Article Text

Download PDFPDF
Visualisation of evidence for shared decision making
  1. Marie-Anne Durand1,2,3,
  2. Kevin Selby2,
  3. Yasmina Okan4
  1. 1 Centre d'Epidémiologie et de Recherche en santé des Populations, Team EQUITY, Université Toulouse III Paul Sabatier, Toulouse, France
  2. 2 Département des policliniques, Unisanté, Lausanne, Vaud, Switzerland
  3. 3 The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, USA
  4. 4 Department of Communication, Pompeu Fabra University, Barcelona, Spain
  1. Correspondence to Dr Marie-Anne Durand, Centre d'Epidémiologie et de Recherche en santé des Populations, Université Toulouse III Paul Sabatier, Toulouse, France; marie-anne.durand{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Why does it matter?

Consistent with the principles of evidence-based medicine, effectively communicating evidence (including risks) in medicine is an essential part of shared decision making (SDM). SDM has been defined as ‘an approach where clinicians and patients share the best available evidence when faced with the task of making decisions, and where patients are supported to consider options, to achieve informed preferences’.1 This process relies on access and understanding of evidence-based information by both patients and healthcare professionals. This includes outcome probabilities, typically presented numerically. Yet, a considerable fraction of the population is confronted with limited numeracy. Numeracy is defined as the ability to understand, use and interpret numbers and calculations in everyday situations.2 This difficulty processing numbers is a significant barrier to effective communication in healthcare and SDM.

How can visualisation of evidence help?

Many studies demonstrate the potential of visuals to facilitate the presentation and understanding of both qualitative and quantitative information, including numbers.3 4 We define visuals broadly, as including pictures and graphical displays used to show or explain something. We define graphical displays as two-dimensional graphical representations showing a risk information, and graph literacy, as the ability to understand information presented graphically.

Our systematic review and meta-analysis of 54 randomised controlled trials comparing visuals and text to text alone (42 in the meta-analysis) suggested that visuals moderately improved knowledge/understanding and information recall, but largely increased knowledge/understanding for people with limited health literacy (n=13).5 Health literacy is defined as the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions. Our narrative synthesis suggested that visuals with few words may be most helpful in conveying health information. These findings further support the hypothesis of pictorial superiority. Pictorial superiority is defined as the tendency to remember concrete items more easily when presented as pictures rather than …

View Full Text


  • Contributors M-AD, KS and YO brainstormed the content of the article. M-AD developed the first draft, which was completed by YO and KS. All authors reviewed and approved the final version of the manuscript before submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests M-AD has contributed to the development of Option Grid patient decision aids (from which Picture Option Grid is derived). EBSCO Information Services sells subscription access to Option Grid patient decision aids. She receives consulting income from EBSCO Health, and royalties.

  • Provenance and peer review Not commissioned; externally peer reviewed.