The stadium diagram, a web-based tool for visualizing the expected outcomes of alternative clinical management strategies.

Objective: To explore the use of graphical animation for helping clinicians to understand the evidence about expected risks and benefits associated with multi-step clinical management strategies.

Methods: We used Flash and XML to create a tool capable of displaying the sequence of health state changes that may result from a specific management strategy, as applied to a simulated population. We evaluated this tool in 6 focus groups involving a total of 44 community internists and family physicians. We successively revised the tool based on grounded theory analysis of the focus group transcripts.

Results: The process of responding to design issues raised in focus groups resulted in a final tool that presents a group of person icons arranged in rows to give the illusion of people in a stadium or theater. Each action in the management strategy causes persons to change color and move among rows to reflect changes in health state. The tool can play audio narration to explain each step and links are provided to the supporting evidence. Most physicians found these visualizations to be attractive and clear. Some were interested in using the tool with patients. Others rejected the specific decision model used to demonstrate the tool and a few rejected the notion of applying quantitative risks to individual patients.

Conclusions: A visual approach to demonstrating the possible benefits and harms of a given management strategy holds interest for many clinicians. However, visualizations may fail to influence clinicians who do not believe the available evidence.