5): e56 - 56. [Full Text] [PDF]
|
|
|
|
|
|
R. J. Gordon-Lubitz Risk Communication: Problems of Presentation and Understanding JAMA, January 1, 2003; 289(1): 95 - 95. [Full Text] [PDF]
|
|
|
|
 |
|
 L. Kahlor, S. Dunwoody, and R. J. Griffin Attributions in explanations of risk estimates Public Understanding of Science, July 1, 2002; 11(3): 243 - 257. [Abstract] [PDF]
|
|
|
|
 |
|
 T. C. Davis, M. V. Williams, E. Marin, R. M. Parker, and J. Glass Health Literacy and Cancer Communication CA Cancer J Clin, May 1, 2002; 52(3): 134 - 149. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. R. Fried, E. H. Bradley, V. R. Towle, and H. Allore Understanding the Treatment Preferences of Seriously Ill Patients N. Engl. J. Med., April 4, 2002; 346(14): 1061 - 1066. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. R. Berger Base-Rate Bingo: Ephemeral Effects of Population Data on Cognitive Responses, Apprehension, and Perceived Risk Communication Research, April 1, 2002; 29(2): 99 - 124. [Abstract] [PDF]
|
|
|
|
 |
|
 L. Fraenkel, S. Bogardus, J. Concato, and D. Felson Unwillingness of rheumatoid arthritis patients to risk adverse effects Rheumatology, March 1, 2002; 41(3): 253 - 261. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. J. Murphy, G. J. Gahm, S. Santilli, P. North, S. C.N. Oliver, and H. Shapiro Seniors' Preferences for Cancer Screening and Medication Use Based on Absolute Risk Reduction J. Gerontol. A Biol. Sci. Med. Sci., February 1, 2002; 57(2): M100 - 105. [Abstract] [Full Text]
|
|
|
|
|
|
S. Woloshin, L. M. Schwartz, M. Moncur, S. Gabriel, and A. N. A. Tosteson Assessing Values for Health: Numeracy Matters Med Decis Making, October 1, 2001; 21(5): 382 - 390. [Abstract] [PDF]
|
|
|
|
|
|
L. C. Walter and K. E. Covinsky Cancer Screening in Elderly Patients: A Framework for Individualized Decision Making JAMA, June 6, 2001; 285(21): 2750 - 2756. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. M. Lipkus, G. Samsa, and B. K. Rimer General Performance on a Numeracy Scale among Highly Educated Samples Med Decis Making, February 1, 2001; 21(1): 37 - 44. [Abstract] [PDF]
|
|
|
|
 |
|
 M. B. Barton Screening mammography for women aged 40-49: Are we off the fence yet? Can. Med. Assoc. J., February 1, 2001; 164(4): 498 - 499. [Full Text] [PDF]
|
|
|
|
|
|
J R Benson, A D Purushotham, R Warren, C. I F Rooney, L. C Rodrigues, O. M R Campbell, D V Coleman, R. W M Giard, and R. M Wilson Screening and litigation BMJ, September 23, 2000; 321(7263): 760 - 760. [Full Text]
|
|
|
|
|
|
F. A. McAlister, A. M. O'Connor, G. Wells, S. A. Grover, and A. Laupacis When should hypertension be treated? The different perspectives of Canadian family physicians and patients Can. Med. Assoc. J., August 1, 2000; 163(4): 403 - 408. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Woloshin, L. M. Schwartz, S. Byram, B. Fischhoff, and H. G. Welch A New Scale for Assessing Perceptions of Chance: A Validation Study Med Decis Making, July 1, 2000; 20(3): 298 - 307. [Abstract] [PDF]
|
|
|
|
|
|
K. Armstrong, S. Popik, C. Guerra, and P. A. Ubel Beliefs about Breast Cancer Risk and Use of Postmenopausal Hormone Replacement Therapy Med Decis Making, July 1, 2000; 20(3): 308 - 313. [Abstract] [PDF]
|
|
|
|
|
|
K. Armstrong, A. Eisen, and B. Weber Assessing the Risk of Breast Cancer N. Engl. J. Med., February 24, 2000; 342(8): 564 - 571. [Full Text] [PDF]
|
|
|
|
|
|
A. Must, J. Spadano, E. H. Coakley, A. E. Field, G. Colditz, and W. H. Dietz The Disease Burden Associated With Overweight and Obesity JAMA, October 27, 1999; 282(16): 1523 - 1529. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Estrada, V. Barnes, C. Collins, and J. C. Byrd Health Literacy and Numeracy JAMA, August 11, 1999; 282(6): 527 - 527. [Full Text] [PDF]
|
|
|
|
|
|
S. Woloshin, L. M. Schwartz, W. C. Black, and H. G. Welch Women's Perceptions of Breast Cancer Risk: How You Ask Matters Med Decis Making, August 1, 1999; 19(3): 221 - 229. [Abstract] [PDF]
|
|
|
|
|
|
L. M. Schwartz, S. Woloshin, and H. G. Welch Misunderstandings about the Effects of Race and Sex on Physicians' Referrals for Cardiac Catheterization N. Engl. J. Med., July 22, 1999; 341(4): 279 - 283. [Full Text]
|
|
|
|
|
|
J. F. Steiner Talking about Treatment: The Language of Populations and the Language of Individuals Ann Intern Med, April 6, 1999; 130(7): 618 - 622. [Full Text] [PDF]
|
|
|
|
 |
|
 A. J. Rothman and M. T. Kiviniemi Treating People With Information: an Analysis and Review of Approaches to Communicating Health Risk Information J Natl Cancer Inst Monographs, January 1, 1999; 1999(25): 44 - 51. [Abstract] [Full Text]
|
|
|
|
|
|
S. W. Vernon Risk Perception and Risk Communication for Cancer Screening Behaviors: a Review J Natl Cancer Inst Monographs, January 1, 1999; 1999(25): 101 - 119. [Abstract] [Full Text]
|
|
|
|
|
|
L. M. Schwartz, S. Woloshin, and H. G. Welch Risk Communication in Clinical Practice: Putting Cancer in Context J Natl Cancer Inst Monographs, January 1, 1999; 1999(25): 124 - 133. [Abstract] [Full Text]
|
|
|
|
|
|
I. M. Lipkus and J. G. Hollands The Visual Communication of Risk J Natl Cancer Inst Monographs, January 1, 1999; 1999(25): 149 - 163. [Abstract] [Full Text]
|
|
|
|
|
|
J. H. Wasson Finasteride to Prevent Morbidity from Benign Prostatic Hyperplasia N. Engl. J. Med., February 26, 1998; 338(9): 612 - 613. [Full Text]
|
|
