Background/Purpose: The order and amount of information has been shown to influence risk perceptions related to hazards. In this study we sought to examine whether order and amount of risk and benefit information influences patients’ perceived value of a proposed new medication.

Methods: We created 5 videos of a physician describing a new medication. The videos were identical except for the order and number of side effects (SEs) and benefits presented (see Table). Subjects with a systemic inflammatory rheumatic disease were randomly assigned to view one of the videos. Perceived medication value (PMV) was assessed by having subjects choose: the risks outweigh the benefits, the risks and benefits are equally balanced or the benefits outweigh the risks. We subsequently examined whether differences in the order and amount of information was associated with subjects’ PMV. This outcome was chosen because one’s overall impression more strongly predicts behavior than recall of verbatim information. We also examined the association of demographic characteristics (age, minority status, and difficulty paying for medications), attitudes towards illness and treatment (factor analysis of illness perceptions, patient activation and trust resulting in 4 factors: worry about illness, perceived treatment efficacy, impact of illness, patient activation), and current medications on PMV using bivariate analyses. Variables found to be significant (p<0.05) were included in a multinomial logistic regression model. Because of the known influence of numeracy on risk perception, all analyses were stratified by high versus low subjective numeracy (dichotomized at the median).

Results: 389 subjects participated: mean (SD) age= 55 (14), 75% female, 40% minority (African American and/or Hispanic). In bivariate analyses, the order and number of SEs and benefits, current use of prednisone, and minority status were associated with PMV in subjects with high numeracy (n=242). Presenting SEs first or between benefits were both associated with more negative PMV compared to the reference video (3 benefits followed by 6 SEs) (See Table). Among subjects with low numeracy (n=142), the order and number of risk and benefits presented were not associated with PMV. In bivariate analyses, use of a biologic, difficulty paying for medications, perceived treatment efficacy, patient activation, and minority status, were associated with PMV in subjects with low numeracy. Except for current use of a biologic, all remained significant in the multivariate model (see Table).

Conclusion: Order and amount of information matter, but only in patients with high subjective numeracy. Minority patients have a much more negative PMV compared to Caucasian, non-Hispanic patients, regardless of their level of numeracy.

Table: Multinomial logistic regression model examining association of risk-benefit presentation and patients characteristics on perceived medication value.

Variable	Perceived   Medication Value (Ref= Risks outweigh Benefits)	Adjusted   Odd Ratio (95% CI)
High   Numeracy
Video (Ref= 3 benefits   → 6 SEs)
6 benefits → 6 SEs	Balanced	1.87   (0.59 – 5.98)
	Benefits outweigh   Risks	0.45   (0.14 – 1.48)
6 benefits → 3 SEs	Balanced	0.79   (0.24 –  2.64)
	Benefits outweigh   Risks	0.60   (0.19 – 1.83)
6 SEs → 3 benefits	Balanced	0.47   (0.16 – 1.40)
	Benefits outweigh   Risks	0.20 (0.07 – 0.58)
3 benefits → 6 SEs → 3   benefits	Balanced	0.54   (0.18 – 1.66)
	Benefits outweigh   Risks	0.26   (0.09 – 0.78)
Currently on   prednisone	Balanced	0.75 (0.34 – 1.67)
	Benefits outweigh   Risks	1.77 (0.82 – 3.80)
Minority vs Caucasian	Balanced	0.95   (0.48 – 1.89)
	Benefits outweigh   Risks	0.25 (0.11 – 0.58)
Low   Numeracy
Perceived treatment   efficacy	Balanced	1.46   (0.90 – 2.37)
	Benefits outweigh   Risks	2.22 (1.28 – 3.83)
Patient activation	Balanced	1.75 (1.09 – 2.81)
	Benefits outweigh   Risks	1.05   (0.62 – 1.78)
Currently on a   biologic	Balanced	1.13   (0.35 – 3.66)
	Benefits outweigh   Risks	2.64   (0.87 – 8.04)
Difficulty paying for   medications	Balanced	0.17 (0.07 – 0.44)
	Benefits outweigh   Risks	0.73   (0.27 – 2.00)
Minority vs Caucasian	Balanced	0.23 (0.09 – 0.62)
	Benefits outweigh   Risks	0.22 (0.08 – 0.63)

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/does-the-order-or-amount-of-risk-benefit-information-presented-influence-patients-perceived-value-of-a-proposed-new-medication/