The Impact of Structuring the Interface as a Decision Tree in a Treatment Decision Support Tool

  • Neil Carrigan
  • Peter H. Gardner
  • Mark Conner
  • John Maule
Part of the Lecture Notes in Computer Science book series (LNCS, volume 4799)


This study examined whether interfaces in computer-based decision aids can be designed to reduce the mental effort required by people to make difficult decisions about their healthcare and allow them to make decisions that correspond with their personal values. Participants (N=180) considered a treatment scenario for a heart condition and were asked to advise a hypothetical patient whether to have an operation or not. Attributes for decision alternatives were presented via computer in one of two formats; alternative-tree or attribute-tree. Participants engaged in significantly more compensatory decision strategies (i.e., comparing attributes of each option) using an interface congruent with their natural tendency to process such information (i.e., alternative-tree condition). There was also greater correlation (p<.05) between participants’ decision and personal values in the alternative-tree. Patients who are ill and making decisions about treatment often find such choices stressful. Being able to reduce some of the mental burden in such circumstances adds to the importance of interface designers taking account of the benefits derived from structuring information for the patient.


Patient decision making Interface design Decision-making process computer based decision support 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Ubel, P.A., Lowenstein, G.: The role of decision analysis in informed consent: Choosing between intuition and systematicity. Social Science and Medicine 44, 647–656 (1997)CrossRefGoogle Scholar
  2. 2.
    Fallowfield, L.J., Hall, A., Maguire, P., Baum, M., A’Hern, R.P.: Psychological effects of being offered choice of surgery for breast cancer. British Medical Journal 309, 448 (1994)Google Scholar
  3. 3.
    Molenaar, S., Sprangers, M.A.G., Rutgers, E.J.T., Luiten, E.J., Mulder, J., Bossuy, P.M.M., et al.: Decision support for patients with early stage breast cancer: Effects of an interactive breast cancer CDROM on treatment decision, satisfaction, and quality of life. Journal of Clinical Oncology 19, 1676–1687 (2001)Google Scholar
  4. 4.
    Darke, S.: Effects of anxiety on inferential reasoning task performance. Journal of Personality and Social Psychology 55, 499–505 (1988)CrossRefGoogle Scholar
  5. 5.
    Bekker, H., Legare, F., Stacey, D., O’Connor, A.M., Lemyre, L.: Evaluating the effectiveness of decision aids: is anxiety a suitable measure (unpublished Work)Google Scholar
  6. 6.
    Margalith, I., Shapiro, A.: Anxiety and patient participation in clinical decision-making: The case of patients with ureteral calculi. Social Science and Medicine 45, 419–427 (1997)CrossRefGoogle Scholar
  7. 7.
    Michie, S., Smith, D., McClennan, A., Marteau, T.M.: Patient decision-making: An evaluation of two different methods of presenting information about a screening test. British Journal of Health Psychology 2, 317–326 (1997)Google Scholar
  8. 8.
    Murray, E., Davis, H., See Tai, S., Coulter, A., Gray, A., Haines, A.: Randomised controlled trial of an interactive multimedia decision aid on hormone replacement therapy in primary care. British Medical Journal 323, 1–5 (2001)CrossRefGoogle Scholar
  9. 9.
    Thornton, J.G., Hewision, J., Lilford, R.J., Vail, A.: A randomised trial of three methods of giving information about prenatal testing. British Medical Journal 311, 1127–1130 (1995)Google Scholar
  10. 10.
    Rostom, A., O’Connor, A.M., Tugwell, P., Wells, G.A.: A randomized trial of a computerized versus an audio-booklet decision aid for women considering post-menopausal hormone replacement therapy. Patient Education and Counselling 46, 67–74 (2002)CrossRefGoogle Scholar
  11. 11.
    Schapira, M.M., Meade, C., Nattinger, A.B.: Enhanced decision-making: The use of a videotape decision-aid for patients with prostate cancer. Patient Education and Counselling 30, 119–127 (1997)CrossRefGoogle Scholar
  12. 12.
    Mitchell, S.L., Tetroe, J., O’Connor, A.M.: A decision aid for long-term tube feeding in cognitively impaired older persons. The. Journal of the American Geriatrics Society 49, 313–316 (2001)CrossRefGoogle Scholar
  13. 13.
    Broadstock, M., Michie, S.: Processes of patient decision-making: Theoretical and methodological issues. Psychology and Health 15, 191–204 (2000)Google Scholar
  14. 14.
    Carrigan, N.A., Gardner, P.H., Conner, M., Maule, J.: The impact of structuring information in a patient decision aid. Psychology and Health 19, 457–477 (2004)CrossRefGoogle Scholar
  15. 15.
    Holmes-Rovner, M., Kroll, J., Rovner, D.R., Schmitt, N., Rothert, M., Padonu, G., et al.: Patient decision support intervention: Increased consistency with decision analytic models. Medical Care. 37, 270–284 (1999)CrossRefGoogle Scholar
  16. 16.
    Llewellyn-Thomas, H.A., Thiel, E.C., Sem, F.W.C., Wormke, D.E.: Presenting clinical trial information - A comparison of methods. Patient Education and Counselling 25, 97–107 (1995)CrossRefGoogle Scholar
  17. 17.
    Street, R.L., Voigt, B., Geyer, C., Manning, T., Swanson, G.P.: Increasing patient involvement in choosing treatment for early breast-cancer. Cancer 76, 2275–2285 (1995)CrossRefGoogle Scholar
  18. 18.
    Payne, J.W., Bettman, J.R., Johnson, E.J.: The adaptive decision maker. Cambridge University Press, Cambridge (1993)Google Scholar
  19. 19.
    Todd, P., Benbasat, I.: Inducing compensatory Information processing through Decision aids that facilitate effort Reduction: An experimental Assessment. Journal of Behavioral Decision Making 13, 91–106 (2000)CrossRefGoogle Scholar
  20. 20.
    Klayman, J.: Children’s decision strategies and their adaptation to task characteristics. Organizational Behavior and Human Decision Processes 35, 179–201 (1985)CrossRefGoogle Scholar
  21. 21.
    Redelmeir, D.A., Shafir, E.: Medical decision making in situations that offer multiple alternatives. Journal of the American Medical Association 273, 302–305 (1995)CrossRefGoogle Scholar
  22. 22.
    Simon, H.A.: Rational choice and the structure of the environment. Psychological Review 63, 129–138 (1956)CrossRefGoogle Scholar
  23. 23.
    Tversky, A., Kahneman, D.: Judgement under uncertainty: Heuristics and biases. Science 185, 1124–1131 (1974)CrossRefGoogle Scholar
  24. 24.
    Thorngate, W.: Efficient decision heuristics. Behavioral Science 25, 219–225 (1980)CrossRefGoogle Scholar
  25. 25.
    O’Connor, A.M., Tugwell, P., Wells, G.A., Elmslie, T., Jolly, E., Hollingworth, G., et al.: A decision aid for women considering hormone therapy after menopause: decision support framework and evaluation. Patient Education and Counselling 33, 267–279 (1998)CrossRefGoogle Scholar
  26. 26.
    Baron, J.: Thinking and Deciding, 3rd edn. Cambridge University Press, Cambridge (2001)Google Scholar
  27. 27.
    Frisch, D., Clemen, R.T.: Beyond expected utility: Rethinking behavioral decision research. Psychological Bulletin 116, 46–54 (1994)CrossRefGoogle Scholar
  28. 28.
    Zey, M.: Rational choice theory and organizational theory: a critique. Sage Publications, USA (1998)Google Scholar
  29. 29.
    Bekker, H.: Understanding why decision aids work: linking process with outcome. Patient Education and Counselling 50, 323–329 (2003)CrossRefMathSciNetGoogle Scholar
  30. 30.
    Janis, I.L., Mann, L.: Decision making: a psychological analysis of conflict, choice and commitment. The Free Press, New York (1977)Google Scholar
  31. 31.
    Stone, D.N., Schkade, D.A.: Numeric and Linguistic Information Representation in Multiattribute Choice. Organizational Behavior and Human Decision Processes 49, 42–59 (1991)CrossRefGoogle Scholar
  32. 32.
    Sundstroem, G.A.: Information search and decision making: The effects of information displays. In: Montgomery, H., Svenson, O. (eds.) Process and structure in human decision making, John Wiley & Sons, New York (1989)Google Scholar
  33. 33.
    Billings, R.S., Scherer, L.L.: The effects of response mode and importance on decision-making strategies. Organizational Behavior and Human Decision Processes 41, 1–19 (1988)CrossRefGoogle Scholar
  34. 34.
    Maheswaran, D., Meyers-Levy, J.: The influence of message framing and issue involvement. Journal of Marketing Research 27, 361–367 (1990)CrossRefGoogle Scholar
  35. 35.
    Flesch, R.: A new readability yardstick. Journal of Applied Psychology 32, 221–233 (1948)CrossRefGoogle Scholar
  36. 36.
    Westenberg, M.R.M., Koele, P.: Multi-attribute evaluation processes: Methodological and conceptual issues. Acta. Psychologica 87, 65–84 (1994)CrossRefGoogle Scholar
  37. 37.
    Baron, R.M., Kenny, D.A.: The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology 51, 1173–1182 (1986)CrossRefGoogle Scholar
  38. 38.
    Edwards, A.L.: An introduction to linear regression and correlation. Freeman and Company, New York (1976)Google Scholar
  39. 39.
    Jarvenpaa, S.L.: The effect of task demands and graphical format on information processing strategies. Management Science 35, 285–303 (1989)CrossRefGoogle Scholar
  40. 40.
    O’Connor, A.M., Rostom, A., Fiset, V., Tetroe, J., Entwistle, V., Llewellyn-Thomas, H.A., et al.: Decision aids for patients facing health treatment or screening decisions: systematic review. British Medical Journal 319, 731–734 (1999)Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2007

Authors and Affiliations

  • Neil Carrigan
    • 1
  • Peter H. Gardner
    • 2
  • Mark Conner
    • 2
  • John Maule
    • 3
  1. 1.Department of Computer Science, University of Bath, Bath, BA2 7AYUK
  2. 2.Institute of Psychological Sciences, University of Leeds, Leeds, LS2 9JTUK
  3. 3.Leeds University Business School, University of Leeds, LS2 9JTUK

Personalised recommendations