Risk and Uncertainty Communication

“…many systematic and nonsystematic reviews of the use of graphics in risk communication, primarily in the health fields (Ancker et al. 2006, Visschers et al. 2009, Spiegelhalter et al. 2011, Hildon et al. 2012, Stephens et al. 2012, Trevena et al. 2013, Zipkin et al. 2014, Hallgreen et al. 2016).”

“Key challenges include communication of the nuances of scenario projections to lay audiences (as different from forecasts), and visualization of uncertainty (Kamal et al., 2021; Hullman et al., 2019; Hägele et al., 2022; Spiegelhalter, 2017).”

“To express the probabilities, we use verbal mapping proposed by [26].”

“As established by Sprenger and Stegenga (2017), absolute measures but not relative ones always do so for choices between a treatment and a control group treatment.”

“(Spiegelhalter, 2017).”

“” Several publications (e.g., [53, 54]) recommend presenting the probabilities of both events together as “5 % have side effects, 95 % do not” to avoid bias induced by the presentation chosen.”

“For a detailed discussion about uncertainty and ways of communicating it see Spiegelhalter (2017). The accuracy of the approximation to the temporal aggregation constraint can be evaluated by aggregating the unobserved components’ smoothed estimates by using the exact observation function (1) and comparing the resulti…”

“A consistent finding in the literature is that different people typically have various numerical interpretations of the same verbal probability expressions (for reviews, see Simpson, 1963; Spiegelhalter, 2017; Visscher et al., 2009).”

“…et al., 1995), the term “risk” was used in a general manner, recent research sought to understand whether the public differentiates between the concepts of risk and hazard (Freudenstein et al., 2020) or how epistemic uncertainty is best communicated (Jansen et al., 2020a; Spiegelhalter, 2017).”

“Speci fi cally, the guiding principles of risk communication (27, 28) have been implemented in the web-based format of the NILS tool and involve the following: I) Presenting the numeric estimate of the probability of N0 for an individual patient.”

“However, Rumsfeld’s triptych has been described as the ‘simplest’ attempt to structuring uncertainty 84 despite the existence of a range of taxonomies of uncertainty that have been developed across a number of other disciplines, such as environmental science 85 .”

“For example, several reviews (Morgan et al., 2009; Oppenheimer, Little, & Cooke, 2016; Spiegelhalter, 2017) describe choices ranging from less precise verbal likelihood phrases and evaluative labels to more precise density or cumulative probability distributions, including a variety of visual and…”

“In a world increasingly threatened by disasters, effectively communicating uncertainty in decision-making is crucial (Doyle et al. 2018; Lammers et al. 2024; Schneider 2016; Spiegelhalter 2017).”

“However, the specific ontologies that are used in our application examples are subject to ontological uncertainties [71] and are limited to the scope of the considered scenarios.”

“Additional instantiations of these and other strategies can be found in excellent articles about risk and uncertainty (Spiegelhalter, 2017; Fagerlin et al., 2011), data visualization (Garcia-Retamero & Cokely, 2013), adding familiar perspectives to numbers to help make sense of them (Riederer et…”

“These numbers may need qualifiers, however, which acknowledge that they are the best estimates available, given the current research evidence, and that estimates come with uncertainty [24].”

“In a similar vein, Spiegelhalter (2017) distinguishes aleatoric uncertainty (i.e., the unpredictability of future events which we cannot know and which is similar to the unknown unknowns and scientific uncertainty by Gustafson & Rice, 2020) from epistemic uncertainty (uncertainty from a lack of…”

“Risk communication may also play an important role in aiding the comparison of two risks [17–19].”

“Since the purpose of a visualisation is to give a quick gist of the information (Spiegelhalter 2017), this hedging should be communicated visually without the need for complicated mental calculations.”

“0.0001 (10 -4 ) Spiegelhalter (2017) American risk experts and were first used for the analysis of dam safety.”

“It is a situation of inadequate information in terms of inexactness, unreliability, and bordering on ignorance (Funtowicz & Ravetz, 1990; Spiegelhalter, 2017).”

“Nevertheless, a large degree of uncertainty and speculation remains in news making (Neiger, 2007; Spiegelhalter, 2017), especially when predicting the future.”

“In contrast parameter and model uncertainty is uncertainty that is attributable to a lack of information and is often referred to epistemic uncertainty, see Hacking (1975), Fox and Ülkümen (2011), Spiegelhalter (2017) for discussions on the topic.”

“Likewise, the US Centers for Disease Control and Prevention (CDC) has recommended six core principles to guide “Crisis and Emergency Risk Communication”: (1) be first, (2) be right, (3) be credible, (4) express empathy, (5) promote action, and (6) show respect.”

“However, most patients appreciate this transparent approach (19) and the use of absolute risks is generally recommended (60).”

“Analyzing the definitions of uncertainty presented in Table 1, four categories of approaches to defining them can be identified: · due to reasons (Smithson, 1999; Krickx, 2000; Carbonara & Caizza, 2010), · due to the ability / inability to assess probability (van der Heijden, 2000; Holton, 2004; Spiegelhalter, 2017),”

“Both Spiegelhalter (2017), and GarciaRetamero and Galesic (2010) report that the visual formats (e.g. percentages, frequency, graphics) used when presenting risk information can significantly affect how the message is comprehended; and further, that it is critical to develop optimal risk…”

“Moreover, the appropriate communication of uncertainties (Spiegelhalter 2017) is often not part of these technical reviews.”

“A combination of words, numbers and graphics used collectively, allows for greater communication interpretability on the topic [38].”

“Disagreement among experts on what constitutes the ground truth concerning a pulmonary nodule is a matter of ontological uncertainty (Spiegelhalter, 2017), measuring the limitations of the proposed prediction pipeline as a description of reality.”

“…and that other formats such as natural frequencies (i.e. 9 out of 100 people) or visual aids (i.e. icon arrays) are more suitable formats for communicating complex health risk information (Bonner et al. 2021; Gigerenzer et al. 2008; Spiegelhalter 2017; Fagerlin, Zikmund-Fisher, and Ubel 2011).”

“The use of graphical representation formats is recommended by the International Patient Decision Aid Standards (IPDAS) 5 because a multitude of studies has shown that graphical representation formats lead to better understanding of medical information compared with numerical representation formats (for reviews, see Ga…”

“trust, and specifically on the visual aids for risk evaluation (Spiegelhalter, 2017), such as the risk budget bar and the yellow circles estimating possible future vehicle locations.”

“It was not surprising that people struggled to understand their cancer risks and what it meant to them, given established challenges presenting risk information to the public (Freeman, 2019; Spiegelhalter, 2017).”

“Hence, relying on averaged causal quantities for medical decision-making can be misleading and, in some cases, even dangerous [43, 46].”

“…probabilities to aid interpretation of effect sizes where relevant; that is, we reported absolute effect sizes (i.e., %-point differences between levels of the exposure) in addition to relative effect sizes (i.e., odds ratios and relative risk ratios), as the former are easier to interpret [57].”

“8 Additionally, Spiegelhalter [75] ofers advice for how to communicate and visualize uncertainty, like expressing uncertainty as a proportion, frequency, or percentage with a clear denominator and visualizing uncertainty several ways to reach diferent audiences.”

“13,14 In comparison, absolute risk of a given outcome provides the proportion of individuals who will develop the disorder of interest.”

“In the future, it is worth investigating additional modalities, such as words and graphs, e.g., charts and icon arrays (Spiegelhalter, 2017; Zipkin et al., 2014), as well as combinations of modalities.”

“The communication of risk involves a description of reality, which can be expressed as a qualitative and subjective assessment of events [25].”

“There are numerous approaches that could be used to express the uncertainty of a clinical outcome all of which have potential benefits and drawbacks, although there is little consensus as to what the best approach would be [11].”

“Critical thinking techniques such as the “double standard test”, the “outsider test”, the “conformity test”, and the “selective skeptic test” are likely to be useful in testing inference and argument.(61) Courts in the UK have warned, at the highest level, that “there is a danger that so-called ‘epidemiological eviden…”

“The aleatoric uncertainty is particularly important for reliable decision-making (Spiegelhalter, 2017; van der Bles et al., 2019): by knowing the whole distribution of the PO, decision-makers such as clinicians may be able to evaluate the probabilities of unwanted outcomes.”

“However, this is certainly not the norm (Spiegelhalter 2017); thus, we focus on instances when a selective algorithmic intervention is triggered due to a confidence value being below a specified threshold.”

“We also sought to present the risk information in absolute terms, using icon arrays, in accord with accepted risk communication practices [42–44].”

“In addition to numeric representation, graphical, textual and tabular risk communication methods are also well explored in literature[24], however, with no conclusive evidence of an appropriate method.”

“Although risk communication is complex and there is no one-size-fits-all communication strategy, visual representation of risk can improve patient understanding and satisfaction [32,36,41].”

“Consistent with dual coding theory and CTML, there is large body of literature showing that different types of visual aids can improve understanding and perception of different types of (complex) health statistics [21, 22, 30].”

“numerical probability expressions, see [8-17].”

“Even better, different levels of risk should have verbal and numerical definitions, accompanied by clear visualisations that are easy to understand by the target population (Spiegelhalter, 2017), considering the population’s numeracy level.”

“This concern is consistent with longstanding challenges in risk communication, where presenting uncertainty may be perceived as undermining clarity or public confidence, which could explain the reliance on simplified dashboard designs observed in this study (4).”

“…uncertainty communication is plagued by challenges such as cognitive biases [4, 25, 35], numeracy skills [11, 26], calibrating risk perception, [29] and increased cognitive load [13], with research fnding that lay users can struggle to interpret probabilities and uncertainty visualizations…”

“From our observations, and those noted by Spiegelhalter ( 2017 ), many risk communication practitioners still predominantly operate within the first three stages of Fischhoff’s ( 1995 ) stages: Getting the numbers right , telling people the numbers , and, to a limited extent, explaining what the…”

“A considerable amount of literature has been published on risk and uncertainty communication in the past (Balog-Way et al. 2020 , Spiegelhalter 2017 ).”

“32 The TRIPOD statement 33 provides guidance on how to report a prediction model, but it does not address how to report the resulting predictions.”

“Even though past research has frequently highlighted that the communication of uncertainty is tricky (see for a review Spiegelhalter 2017), research on the effects of communication practices on subsequent decision-making is still in its infancy.”

“Effective policy design in this context requires the government to develop a deep understanding of how local populations form their risk perceptions, enabling them to reduce perceived threats and foster confidence in public institutions (Lachlan and Spence 2010; He et al. 2013; Spiegelhalter 2017).”

“Uncertainty can refer to different phenomena (see work by Spiegel-halter [54] for a deeper discussion), but this article is concerned with the visualization of aleatoric uncertainty (i.e., calculable risk given a mathematical model to make predictions of future outcomes).”

“However, the use of relative measures can increase the perceived size of the effect and absolute risk estimates should be added to improve clinical value (Noordzij et al., 2017; Novelli et al., 2021; Spiegelhalter, 2017; Stensrud and Hern ´ an, 2020).”

“Mapping confidence intervals to verbal terms is the commonly employed approach in risk communication (Spiegelhalter, 2017).”

“2001; Spieglhalter 2017; Spieglhalter et al.”

“It regards the media that can transmit needed information for uncertainty reduction and ambiguity resolution to achieve the goal of communication (Spiegelhalter, 2017).”