One size fits all? Choosing the right format to convey statistical information

Editor,

Good doctor–patient communication is undoubtedly critical to improved quality of care for patients with IBD. Panes et al. rightfully suggest the consistent use of the same statistical format to allow patients better comparison of risks and benefit.¹ Yet their preference of absolute risk reduction (AR) and optical illustrations with Cates plots (CP) is not supported by the evidence, albeit, scarce for patients with IBD. Our study published previously in this journal demonstrated in 50 patients with ulcerative colitis that patients prefer relative risk reduction (RR, 48%) over CP (28%) and AR (20%).² Patient opinion on CP is much divided as 28% chose it as preferred statistical format and 42% as least preferred.² Self reported patient understanding of the different formats was acceptable for all three.

The effects of using different statistical formats and medication adherence also need to be considered and this adds a further layer of complexity. We demonstrated that significantly more patients were willing to adhere to 5-ASA medication if the same benefit was expressed as RR rather than by CP.² Indeed patients indicated the need for much higher benefits of medication to adhere if data were presented by CP.²

Doctors should always strive to inform their patient’s decision making by providing a full overview of risks and benefits. Yet patient knowledge of IBD is often poor ³ and information overload may occur in patients with poor health literacy. ⁴

In our opinion it is important to consider patients’ preferences and possible effects on adherence when choosing the optimal statistical format to convey risks and benefits to patients with IBD. Ideally, the choice of format should be individualised to accommodate health literacy, patient preference and previous adherence history.