Quantitative PDA improves understanding and confidence versus qualitative PDA in dysplastic nevus screening

BACKGROUND: Patient decision aids (PDAs) support shared decision-making by presenting treatment options clearly and objectively. However, little is known about how risk framing and diagnostic severity labels influence patient preferences in dermatology. OBJECTIVE: Assess how PDA format (quantitative vs qualitative) and dysplastic nevus severity (mild, moderate, or severe) affect understanding, risk perception, confidence, and treatment intent. METHODS: In this randomized A/B testing design, 600 US adults viewed a quantitative or qualitative PDA describing a mild, moderate, or severe dysplastic nevus scenario. Self-reported outcomes included understanding, treatment selection (excision vs monitoring), satisfaction, decision-making confidence, perceived melanoma risk, and concern. Analyses used nonparametric tests and logistic regression. RESULTS: Quantitative PDAs improved self-reported understanding (median 80 vs 72; P = .008) and confidence (P = .003) and lowered perceived melanoma risk for monitoring (P = .003) and excision (P < .001), but did not change excision intent (52% vs 53%; odds ratio 1.04, 95% CI 0.75-1.43; P = .818). Dysplastic nevus severity significantly increased excision intent (31% mild, 41% moderate, 72% severe; P < .001), without affecting understanding. CONCLUSION: Quantitative PDAs enhance comprehension, yet diagnostic severity labels predominantly drive treatment intent. Approximately one-third of participants diverged from expert recommendations despite high comprehension, underscoring that individual values drive treatment choices.