Quantitative versus qualitative risk framing in patient decision aids for dysplastic nevi: A randomized A/B testing study.

Abstract

Patient decision aids (PDAs) support shared decision-making by presenting treatment options clearly and objectively. However, little is known about how risk framing and diagnostic severity labels influence patient preferences in dermatology. Assess how PDA format (quantitative vs qualitative) and dysplastic nevus severity (mild, moderate, or severe) affect understanding, risk perception, confidence, and treatment intent. In this randomized A/B testing design, 600 US adults viewed a quantitative or qualitative PDA describing a mild, moderate, or severe dysplastic nevus scenario. Self-reported outcomes included understanding, treatment selection (excision vs monitoring), satisfaction, decision-making confidence, perceived melanoma risk, and concern. Analyses used nonparametric tests and logistic regression. Quantitative PDAs improved self-reported understanding (median 80 vs 72; P = .008) and confidence (P = .003) and lowered perceived melanoma risk for monitoring (P = .003) and excision (P < .001), but did not change excision intent (52% vs 53%; odds ratio 1.04, 95% CI 0.75-1.43; P = .818). Dysplastic nevus severity significantly increased excision intent (31% mild, 41% moderate, 72% severe; P < .001), without affecting understanding. Quantitative PDAs enhance comprehension, yet diagnostic severity labels predominantly drive treatment intent. Approximately one-third of participants diverged from expert recommendations despite high comprehension, underscoring that individual values drive treatment choices.