Visualization formats of Patient-Reported Outcomes in clinical practice: a systematic review about preferences and interpretation accuracy. (Preprint)

BACKGROUND The use of Patient-Reported Outcomes (PROs) for individual patient management within clinical practice is becoming increasingly important. However, there is no consensus on which graphic visualization format of PRO scores is most suitable. OBJECTIVE This systematic review evaluated evidence for graphic visualization of PROs in clinical practice for patients and clinicians, including preferences, interpretation accuracy, and guidance for clinical interpretation of PRO scores. METHODS We extracted studies published between 2000 and 2020 from CINAHL, PubMed, PsychInfo and Medline. Studies included patients ≥18 years old from daily clinical practice. Papers not available in English, without full-text access or that did not specifically describe PRO visualization were excluded. Outcome measures were: visualization preferences; interpretation accuracy; guidance for clinical interpretation. RESULTS We included 26 out of 789 papers for final analysis. Most frequently studied formats were: bar charts, line graphs and pie charts. Patients preferred bar charts and line graphs as these were easy and quick for retrieving information about their PRO scores over time. Clinicians’ interpretation accuracy was similar among graph formats. Scores were most often compared with patients’ own previous scores; to guide clinical interpretation, scores were compared to norm population scores. Different add-ons improved graph interpretability for patients and clinicians, e.g. using colors, descriptions of measurement scale directionality, descriptive labels and brief definitions. CONCLUSIONS Although we found no predominant format for graphic visualization of PRO scores, straightforward formats like bar charts and line graphs were preferred by both patients and clinicians. Additionally, detailed clarification of graph content is essential.