401
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Bolger F, Rowe G. The aggregation of expert judgment: do good things come to those who weight? RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2015; 35:5-11. [PMID: 25156754 DOI: 10.1111/risa.12272] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Good policy making should be based on available scientific knowledge. Sometimes this knowledge is well established through research, but often scientists must simply express their judgment, and this is particularly so in risk scenarios that are characterized by high levels of uncertainty. Usually in such cases, the opinions of several experts will be sought in order to pool knowledge and reduce error, raising the question of whether individual expert judgments should be given different weights. We argue--against the commonly advocated "classical method"--that no significant benefits are likely to accrue from unequal weighting in mathematical aggregation. Our argument hinges on the difficulty of constructing reliable and valid measures of substantive expertise upon which to base weights. Practical problems associated with attempts to evaluate experts are also addressed. While our discussion focuses on one specific weighting scheme that is currently gaining in popularity for expert knowledge elicitation, our general thesis applies to externally imposed unequal weighting schemes more generally.
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Affiliation(s)
- Fergus Bolger
- Department of Management, Durham University Business School, Mill Hill Lane, Durham, DH1 3LB, UK
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402
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Hopmans W, Damman OC, Timmermans DRM, Haasbeek CJA, Slotman BJ, Senan S. Communicating cancer treatment information using the Web: utilizing the patient's perspective in website development. BMC Med Inform Decis Mak 2014; 14:116. [PMID: 25481306 PMCID: PMC4271466 DOI: 10.1186/s12911-014-0116-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 11/20/2014] [Indexed: 01/04/2023] Open
Abstract
Background Online cancer information can support patients in making treatment decisions. However, such information may not be adequately tailored to the patient’s perspective, particularly if healthcare professionals do not sufficiently engage patient groups when developing online information. We applied qualitative user testing during the development of a patient information website on stereotactic ablative radiotherapy (SABR), a new guideline-recommended curative treatment for early-stage lung cancer. Methods We recruited 27 participants who included patients referred for SABR and their relatives. A qualitative user test of the website was performed in 18 subjects, followed by an additional evaluation by users after website redesign (N = 9). We primarily used the ‘thinking aloud’ approach and semi-structured interviewing. Qualitative data analysis was performed to assess the main findings reported by the participants. Results Study participants preferred receiving different information that had been provided initially. Problems identified with the online information related to comprehending medical terminology, understanding the scientific evidence regarding SABR, and appreciating the side-effects associated with SABR. Following redesign of the website, participants reported fewer problems with understanding content, and some additional recommendations for better online information were identified. Conclusions Our findings indicate that input from patients and their relatives allows for a more comprehensive and usable website for providing treatment information. Such a website can facilitate improved patient participation in treatment decision-making for cancer.
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Affiliation(s)
- Wendy Hopmans
- Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. .,Department of Radiation Oncology, VU University Medical Center, De Boelelaan 1117, 1007MB, Amsterdam, The Netherlands.
| | - Olga C Damman
- Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Danielle R M Timmermans
- Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Cornelis J A Haasbeek
- Department of Radiation Oncology, VU University Medical Center, De Boelelaan 1117, 1007MB, Amsterdam, The Netherlands.
| | - Ben J Slotman
- Department of Radiation Oncology, VU University Medical Center, De Boelelaan 1117, 1007MB, Amsterdam, The Netherlands.
| | - Suresh Senan
- Department of Radiation Oncology, VU University Medical Center, De Boelelaan 1117, 1007MB, Amsterdam, The Netherlands.
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403
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Sturmberg J, Topolski S. For every complex problem, there is an answer that is clear, simple and wrong: and other aphorisms about medical statistical fallacies. J Eval Clin Pract 2014; 20:1017-25. [PMID: 24814825 DOI: 10.1111/jep.12156] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2014] [Indexed: 11/27/2022]
Abstract
RATIONALE, METHOD This essay examines the notions of knowledge, truth and certainty as they apply to medical research and patient care. The human body does not behave in mechanistic but rather complex adaptive ways; thus, its behaviour to challenges is non-deterministic. This insight has important ramifications for experimental studies in health care and their statistical interrogation that are described in detail. RESULTS AND CONCLUSIONS Four implications are highlighted: one, there is an urgent need to develop a greater awareness of uncertainties and how to respond to them in clinical practice, namely, what is important and what is not in the context of this patient; two, there is an equally urgent need for health professionals to understand some basic statistical terms and their meanings, specifically absolute risk, its reciprocal, numbers needed to treat and its inverse, index of therapeutic impotence, as well as seeking out the effect size of an intervention rather than blindly accepting P-values; three, there is an urgent need to accurately present the known in comprehensible ways through the use of visual tools; and four, there is a need to overcome the perception, that errors of commission are less troublesome than errors of omission as neither's consequences are predictable.
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404
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Advances in examining preferences for similarity in seating: Revisiting the aggregation index. Behav Res Methods 2014; 47:1328-1342. [PMID: 25427955 DOI: 10.3758/s13428-014-0541-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Past research finds that people prefer to sit next to others who are similar to them in a variety of dimensions such as race, sex, and physical appearance. This preference for similarity in seating arrangements is called aggregation and is most commonly measured with the aggregation index (Campbell, Kruskal, & Wallace, Sociometry 29, 1-15, 1966). The aggregation index compares the observed dissimilarity in seating with the amount of dissimilarity that would be expected if seats were chosen randomly. However, the current closed-form equations for this method limit the ease, flexibility, and inferences that researchers have. This paper presents a new approach for studying aggregation that uses bootstrapped resampling of the seating environment to estimate the aggregation index parameters. This method, compiled as an executable program, SocialAggregation, reads a seating chart matrix provided by the researcher and automatically computes the observed number of dissimilar adjacencies, and simulates random seating preferences. The current method's estimates not only converge with those of the original method, but it also handles a wider variety of situations and also allows for more precise hypothesis testing by directly modeling the distribution of the seating arrangements. Developing a better measure of aggregation opens new possibilities for understanding intergroup biases, and allows researchers to examine aggregation more efficiently.
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405
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Navarrete G, Correia R, Froimovitch D. Communicating risk in prenatal screening: the consequences of Bayesian misapprehension. Front Psychol 2014; 5:1272. [PMID: 25414688 PMCID: PMC4222132 DOI: 10.3389/fpsyg.2014.01272] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 10/20/2014] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gorka Navarrete
- Laboratory of Cognitive and Social Neuroscience, Department of Psychology, Universidad Diego Portales, UDP-INECO Foundation Core on Neuroscience Santiago, Chile
| | - Rut Correia
- Faculty of Education, Universidad Diego Portales Santiago, Chile
| | - Dan Froimovitch
- Department of Physiology, University of Toronto Toronto, ON, Canada
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406
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Caverly TJ, Prochazka AV, Combs BP, Lucas BP, Mueller SR, Kutner JS, Binswanger I, Fagerlin A, McCormick J, Pfister S, Matlock DD. Doctors and numbers: an assessment of the critical risk interpretation test. Med Decis Making 2014; 35:512-24. [PMID: 25378297 DOI: 10.1177/0272989x14558423] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 09/26/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Risk interpretation affects decision making. Yet, there is no valid assessment of how clinicians interpret the risk data that they commonly encounter. OBJECTIVE To establish the reliability and validity of a 20-item test of clinicians' risk interpretation. METHODS The Critical Risk Interpretation Test (CRIT) measures clinicians' abilities to 1) modify the interpretation based on meaningful differences in the outcome (e.g., disease specific v. all-cause mortality) and time period (e.g., lifetime v. 10-year mortality), 2) maintain a stable interpretation for different risk framings (e.g., relative v. absolute risk), and 3) correctly interpret how diagnostic testing modifies risk. There were 658 clinicians and medical trainees who participated: 116 nurse practitioners (NPs) at a national conference, 273 medical students at 1 institution, 148 residents in internal medicine at 2 institutions, and 121 internists at 1 institution. Participants completed a self-administered paper test during educational conferences. Seventeen evidence-based medicine experts took the test online and formally assessed content validity. Eighteen second-year medical students were recruited to take the test and a retest 3 weeks later to explore test-retest correlation. RESULTS Expert review supported test clarity and content validity. Factor analysis supported that the CRIT identifies at least 3 separable areas of clinician knowledge. Test-retest correlation was fair (intraclass correlation coefficient = 0.65; standard error = 0.15). Scores on our test correlated with other tests of related abilities. Mean test scores varied among groups, with differences in prior evidence-based medicine training and experience (93 for NPs, 101 for medical students, 101 for residents, 103 for academic internists, and 110 for physician experts; P < 0.001). CONCLUSIONS Our results provide supporting evidence for the reliability and validity of the CRIT as an index of critical risk interpretation abilities, which is acceptable and feasible to administer in an educational setting.
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Affiliation(s)
- Tanner J Caverly
- Veterans Affairs Center for Clinical Management Research, Ann Arbor Veterans Affairs Health System, University of Michigan Medical School, Ann Arbor, MI (TJC, AF)
| | - Allan V Prochazka
- Internal Medicine, University of Colorado School of Medicine, Aurora, CO (AVP, BPC, SRM, JSK, IB, DDM),Ambulatory Care, Denver Veterans Affairs Medical Center, Denver, CO (AVP, JM, SP)
| | - Brandon P Combs
- Internal Medicine, University of Colorado School of Medicine, Aurora, CO (AVP, BPC, SRM, JSK, IB, DDM)
| | - Brian P Lucas
- Department of Medicine, John H. Stroger Jr. Hospital of Cook County, Chicago, IL (BPL)
| | - Shane R Mueller
- Internal Medicine, University of Colorado School of Medicine, Aurora, CO (AVP, BPC, SRM, JSK, IB, DDM)
| | - Jean S Kutner
- Internal Medicine, University of Colorado School of Medicine, Aurora, CO (AVP, BPC, SRM, JSK, IB, DDM)
| | - Ingrid Binswanger
- Internal Medicine, University of Colorado School of Medicine, Aurora, CO (AVP, BPC, SRM, JSK, IB, DDM)
| | - Angela Fagerlin
- Veterans Affairs Center for Clinical Management Research, Ann Arbor Veterans Affairs Health System, University of Michigan Medical School, Ann Arbor, MI (TJC, AF)
| | - Jacqueline McCormick
- Ambulatory Care, Denver Veterans Affairs Medical Center, Denver, CO (AVP, JM, SP)
| | - Shirley Pfister
- Ambulatory Care, Denver Veterans Affairs Medical Center, Denver, CO (AVP, JM, SP)
| | - Daniel D Matlock
- Internal Medicine, University of Colorado School of Medicine, Aurora, CO (AVP, BPC, SRM, JSK, IB, DDM)
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407
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Kakos AB, Lovejoy DA, Whiteside JL. Quality of information on pelvic organ prolapse on the Internet. Int Urogynecol J 2014; 26:551-5. [DOI: 10.1007/s00192-014-2538-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 10/03/2014] [Indexed: 11/29/2022]
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408
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Affiliation(s)
- M. G. Irwin
- Department of Anaesthesiology; University of Hong Kong; Hong Kong
| | - V. K. F. Kong
- Department of Anaesthesiology; University of Hong Kong; Hong Kong
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409
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Hersch J, Jansen J, Barratt A, Irwig L, Houssami N, Jacklyn G, Thornton H, Dhillon H, McCaffery K. Overdetection in breast cancer screening: development and preliminary evaluation of a decision aid. BMJ Open 2014; 4:e006016. [PMID: 25256188 PMCID: PMC4179580 DOI: 10.1136/bmjopen-2014-006016] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 08/19/2014] [Accepted: 09/05/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To develop, pilot and refine a decision aid (ahead of a randomised trial evaluation) for women around age 50 facing their initial decision about whether to undergo mammography screening. DESIGN Two-stage mixed-method pilot study including qualitative interviews (n=15) and a randomised comparison using a quantitative survey (n=34). SETTING New South Wales, Australia. PARTICIPANTS Women aged 43-59 years with no personal history of breast cancer. INTERVENTIONS The decision aid provides evidence-based information about important outcomes of mammography screening over 20 years (breast cancer mortality reduction, overdetection and false positives) compared with no screening. The information is presented in a short booklet for women, combining text and visual formats. A control version produced for the purposes of comparison omits the overdetection-related content. OUTCOMES Comprehension of key decision aid content and acceptability of the materials. RESULTS Most women considered the decision aid clear and helpful and would recommend it to others. Nonetheless, the piloting process raised important issues that we tried to address in iterative revisions. Some participants found it hard to understand overdetection and why it is of concern, while there was often confusion about the distinction between overdetection and false positives. In a screening context, encountering balanced information rather than persuasion appears to be contrary to people's expectations, but women appreciated the opportunity to become better informed. CONCLUSIONS The concept of overdetection is complex and new to the public. This study highlights some key challenges for communicating about this issue. It is important to clarify that overdetection differs from false positives in terms of its more serious consequences (overtreatment and associated harms). Screening decision aids also must clearly explain their purpose of facilitating informed choice. A staged approach to development and piloting of decision aids is recommended to further improve understanding of overdetection and support informed decision-making about screening.
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Affiliation(s)
- Jolyn Hersch
- Screening & Test Evaluation Program (STEP) and Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jesse Jansen
- Screening & Test Evaluation Program (STEP) and Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Alexandra Barratt
- Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Les Irwig
- Screening & Test Evaluation Program (STEP), School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Nehmat Houssami
- Screening & Test Evaluation Program (STEP), School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Gemma Jacklyn
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Hazel Thornton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Haryana Dhillon
- Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), Central Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Kirsten McCaffery
- Screening & Test Evaluation Program (STEP) and Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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410
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Dreier M, Borutta B, Seidel G, Münch I, Kramer S, Töppich J, Dierks ML, Walter U. Communicating the benefits and harms of colorectal cancer screening needed for an informed choice: a systematic evaluation of leaflets and booklets. PLoS One 2014; 9:e107575. [PMID: 25215867 PMCID: PMC4162645 DOI: 10.1371/journal.pone.0107575] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 08/20/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Evidence-based health information (EBHI) can support informed choice regarding whether or not to attend colorectal cancer (CRC) screening. The present study aimed to assess if German leaflets and booklets appropriately inform consumers on the benefits and harms of CRC screening. METHODS A systematic search for print media on CRC screening was performed via email enquiry and internet search. The identified documents were assessed for the presence and correctness of information on benefits and harms by two reviewers independently using a comprehensive list of criteria. RESULTS Many of the 28 leaflets and 13 booklets identified presented unbalanced information on the benefits and harms of CRC screening: one-third did not provide any information on harms. Numeracy information was often lacking. Ten cross-language examples of common misinterpretations or basically false and misleading information were identified. DISCUSSION Most of the CRC screening leaflets and booklets in Germany do not meet current EBHI standards. After the study, the publishers of the information materials were provided feedback, including a discussion of our findings. The results can be used to revise existing information materials or to develop new materials that provide correct, balanced, quantified, understandable and unbiased information on CRC screening.
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Affiliation(s)
- Maren Dreier
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
- * E-mail:
| | - Birgit Borutta
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Gabriele Seidel
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Inga Münch
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Silke Kramer
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Jürgen Töppich
- Department 2 Effectivity and Efficiency of Health Education, Federal Centre for Health Education (BZgA), Köln, Germany
| | - Marie-Luise Dierks
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Ulla Walter
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
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411
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Hanoch Y, Miron-Shatz T, Rolison JJ, Omer Z, Ozanne E. Shared decision making in patients at risk of cancer: the role of domain and numeracy. Health Expect 2014; 18:2799-810. [PMID: 25186806 DOI: 10.1111/hex.12257] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Shared decision making has become an integral part of medical consultation. Research has, however, reported wide differences in individuals' desires to be involved in the decision-making process, and these differences in preferences are likely to be the result of a number of factors including age, education and numeracy. OBJECTIVE To investigate whether patients at genetic risk for cancer had preferences for shared decision making that differed depending on medical domain (general health vs. cancer) and whether decision preferences are linked to numeracy abilities. METHODS Four hundred and seventy-six women who consented to participate in response to an email sent by a local branch of the U.S.-based Cancer Genetics Network (CGN) to its members. Participants completed the Control Preference Scale, as well as an objective and subjective numeracy scales. RESULTS Decision domain (cancer vs. general health) was not associated with women's preferences for involvement in decision making. Objective and subjective numeracy predicted a preference for decision involvement in general, and only objective numeracy was predictive with regard to cancer. CONCLUSION Participants were equally likely to state they wanted to play an active, collaborative or passive role in both medical domains (general and cancer). High-numeracy participants were more likely to express a desire for an active role in general and in case they were diagnosed with cancer. PRACTICE IMPLICATIONS Health authorities' recommendations to clinicians to include patients in their medical decisions are supported by patients' desires, and clinicians should be cognizant of their patients' preferences as well as their numeracy skills.
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Affiliation(s)
- Yaniv Hanoch
- School of Psychology, Cognition Institute, University of Plymouth, Drake Circus, Plymouth, UK
| | - Talya Miron-Shatz
- Center for Medical Decision Making, Ono Academic College, Kiryat Ono, Israel
| | | | - Zehra Omer
- Massachusetts General Hospital-Institute for Technology Assessment, Boston, MA, USA
| | - Elisa Ozanne
- The Dartmouth Institute Geisel School of Medicine at Dartmouth, Centerra Parkway, Lebanon, NH, USA
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412
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Mathematical anxiety is linked to reduced cognitive reflection: a potential road from discomfort in the mathematics classroom to susceptibility to biases. Behav Brain Funct 2014; 10:31. [PMID: 25179230 PMCID: PMC4166027 DOI: 10.1186/1744-9081-10-31] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 08/25/2014] [Indexed: 11/21/2022] Open
Abstract
Background When asked to solve mathematical problems, some people experience anxiety and threat, which can lead to impaired mathematical performance (Curr Dir Psychol Sci 11:181–185, 2002). The present studies investigated the link between mathematical anxiety and performance on the cognitive reflection test (CRT; J Econ Perspect 19:25–42, 2005). The CRT is a measure of a person’s ability to resist intuitive response tendencies, and it correlates strongly with important real-life outcomes, such as time preferences, risk-taking, and rational thinking. Methods In Experiments 1 and 2 the relationships between maths anxiety, mathematical knowledge/mathematical achievement, test anxiety and cognitive reflection were analysed using mediation analyses. Experiment 3 included a manipulation of working memory load. The effects of anxiety and working memory load were analysed using ANOVAs. Results Our experiments with university students (Experiments 1 and 3) and secondary school students (Experiment 2) demonstrated that mathematical anxiety was a significant predictor of cognitive reflection, even after controlling for the effects of general mathematical knowledge (in Experiment 1), school mathematical achievement (in Experiment 2) and test anxiety (in Experiments 1–3). Furthermore, Experiment 3 showed that mathematical anxiety and burdening working memory resources with a secondary task had similar effects on cognitive reflection. Conclusions Given earlier findings that showed a close link between cognitive reflection, unbiased decisions and rationality, our results suggest that mathematical anxiety might be negatively related to individuals’ ability to make advantageous choices and good decisions.
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413
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Büchter RB, Fechtelpeter D, Knelangen M, Ehrlich M, Waltering A. Words or numbers? Communicating risk of adverse effects in written consumer health information: a systematic review and meta-analysis. BMC Med Inform Decis Mak 2014; 14:76. [PMID: 25155972 PMCID: PMC4153005 DOI: 10.1186/1472-6947-14-76] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 08/20/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Various types of framing can influence risk perceptions, which may have an impact on treatment decisions and adherence. One way of framing is the use of verbal terms in communicating the probabilities of treatment effects. We systematically reviewed the comparative effects of words versus numbers in communicating the probability of adverse effects to consumers in written health information. METHODS Nine electronic databases were searched up to November 2012. Teams of two reviewers independently assessed studies. INCLUSION CRITERIA randomised controlled trials; verbal versus numerical presentation; context: written consumer health information. RESULTS Ten trials were included. Participants perceived probabilities presented in verbal terms as higher than in numeric terms: commonly used verbal descriptors systematically led to an overestimation of the absolute risk of adverse effects (Range of means: 3% - 54%). Numbers also led to an overestimation of probabilities, but the overestimation was smaller (2% - 20%). The difference in means ranged from 3.8% to 45.9%, with all but one comparison showing significant results. Use of numbers increased satisfaction with the information (MD: 0.48 [CI: 0.32 to 0.63], p < 0.00001, I2 = 0%) and likelihood of medication use (MD for very common side effects: 1.45 [CI: 0.78 to 2.11], p = 0.0001, I2 = 68%; MD for common side effects: 0.90 [CI: 0.61 to 1.19], p < 0.00001, I2 = 1%; MD for rare side effects: 0.39 [0.02 to 0.76], p = 0.04, I2 = not applicable). Outcomes were measured on a 6-point Likert scale, suggesting small to moderate effects. CONCLUSIONS Verbal descriptors including "common", "uncommon" and "rare" lead to an overestimation of the probability of adverse effects compared to numerical information, if used as previously suggested by the European Commission. Numbers result in more accurate estimates and increase satisfaction and likelihood of medication use. Our review suggests that providers of consumer health information should quantify treatment effects numerically. Future research should focus on the impact of personal and contextual factors, use representative samples or be conducted in real life settings, measure behavioral outcomes and address whether benefit information can be described verbally.
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Affiliation(s)
- Roland Brian Büchter
- Department of Health Information, Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670 Cologne, Germany
| | - Dennis Fechtelpeter
- Department of Health Information, Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670 Cologne, Germany
| | - Marco Knelangen
- Department of Health Information, Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670 Cologne, Germany
| | - Martina Ehrlich
- Department of Health Information, Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670 Cologne, Germany
| | - Andreas Waltering
- Department of Health Information, Institute for Quality and Efficiency in Health Care (IQWiG), Im Mediapark 8, 50670 Cologne, Germany
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414
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Yacoub MH, El-Hamamsy I, Sievers HH, Carabello BA, Bonow RO, Stelzer P, da Costa FDA, Schäfers HJ, Skillington P, Charitos EI, Luciani GB, Takkenberg JJM. Under-use of the Ross operation--a lost opportunity. Lancet 2014; 384:559-560. [PMID: 25131967 DOI: 10.1016/s0140-6736(14)61090-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Magdi H Yacoub
- Magdi Yacoub Institute, Imperial College, London UB9 6JH, UK.
| | | | | | | | - Robert O Bonow
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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415
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Ruggeri A, Gummerum M, Hanoch Y. Braving difficult choices alone: children's and adolescents' medical decision making. PLoS One 2014; 9:e103287. [PMID: 25084274 PMCID: PMC4118856 DOI: 10.1371/journal.pone.0103287] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 06/30/2014] [Indexed: 11/19/2022] Open
Abstract
Objective What role should minors play in making medical decisions? The authors examined children's and adolescents' desire to be involved in serious medical decisions and the emotional consequences associated with them. Methods Sixty-three children and 76 adolescents were presented with a cover story about a difficult medical choice. Participants were tested in one of four conditions: (1) own informed choice; (2) informed parents' choice to amputate; (3) informed parents' choice to continue a treatment; and (4) uninformed parents' choice to amputate. In a questionnaire, participants were asked about their choices, preference for autonomy, confidence, and emotional reactions when faced with a difficult hypothetical medical choice. Results Children and adolescents made different choices and participants, especially adolescents, preferred to make the difficult choice themselves, rather than having a parent make it. Children expressed fewer negative emotions than adolescents. Providing information about the alternatives did not affect participants' responses. Conclusions Minors, especially adolescents, want to be responsible for their own medical decisions, even when the choice is a difficult one. For the adolescents, results suggest that the decision to be made, instead of the agent making the decision, is the main element influencing their emotional responses and decision confidence. For children, results suggest that they might be less able than adolescents to project how they would feel. The results, overall, draw attention to the need to further investigate how we can better involve minors in the medical decision-making process.
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Affiliation(s)
- Azzurra Ruggeri
- Max Planck Institute for Human Development, Berlin, Germany
- * E-mail:
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416
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Halley MC, Rendle KAS, Frosch DL. A conceptual model of the multiple stages of communication necessary to support patient-centered care. J Comp Eff Res 2014; 2:421-33. [PMID: 24236683 DOI: 10.2217/cer.13.46] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Patient-centered care requires that both healthcare providers and patients have access to comparative effectiveness research (CER), which provides direct comparisons of the risks and benefits of available clinical options. However, insufficient attention has been paid to developing the comprehensive communication systems necessary to ensure that CER reaches patients and healthcare providers. In this review, we propose a model of the multiple stages of CER communication necessary for patient-centered care and review the existing research and gaps in knowledge relevant to each stage. These stages include: promotion of the underlying concepts and value of CER; translation of CER results; dissemination of CER results; and utilization of the results of CER in shared decision-making between patients and providers. A comprehensive approach to CER communication is necessary to ensure that the growing interest in and availability of CER is able to support a more patient-centered model of healthcare.
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Affiliation(s)
- Meghan C Halley
- Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Palo Alto, CA 94301, USA
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417
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Affiliation(s)
- Trisha Greenhalgh
- Barts and the London School of Medicine and Dentistry, London E1 2AB, UK
| | - Jeremy Howick
- Centre for Evidence-Based Medicine, University of Oxford, Oxford OX2 6NW, UK
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418
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Altitude does not reduce concussion incidence in professional football players: a poor understanding of health statistics and altitude physiology. J Orthop Sports Phys Ther 2014; 44:458-9. [PMID: 24881904 DOI: 10.2519/jospt.2014.0201] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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419
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Bodemer N, Meder B, Gigerenzer G. Communicating Relative Risk Changes with Baseline Risk: Presentation Format and Numeracy Matter. Med Decis Making 2014; 34:615-26. [PMID: 24803429 DOI: 10.1177/0272989x14526305] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2012] [Accepted: 02/08/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Treatment benefits and harms are often communicated as relative risk reductions and increases, which are frequently misunderstood by doctors and patients. One suggestion for improving understanding of such risk information is to also communicate the baseline risk. We investigated 1) whether the presentation format of the baseline risk influences understanding of relative risk changes and 2) the mediating role of people's numeracy skills. METHOD We presented laypeople (N = 1234) with a hypothetical scenario about a treatment that decreased (Experiments 1a, 2a) or increased (Experiments 1b, 2b) the risk of heart disease. Baseline risk was provided as a percentage or a frequency. In a forced-choice paradigm, the participants' task was to judge the risk in the treatment group given the relative risk reduction (or increase) and the baseline risk. Numeracy was assessed using the Lipkus 11-item scale. RESULTS Communicating baseline risk in a frequency format facilitated correct understanding of a treatment's benefits and harms, whereas a percentage format often impeded understanding. For example, many participants misinterpreted a relative risk reduction as referring to an absolute risk reduction. Participants with higher numeracy generally performed better than those with lower numeracy, but all participants benefitted from a frequency format. Limitations are that we used a hypothetical medical scenario and a nonrepresentative sample. CONCLUSIONS Presenting baseline risk in a frequency format improves understanding of relative risk information, whereas a percentage format is likely to lead to misunderstandings. People's numeracy skills play an important role in correctly understanding medical information. Overall, communicating treatment benefits and harms in the form of relative risk changes remains problematic, even when the baseline risk is explicitly provided.
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Affiliation(s)
- Nicolai Bodemer
- Max Planck Institute for Human Development, Harding Center for Risk Literacy, Berlin, Germany (NB, GG),Max Planck Institute for Human Development, Center for Adaptive Behavior and Cognition (ABC), Berlin, Germany (NB, BM, GG)
| | - Björn Meder
- Max Planck Institute for Human Development, Center for Adaptive Behavior and Cognition (ABC), Berlin, Germany (NB, BM, GG)
| | - Gerd Gigerenzer
- Max Planck Institute for Human Development, Harding Center for Risk Literacy, Berlin, Germany (NB, GG),Max Planck Institute for Human Development, Center for Adaptive Behavior and Cognition (ABC), Berlin, Germany (NB, BM, GG)
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420
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Hallas J, Christensen RD, Stürmer T, Pottegård A. Measures of 'exposure needed for one additional patient to be harmed' in population-based case-control studies. Pharmacoepidemiol Drug Saf 2014; 23:868-74. [PMID: 24789145 DOI: 10.1002/pds.3635] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 03/07/2014] [Accepted: 04/03/2014] [Indexed: 11/11/2022]
Abstract
PURPOSE The magnitude of risk for adverse drug reactions may be communicated by a measure of 'exposure needed for one additional patient to be harmed' (ENH). We present four ENH measures, based on four different counterfactual contrasts, as illustrated by the known effects of NSAID use on peptic ulcer bleeding. METHODS The four measures were basic ENH (estimating the excess risk when treating the entire source population versus treating no one), age-restricted ENH (the entire source population above, e.g. 50 years old treated versus no one above 50 years old treated), standardised ENH (a population of similar age and gender distribution as those actually treated versus same subjects not treated) and naturalistic ENH (those actually treated versus same subjects not treated). Data were derived from a case-control dataset on NSAIDs and severe peptic ulcer bleeding, collected in Funen County in 1995-2006. We incorporated prescription and census data to account for the source population's drug use. RESULTS Estimates of basic, age-restricted, standardised and naturalistic ENH were 619 person-years (py) (95% confidence interval (CI): 558-684), 223 py (CI: 201-246), 131 py (CI: 118-144) and 162 py (CI: 151-173). The age-restricted ENH showed strong dependence on the chosen age limit. CONCLUSION The differing counterfactual contrasts underlying the ENH result in widely different estimates. These differences reflect the clinical and epidemiological aspects of NSAID-related peptic ulcer bleeding. The ultimate choice of ENH measure will depend on epidemiological or clinical considerations and on availability of data.
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Affiliation(s)
- Jesper Hallas
- Clinical Pharmacology, IST, University of Southern Denmark, Odense, Denmark; Department of Clinical Chemistry and Pharmacology, Odense University Hospital, Odense, Denmark
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421
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Abstract
Six decades-worth of published information has shown irrefutably that null-hypothesis significance tests (NHSTs) provide no information about the reliability of research outcomes. Nevertheless, they are still the core of editorial decision-making in Psychology. Two reasons appear to contribute to the continuing practice. One, survey information suggests that a majority of psychological researchers incorrectly believe that p values provide information about reliability of results. Two, a position sometimes taken is that using them to make decisions has been essentially benign. The mistaken belief has been pointed out many times, so it is briefly covered because of the apparent persistence of the misunderstanding. The idea that NHSTs have been benign is challenged by seven “side-effects” that continue to retard effective development of psychological science. The article concludes with both a few suggestions about possible alternatives and a challenge to psychological researchers to develop new methods that actually assess the reliability of research findings.
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422
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Wiedemann PM, Boerner FU, Repacholi MH. Do people understand IARC's 2B categorization of RF fields from cell phones? Bioelectromagnetics 2014; 35:373-8. [PMID: 24737130 DOI: 10.1002/bem.21851] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 02/04/2014] [Indexed: 11/10/2022]
Abstract
In May 2011, the International Agency on Cancer in Research (IARC) issued an official statement concluding that cell phone usage was "possibly carcinogenic to humans." There have been considerable doubts that non-experts and experts alike fully understood what IARC's categorization actually meant, as "possibly carcinogenic" can be interpreted in many ways. The present study is based on an online survey indicating that both the characterization of the probability of carcinogenicity, as well as the description of the risk increase given in the IARC press release, was mostly misunderstood by study participants. Respondents also greatly overestimated the magnitude of the potential risk. Our study results showed that IARC needs to improve their scientific communications.
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Affiliation(s)
- Peter M Wiedemann
- Karlsruhe Institute of Technology (KIT), Institute for Technology Assessment and Systems Analysis (ITAS), Science Forum EMF, Berlin, Germany
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423
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Caverly TJ, Prochazka AV, Binswanger IA, Kutner JS, Matlock DD. Confusing Relative Risk with Absolute Risk Is Associated with More Enthusiastic Beliefs about the Value of Cancer Screening. Med Decis Making 2014; 34:686-92. [DOI: 10.1177/0272989x14526641] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 02/05/2014] [Indexed: 11/16/2022]
Abstract
Background. Reviews of how data are presented in medical literature document that the benefit from an intervention is often exaggerated relative to the harm (e.g., relative risk for benefit and absolute risk for harm). Such mismatched presentations may create unwarranted enthusiasm, especially among those who misinterpret the statistics presented. The objective was to determine whether misinterpretation of risk data predicts enthusiasm for cancer screening. Methods. The authors administered a survey with 14 items assessing beliefs about cancer screening and 6 items measuring data interpretation ability. Multiple linear regression was used to evaluate the association between data interpretation and enthusiasm for cancer screening, with adjustment for gender and year graduated from medical school. Results. Eighty-eight of 139 physicians at a state-wide professional meeting returned completed surveys (63% response rate). Lower data interpretation scores were associated with higher enthusiasm for cancer screening scores ( P = 0.004) in the adjusted primary analysis. Confusing relative risk with absolute risk appeared to drive the overall association. Conclusions. Biased presentations of risk data could affect general beliefs about the value of cancer screening, especially among physicians who uncritically accept mismatched presentations of data.
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Affiliation(s)
- Tanner J. Caverly
- Ann Arbor VA Health System and University of Michigan Medical School, Ann Arbor, MI (TJC)
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (AVP, IAB, JSK, DDM)
- Denver Veterans Affairs Medical Center, Denver, CO (AVP)
- Denver Health Medical Center Denver, Denver, CO (IAB)
| | - Allan V. Prochazka
- Ann Arbor VA Health System and University of Michigan Medical School, Ann Arbor, MI (TJC)
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (AVP, IAB, JSK, DDM)
- Denver Veterans Affairs Medical Center, Denver, CO (AVP)
- Denver Health Medical Center Denver, Denver, CO (IAB)
| | - Ingrid A. Binswanger
- Ann Arbor VA Health System and University of Michigan Medical School, Ann Arbor, MI (TJC)
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (AVP, IAB, JSK, DDM)
- Denver Veterans Affairs Medical Center, Denver, CO (AVP)
- Denver Health Medical Center Denver, Denver, CO (IAB)
| | - Jean S. Kutner
- Ann Arbor VA Health System and University of Michigan Medical School, Ann Arbor, MI (TJC)
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (AVP, IAB, JSK, DDM)
- Denver Veterans Affairs Medical Center, Denver, CO (AVP)
- Denver Health Medical Center Denver, Denver, CO (IAB)
| | - Daniel D. Matlock
- Ann Arbor VA Health System and University of Michigan Medical School, Ann Arbor, MI (TJC)
- Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO (AVP, IAB, JSK, DDM)
- Denver Veterans Affairs Medical Center, Denver, CO (AVP)
- Denver Health Medical Center Denver, Denver, CO (IAB)
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424
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Hanoch Y, Miron-Shatz T, Rolison JJ, Ozanne E. Understanding of BRCA1
/2
genetic tests results: the importance of objective and subjective numeracy. Psychooncology 2014; 23:1142-8. [DOI: 10.1002/pon.3537] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 03/10/2014] [Accepted: 03/12/2014] [Indexed: 11/10/2022]
Affiliation(s)
| | | | | | - Elissa Ozanne
- The Dartmouth Institute for Health Policy and Clinical Practice; Dartmouth MA, USA
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425
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426
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Johnston M, Dixon D, Hart J, Glidewell L, Schröder C, Pollard B. Discriminant content validity: a quantitative methodology for assessing content of theory-based measures, with illustrative applications. Br J Health Psychol 2014; 19:240-57. [PMID: 24628841 DOI: 10.1111/bjhp.12095] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 01/31/2014] [Indexed: 01/21/2023]
Abstract
OBJECTIVES In studies involving theoretical constructs, it is important that measures have good content validity and that there is not contamination of measures by content from other constructs. While reliability and construct validity are routinely reported, to date, there has not been a satisfactory, transparent, and systematic method of assessing and reporting content validity. In this paper, we describe a methodology of discriminant content validity (DCV) and illustrate its application in three studies. METHODS Discriminant content validity involves six steps: construct definition, item selection, judge identification, judgement format, single-sample test of content validity, and assessment of discriminant items. In three studies, these steps were applied to a measure of illness perceptions (IPQ-R) and control cognitions. RESULTS The IPQ-R performed well with most items being purely related to their target construct, although timeline and consequences had small problems. By contrast, the study of control cognitions identified problems in measuring constructs independently. In the final study, direct estimation response formats for theory of planned behaviour constructs were found to have as good DCV as Likert format. CONCLUSIONS The DCV method allowed quantitative assessment of each item and can therefore inform the content validity of the measures assessed. The methods can be applied to assess content validity before or after collecting data to select the appropriate items to measure theoretical constructs. Further, the data reported for each item in Appendix S1 can be used in item or measure selection. Statement of contribution What is already known on this subject? There are agreed methods of assessing and reporting construct validity of measures of theoretical constructs, but not their content validity. Content validity is rarely reported in a systematic and transparent manner. What does this study add? The paper proposes discriminant content validity (DCV), a systematic and transparent method of assessing and reporting whether items assess the intended theoretical construct and only that construct. In three studies, DCV was applied to measures of illness perceptions, control cognitions, and theory of planned behaviour response formats. Appendix S1 gives content validity indices for each item of each questionnaire investigated. Discriminant content validity is ideally applied while the measure is being developed, before using to measure the construct(s), but can also be applied after using a measure.
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Affiliation(s)
- Marie Johnston
- Institute of Applied Health Sciences, University of Aberdeen, UK
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427
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Dreier M, Borutta B, Seidel G, Münch I, Töppich J, Bitzer EM, Dierks ML, Walter U. [Leaflets and websites on colorectal cancer screening and their quality assessment from experts' views]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2014; 57:356-65. [PMID: 24562712 DOI: 10.1007/s00103-013-1906-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
In Germany, individuals who have statutory health insurance have free access to colorectal cancer (CRC) screening tests, and can choose between a fecal occult blood test and a screening colonoscopy. Evidence-based health information may support informed choices regarding whether or not to undergo CRC screening. The aim of this study was to assess whether the available German information materials on CRC screening meet evidence-based health information standards. A systematic search was made for print media and websites on CRC screening addressed to German people with average CRC risk (search period for print media August 2010, for websites January-March 2012). The identified information was assessed with a newly developed comprehensive list of criteria. In all, 41 print media, including 28 flyers and 13 brochures, and 36 websites were identified and assessed. These materials reported more often the benefits than the risks of CRC screening, and quantified presentations of benefits and risks were less frequently given. Most of the materials called for participation and did not indicate the option to decide whether or not to attend CRC screening. This bias in favor of screening was increased by fear-provoking or downplayed wording. Most materials included false and misleading information. The requirements for evidence-based patient information were currently not met by most of the leaflets and websites in Germany. Feedback was given to the producers of the leaflets including a discussion of the findings. The results may be used to revise existing leaflets or to develop new health information on CRC screening.
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Affiliation(s)
- M Dreier
- Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland,
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428
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Haack G, Köster M, Töppich J. [Information on early detection of colorectal cancer: development of an information module for the women's health portal of the Federal Center for Health Education (BZgA)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2014; 57:380-7. [PMID: 24562714 DOI: 10.1007/s00103-013-1907-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Colorectal cancer is the second most prevalent cancer in Germany. The governmental program for early detection of colorectal cancer intends to increase the chances of recovery by identifying colorectal cancer in an early, more treatable stage. Citizens need quality-assured, balanced, and target-group-specific information to be able to make an informed decision. On the basis of the current state of research, of extensive studies, and of expert and user interviews, the Federal Center for Health Education (BZgA) developed an information module on"early detection of colorectal cancer" for the women's health portal of the BZgA. The information module contains information on colorectal cancer, on the governmental program for early detection, as well as on the program's benefits and risks. The information offered is intended to be up to date and is approved by experts. The BZgA approves the quality of this information using methods of process and outcome evaluation.
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Affiliation(s)
- G Haack
- Bundeszentrale für gesundheitliche Aufklärung (BZgA), Ostmerheimerstr. 220, 51109, Köln, Deutschland,
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429
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Harrison M, Rigby D, Vass C, Flynn T, Louviere J, Payne K. Risk as an Attribute in Discrete Choice Experiments: A Systematic Review of the Literature. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2014; 7:151-70. [DOI: 10.1007/s40271-014-0048-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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430
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Binder H. What subject matter questions motivate the use of machine learning approaches compared to statistical models for probability prediction? Biom J 2014; 56:584-7. [DOI: 10.1002/bimj.201300218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 12/06/2013] [Accepted: 12/06/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Harald Binder
- Institute of Medical Biostatistics, Epidemiology and Informatics; University Medical Center; Johannes Gutenberg University Mainz; 55101 Mainz Germany
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431
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Lopez-Gonzalez AA, Aguilo A, Frontera M, Bennasar-Veny M, Campos I, Vicente-Herrero T, Tomas-Salva M, De Pedro-Gomez J, Tauler P. Effectiveness of the Heart Age tool for improving modifiable cardiovascular risk factors in a Southern European population: a randomized trial. Eur J Prev Cardiol 2014; 22:389-96. [DOI: 10.1177/2047487313518479] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Angel A Lopez-Gonzalez
- Prevention of Occupational Risks in Health Services, GESMA, Balearic Islands Health Service, Palma de Mallorca, Spain
| | - Antoni Aguilo
- Research Group on Evidence, Lifestyles & Health, University of the Balearic Islands, Palma de Mallorca, Spain
| | - Margalida Frontera
- Research Group on Evidence, Lifestyles & Health, University of the Balearic Islands, Palma de Mallorca, Spain
| | - Miquel Bennasar-Veny
- Research Group on Evidence, Lifestyles & Health, University of the Balearic Islands, Palma de Mallorca, Spain
| | - Irene Campos
- Prevention of Occupational Risks in Health Services, GESMA, Balearic Islands Health Service, Palma de Mallorca, Spain
| | | | - Matias Tomas-Salva
- Prevention of Occupational Risks, Balearic Islands Government, Palma de Mallorca, Spain
| | - Joan De Pedro-Gomez
- Research Group on Evidence, Lifestyles & Health, University of the Balearic Islands, Palma de Mallorca, Spain
| | - Pedro Tauler
- Research Group on Evidence, Lifestyles & Health, University of the Balearic Islands, Palma de Mallorca, Spain
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432
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Kottwitz A. Mode of birth and social inequalities in health: the effect of maternal education and access to hospital care on cesarean delivery. Health Place 2014; 27:9-21. [PMID: 24513591 DOI: 10.1016/j.healthplace.2014.01.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 01/13/2014] [Accepted: 01/19/2014] [Indexed: 11/26/2022]
Abstract
Access to health care is an important factor in explaining health inequalities. This study focuses on the issue of access to health care as a driving force behind the social discrepancies in cesarean delivery using data from 707 newborn children in the 2006-2011 birth cohorts of the German Socio-Economic Panel Study (SOEP). Data on individual birth outcomes are linked to hospital data using extracts of the quality assessment reports of nearly all German hospitals. Geographic Information Systems (GIS) are used to assess hospital service clusters within a 20-km radius buffer around mother׳s homes. Logistic regression models adjusting for maternal characteristics indicate that the likelihood to deliver by a cesarean section increases for the least educated women when they face constraints with regard to access to hospital care. No differences between the education groups are observed when access to obstetric care is high, thus a high access to hospital care seems to balance out health inequalities that are related to differences in education. The results emphasize the importance of focusing on unequal access to hospital care in explaining differences in birth outcomes.
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Affiliation(s)
- Anita Kottwitz
- German Socio-Economic Panel Study (SOEP), DIW Berlin, Mohrenstraße 58, 10117 Berlin, Germany; International Max Planck Research School on the Life Course (IMPRS LIFE), Max Planck Institute for Human Development, Lentzeallee 94, 14195 Berlin, Germany.
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433
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Rodrigues R, Trigg L, Schmidt AE, Leichsenring K. The public gets what the public wants: experiences of public reporting in long-term care in Europe. Health Policy 2014; 116:84-94. [PMID: 24461213 DOI: 10.1016/j.healthpol.2013.12.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 12/21/2013] [Accepted: 12/31/2013] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Public reporting of quality in long-term care is advocated on the basis of allowing providers to improve their performance by benchmarking and supporting users to choose the best providers. Both mechanisms are intended to drive improvements in quality. However, there is relatively scarce comparative research on the experiences and impact of public reporting on quality in long-term care in Europe. METHODS Using information gathered from key informants by means of a structured questionnaire and country profiles, this paper discusses experiences with public reporting mechanisms in seven European countries and available information on their impact on quality in long-term care. RESULTS Countries surveyed included a variety of public reporting schemes, ranging from pilot programmes to statutory mechanisms. Public reporting mechanisms more often focus on institutional care. Inspections carried out as part of a legal quality assurance framework are the main source of information gathering, supplemented by provider self-assessments in the context of internal quality management and user satisfaction surveys. Information on quality goes well beyond structural indicators to also include indicators on quality of life of users. Information is displayed using numerical scores (percentages), but also measures such as ratings (similar to school grades) and ticks and crosses. Only one country corrects for case-mix. The internet is the preferred medium of displaying information. DISCUSSION There was little evidence to show whether public reporting has a significant impact on driving users' choices of provider. Studies reported low awareness of quality indicators among potential end users and information was not always displayed in a convenient format, e.g. through complicated numerical scores. There is scarce evidence of public reporting directly causing improved quality, although the relative youth and the pilot characteristics of some of the schemes covered here could also have contributed to downplay their impact. The establishment of public reporting mechanisms did however contribute to shaping the discussion on quality measurement in several of the countries surveyed. CONCLUSIONS The findings presented in this paper highlight the need to consider some factors in the discussion of the impact of public reporting in long-term care, namely, the organisation of care markets, frequently characterised by limited competition; the circumstances under which user choice takes place, often made under conditions of duress; and the leadership conditions needed to bring about improvements in quality in different care settings.
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Affiliation(s)
- Ricardo Rodrigues
- European Centre for Social Welfare Policy and Research, Berggasse, 17, A-1090 Vienna, Austria.
| | - Lisa Trigg
- London School of Economics and Political Science, London, UK
| | - Andrea E Schmidt
- European Centre for Social Welfare Policy and Research, Vienna, Austria
| | - Kai Leichsenring
- European Centre for Social Welfare Policy and Research, Vienna, Austria
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434
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Predicting biases in very highly educated samples: Numeracy and metacognition. JUDGMENT AND DECISION MAKING 2014. [DOI: 10.1017/s1930297500004952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AbstractWe investigated the relations between numeracy and superior judgment and decision making in two large community outreach studies in Holland (n=5408). In these very highly educated samples (e.g., 30–50% held graduate degrees), the Berlin Numeracy Test was a robust predictor of financial, medical, and metacognitive task performance (i.e., lotteries, intertemporal choice, denominator neglect, and confidence judgments), independent of education, gender, age, and another numeracy assessment. Metacognitive processes partially mediated the link between numeracy and superior performance. More numerate participants performed better because they deliberated more during decision making and more accurately evaluated their judgments (e.g., less overconfidence). Results suggest that well-designed numeracy tests tend to be robust predictors of superior judgment and decision making because they simultaneously assess (1) mathematical competency and (2) metacognitive and self-regulated learning skills.
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435
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Han PKJ, Joekes K, Elwyn G, Mazor KM, Thomson R, Sedgwick P, Ibison J, Wong JB. Development and evaluation of a risk communication curriculum for medical students. PATIENT EDUCATION AND COUNSELING 2014; 94:43-9. [PMID: 24128795 DOI: 10.1016/j.pec.2013.09.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 09/04/2013] [Accepted: 09/07/2013] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To develop, pilot, and evaluate a curriculum for teaching clinical risk communication skills to medical students. METHODS A new experience-based curriculum, "Risk Talk," was developed and piloted over a 1-year period among students at Tufts University School of Medicine. An experimental study of 2nd-year students exposed vs. unexposed to the curriculum was conducted to evaluate the curriculum's efficacy. Primary outcome measures were students' objective (observed) and subjective (self-reported) risk communication competence; the latter was assessed using an Observed Structured Clinical Examination (OSCE) employing new measures. RESULTS Twenty-eight 2nd-year students completed the curriculum, and exhibited significantly greater (p<.001) objective and subjective risk communication competence than a convenience sample of 24 unexposed students. New observational measures of objective competence in risk communication showed promising evidence of reliability and validity. The curriculum was resource-intensive. CONCLUSION The new experience-based clinical risk communication curriculum was efficacious, although resource-intensive. More work is needed to develop the feasibility of curriculum delivery, and to improve the measurement of competence in clinical risk communication. PRACTICE IMPLICATIONS Risk communication is an important advanced communication skill, and the Risk Talk curriculum provides a model educational intervention and new assessment tools to guide future efforts to teach and evaluate this skill.
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Affiliation(s)
- Paul K J Han
- Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, USA; Tufts University School of Medicine, Boston, USA.
| | - Katherine Joekes
- Centre for Medical and Healthcare Education, St George's, University of London, London, UK
| | - Glyn Elwyn
- Dartmouth Center for Health Care Delivery Science, Hanover, USA; Cochrane Institute for Primary Care & Public Health, Cardiff University School of Medicine, Cardiff, UK
| | - Kathleen M Mazor
- Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, USA
| | - Richard Thomson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Philip Sedgwick
- Centre for Medical and Healthcare Education, St George's, University of London, London, UK
| | - Judith Ibison
- Centre for Medical and Healthcare Education, St George's, University of London, London, UK
| | - John B Wong
- Tufts University School of Medicine, Boston, USA
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436
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How framing and numerical information affect people's judgments when they read a newspaper story. NEW IDEAS IN PSYCHOLOGY 2014. [DOI: 10.1016/j.newideapsych.2013.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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437
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Uttl B, White CA, Morin A. The numbers tell it all: students don't like numbers! PLoS One 2013; 8:e83443. [PMID: 24358284 PMCID: PMC3865188 DOI: 10.1371/journal.pone.0083443] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 11/04/2013] [Indexed: 11/18/2022] Open
Abstract
Undergraduate Students' interest in taking quantitative vs. non quantitative courses has received limited attention even though it has important consequences for higher education. Previous studies have collected course interest ratings at the end of the courses as part of student evaluation of teaching (SET) ratings, which may confound prior interest in taking these courses with students' actual experience in taking them. This study is the first to examine undergraduate students' interest in quantitative vs. non quantitative courses in their first year of studies before they have taken any quantitative courses. Three hundred and forty students were presented with descriptions of 44 psychology courses and asked to rate their interest in taking each course. Student interest in taking quantitative vs non quantitative courses was very low; the mean interest in statistics courses was nearly 6 SDs below the mean interest in non quantitative courses. Moreover, women were less interested in taking quantitative courses than men. Our findings have several far-reaching implications. First, evaluating professors teaching quantitative vs. non quantitative courses against the same SET standard may be inappropriate. Second, if the same SET standard is used for the evaluation of faculty teaching quantitative vs. non quantitative courses, faculty are likely to teach to SETs rather than focus on student learning. Third, universities interested primarily in student satisfaction may want to expunge quantitative courses from their curricula. In contrast, universities interested in student learning may want to abandon SETs as a primary measure of faculty teaching effectiveness. Fourth, undergraduate students who are not interested in taking quantitative courses are unlikely to pursue graduate studies in quantitative psychology and unlikely to be able to competently analyze data independently.
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Affiliation(s)
- Bob Uttl
- Department of Psychology, Mount Royal University, Calgary, Alberta, Canada
- * E-mail:
| | - Carmela A. White
- Department of Psychology, Mount Royal University, Calgary, Alberta, Canada
| | - Alain Morin
- Department of Psychology, Mount Royal University, Calgary, Alberta, Canada
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438
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Engelhardt EG, Garvelink MM, de Haes JHCJM, van der Hoeven JJM, Smets EMA, Pieterse AH, Stiggelbout AM. Predicting and communicating the risk of recurrence and death in women with early-stage breast cancer: a systematic review of risk prediction models. J Clin Oncol 2013; 32:238-50. [PMID: 24344212 DOI: 10.1200/jco.2013.50.3417] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND It is a challenge for oncologists to distinguish patients with breast cancer who can forego adjuvant systemic treatment without negatively affecting survival from those who cannot. Risk prediction models (RPMs) have been developed for this purpose. Oncologists seem to have embraced RPMs (particularly Adjuvant!) in clinical practice and often use them to communicate prognosis to patients. We performed a systematic review of published RPMs and provide an overview of the prognosticators incorporated and reported clinical validity. Subsequently, we selected the RPMs that are currently used in the clinic for a more in-depth assessment of clinical validity. Finally, we assessed lay comprehensibility of the reports generated by RPMs. METHODS Pubmed, EMBASE, and Web of Science were searched. Two reviewers independently selected relevant articles and extracted data. Agreement on article selection and data extraction was achieved in consensus meetings. RESULTS We identified RPMs based on clinical prognosticators (N = 6) and biomolecular features (N = 14). Generally predictions from RPMs seem to be accurate, except for patients ≤ 50 years or ≥ 75 years at diagnosis, in addition to Asian populations. RPM reports contain much medical jargon or technical details, which are seldom explained in lay terms. CONCLUSION The accuracy of RPMs' prognostic estimates is suboptimal in some patient subgroups. This urgently needs to be addressed. In their current format, RPM reports are not conducive to patient comprehension. Communicating survival probabilities using RPM might seem straightforward, but it is fraught with difficulties. If not done properly, it can backfire and confuse patients. Evidence to guide best communication practice is needed.
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Affiliation(s)
- Ellen G Engelhardt
- Ellen G. Engelhardt, Mirjam M. Garvelink, Jacobus J.M. van der Hoeven, Arwen H. Pieterse, and Anne M. Stiggelbout, Leiden University Medical Center, Leiden; and J. (Hanneke) C.J.M. de Haes and Ellen M. Smets, Academic Medical Center, Amsterdam, the Netherlands
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439
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Predictive Values for Molecular Diagnostics: Converting Unknown Unknowns to Known Unknowns. Mol Diagn Ther 2013; 18:1-4. [DOI: 10.1007/s40291-013-0076-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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440
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Brase GL. The power of representation and interpretation: Doubling statistical reasoning performance with icons and frequentist interpretations of ambiguous numbers. JOURNAL OF COGNITIVE PSYCHOLOGY 2013. [DOI: 10.1080/20445911.2013.861840] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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441
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Matcham F, McNally L, Vogt F. A pilot randomized controlled trial to increase smoking cessation by maintaining National Health Service Stop Smoking Service attendance. Br J Health Psychol 2013; 19:795-809. [PMID: 24289715 DOI: 10.1111/bjhp.12078] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 10/16/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The National Health Service (NHS) Stop Smoking Service (SSS) is an extremely cost-effective method of enabling smoking cessation. However, the SSS is only used by a minority of smokers. Developing interventions to maintain service attendance may help to increase the number of quitters. This study pilots an intervention aimed at maintaining attendance by (1) increasing motivation to attend through a booklet providing evidence of service effectiveness and (2) strengthening the link between motivation to attend and attendance through forming an implementation intention. DESIGN A factorial randomized controlled trial. METHODS A total of 160 newly enrolled smokers at the Surrey NHS SSS were recruited and randomly assigned to one of four conditions: (1) standard care (SC), (2) SC + effectiveness booklet, (3) SC + implementation intention, and (4) SC + effectiveness booklet + implementation intention. The outcome measures included attendance at the SSS and the 4-week quit rate. RESULTS The booklet increased service attendance (OR = 2.93, p < .01, 95% CI = 1.45-5.93; Number Needed to Treat = 3.3) but had no impact on the 4-week quit rate (OR = 1.55, 95% CI = 0.75-3.21). Forming an implementation intention had no impact on service attendance or the 4-week quit rate. Attending the service was associated with a higher 4-week quit rate (ρ = 87.52, p < .001). CONCLUSIONS Presenting information about the effectiveness of the service improved service attendance. A larger trial now needs to evaluate whether this intervention can also increase the quit rate. STATEMENT OF CONTRIBUTION What is already known on this subject? The NHS Stop Smoking Service is an effective yet underused method of enabling smoking cessation. Low uptake levels may be due to smokers' misconception that the service will not improve their chances of quitting successfully. Improving smokers' perceptions of service efficacy may be valuable for maintaining service attendance, and subsequently improving smoking cessation levels in the United Kingdom. What does this study add? This pilot randomized controlled trial is the first to target service attendance rather than cessation levels. The results demonstrate that providing evidence of service efficacy in a simple icon array format can significantly improve service attendance.
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Affiliation(s)
- Faith Matcham
- Department of Psychological Medicine, Weston Education Centre, Institute of Psychiatry, King's College London, UK
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442
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Petrocelli JV. Pitfalls of counterfactual thinking in medical practice: preventing errors by using more functional reference points. J Public Health Res 2013; 2:e24. [PMID: 25170495 PMCID: PMC4147742 DOI: 10.4081/jphr.2013.e24] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 11/01/2013] [Indexed: 01/09/2023] Open
Abstract
Background Counterfactual thinking involves mentally simulating alternatives to reality. The current article reviews literature pertaining to the relevance counterfactual thinking has for the quality of medical decision making. Although earlier counterfactual thought research concluded that counterfactuals have important benefits for the individual, there are reasons to believe that counterfactual thinking is also associated with dysfunctional consequences. Of particular focus is whether or not medical experience, and its influence on counterfactual thinking, actually informs or improves medical practice. It is hypothesized that relatively more probable decision alternatives, followed by undesirable outcomes and counterfactual thought responses, can be abandoned for relatively less probable decision alternatives. Design and Methods Building on earlier research demonstrating that counterfactual thinking can impede memory and learning in a decision paradigm with undergraduate students, the current study examines the extent to which earlier findings can be generalized to practicing physicians (N=10). Participants were asked to complete 60 trials of a computerized Monty Hall Problem simulation. Learning by experience was operationalized as the frequency of switch-decisions. Results Although some learning was evidenced by a general increase in switch-decision frequency across block trials, the extent of learning demonstrated was not ideal, nor practical. Conclusions A simple, multiple-trial, decision paradigm demonstrated that doctors fail to learn basic decision-outcome associations through experience. An agenda for future research, which tests the functionality of reference points (other than counterfactual alternatives) for the purposes of medical decision making, is proposed. Significance for public health The quality of healthcare depends heavily on the judgments and decisions made by doctors and other medical professionals. Findings from this research indicate that doctors fail to learn basic decision-outcome associations through experience, as evidenced by the sample’s tendency to select the optimal decision strategy in only 50% of 60 trials (each of which was followed by veridical feedback). These findings suggest that professional experience is unlikely to enhance the quality of medical decision making. Thus, this research has implications for understanding how doctors’ reactions to medical outcomes shape their judgments and affect the degree to which their future treatment intentions are consistent with clinical practice guidelines. The current research is integrated with earlier research on counter-factual thinking, which appears to be a primary element inhibiting the learning of decision-outcome associations. An agenda for future research is proposed.
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Affiliation(s)
- John V Petrocelli
- Department of Psychology, Wake Forest University , Winston-Salem, NC, USA
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443
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Effective follow-up consultations: the importance of patient-centered communication and shared decision making. Paediatr Respir Rev 2013; 14:224-8. [PMID: 23434177 DOI: 10.1016/j.prrv.2013.01.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Paediatricians spend a considerable proportion of their time performing follow-up visits for children with chronic conditions, but they rarely receive specific training on how best to perform such consultations. The traditional method of running a follow-up consultation is based on the doctor's agenda, and is problem-oriented. Patients and parents, however, prefer a patient-centered, and solution-focused approach. Although many physicians now recognize the importance of addressing the patient's perspective in a follow-up consultation, a number of barriers hamper its implementation in practice, including time constraints, lack of appropriate training, and a strong tradition of the biomedical, doctor-centered approach. Addressing the patient's perspective successfully can be achieved through shared decision making, clinicians and patients making decisions together based on the best clinical evidence. Research shows that shared decision making not only increases patient, parent, and physician satisfaction with the consultation, but also may improve health outcomes. Shared decision making involves building a physician-patient-parent partnership, agreeing on the problem at hand, laying out the available options with their benefits and risks, eliciting the patient's views and preferences on these options, and agreeing on a course of action. Shared decision making requires specific communication skills, which can be learned, and should be mastered through deliberate practice.
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444
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Trevena LJ, Zikmund-Fisher BJ, Edwards A, Gaissmaier W, Galesic M, Han PKJ, King J, Lawson ML, Linder SK, Lipkus I, Ozanne E, Peters E, Timmermans D, Woloshin S. Presenting quantitative information about decision outcomes: a risk communication primer for patient decision aid developers. BMC Med Inform Decis Mak 2013; 13 Suppl 2:S7. [PMID: 24625237 PMCID: PMC4045391 DOI: 10.1186/1472-6947-13-s2-s7] [Citation(s) in RCA: 300] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Making evidence-based decisions often requires comparison of two or more options. Research-based evidence may exist which quantifies how likely the outcomes are for each option. Understanding these numeric estimates improves patients' risk perception and leads to better informed decision making. This paper summarises current "best practices" in communication of evidence-based numeric outcomes for developers of patient decision aids (PtDAs) and other health communication tools. METHOD An expert consensus group of fourteen researchers from North America, Europe, and Australasia identified eleven main issues in risk communication. Two experts for each issue wrote a "state of the art" summary of best evidence, drawing on the PtDA, health, psychological, and broader scientific literature. In addition, commonly used terms were defined and a set of guiding principles and key messages derived from the results. RESULTS The eleven key components of risk communication were: 1) Presenting the chance an event will occur; 2) Presenting changes in numeric outcomes; 3) Outcome estimates for test and screening decisions; 4) Numeric estimates in context and with evaluative labels; 5) Conveying uncertainty; 6) Visual formats; 7) Tailoring estimates; 8) Formats for understanding outcomes over time; 9) Narrative methods for conveying the chance of an event; 10) Important skills for understanding numerical estimates; and 11) Interactive web-based formats. Guiding principles from the evidence summaries advise that risk communication formats should reflect the task required of the user, should always define a relevant reference class (i.e., denominator) over time, should aim to use a consistent format throughout documents, should avoid "1 in x" formats and variable denominators, consider the magnitude of numbers used and the possibility of format bias, and should take into account the numeracy and graph literacy of the audience. CONCLUSION A substantial and rapidly expanding evidence base exists for risk communication. Developers of tools to facilitate evidence-based decision making should apply these principles to improve the quality of risk communication in practice.
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Affiliation(s)
- Lyndal J Trevena
- Primary Health Care, School of Public Health, Room 321b, Edward Ford Building (A27), University of Sydney, NSW 2006, Australia
| | - Brian J Zikmund-Fisher
- Department of Health Behavior & Health Education, School of Public Health, Department of Internal Medicine, School of Medicine, and Center for Bioethics and Social Sciences in Medicine, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - Adrian Edwards
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - Wolfgang Gaissmaier
- Harding Center for Risk Literacy, Max Planck Institute for Human Development, Lentzeallee 94, 14195 Berlin, Germany
| | - Mirta Galesic
- Center for Adaptive Behavior and Cognition, Max Planck Institute for Human Development, Lentzeallee 94, 14195 Berlin, Germany
| | - Paul KJ Han
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, 509 Forest Avenue, Portland, ME 04101, USA
| | - John King
- Department of Family Medicine, University of Vermont College of Medicine, 235 Rowell, 106 Carrigan Drive, University of Vermont, Burlington, Vermont 05405, USA
| | - Margaret L Lawson
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | - Suzanne K Linder
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Isaac Lipkus
- Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710, USA
| | - Elissa Ozanne
- Department of Surgery and Institute for Health Policy Studies, University of California, San Francisco, 3333 California St. Suite 265, San Francisco, CA 94143-0936, USA
| | - Ellen Peters
- Department of Psychology, Ohio State University, 235 Psychology Building, 1835 Neil Avenue, Columbus, OH 43210, USA
| | - Danielle Timmermans
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Steven Woloshin
- Departments of Medicine and of Community & Family Medicine and The Dartmouth Institute for Health Policy & Clinical Practice at the Geisel School of Medicine at Dartmouth and the VA Outcomes Group, VA Medical Center, 215 North Main Street, White River Junction, VT 05009-0001, USA
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445
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Gigerenzer G. How I Got Started: Teaching Physicians and Judges Risk Literacy. APPLIED COGNITIVE PSYCHOLOGY 2013. [DOI: 10.1002/acp.2980] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Gerd Gigerenzer
- Center for Adaptive Behavior and Cognition; Max Planck Institute for Human Development; Berlin Germany
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446
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Bonnefon JF. New ambitions for a new paradigm: Putting the psychology of reasoning at the service of humanity. THINKING & REASONING 2013. [DOI: 10.1080/13546783.2013.774294] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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447
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Hirschberg I, Seidel G, Strech D, Bastian H, Dierks ML. Evidence-based health information from the users' perspective--a qualitative analysis. BMC Health Serv Res 2013; 13:405. [PMID: 24112403 PMCID: PMC3852570 DOI: 10.1186/1472-6963-13-405] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 10/08/2013] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Evidence-based information is a precondition for informed decision-making and participation in health. There are several recommendations and definitions available on the generation and assessment of so called evidence-based health information for patients and consumers (EBHI). They stress the importance of objectively informing people about benefits and harms and any uncertainties in health-related procedures. There are also studies on the comprehensibility, relevance and user-friendliness of these informational materials. But to date there has been little research on the perceptions and cognitive reactions of users or lay people towards EBHI. The aim of our study is to define the spectrum of consumers' reaction patterns to written EBHI in order to gain a deeper understanding of their comprehension and assumptions, as well as their informational needs and expectations. METHODS This study is based on an external user evaluation of EBHI produced by the German Institute for Quality and Efficiency in Health Care (IQWiG), commissioned by the IQWiG. The EBHI were examined within guided group discussions, carried out with lay people. The test readers' first impressions and their appraisal of the informational content, presentation, structure, comprehensibility and effect were gathered. Then a qualitative text analysis of 25 discussion transcripts involving 94 test readers was performed. RESULTS Based on the qualitative text analysis a framework for reaction patterns was developed, comprising eight main categories: (i) interest, (ii) satisfaction, (iii) reassurance and trust, (iv) activation, (v) disinterest, (vi) dissatisfaction and disappointment, (vii) anxiety and worry, (viii) doubt. CONCLUSIONS Many lay people are unfamiliar with core characteristics of this special information type. Two particularly critical issues are the description of insufficient evidence and the attendant absence of clear-cut recommendations. Further research is needed to examine strategies to explain the specific character of EBHI so as to minimize unintended or adverse reaction patterns. The presented framework describes the spectrum of users' reaction patterns to EBHI. It may support existing best practice models for editing EBHI.
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Affiliation(s)
- Irene Hirschberg
- CELLS – Centre for Ethics and Law in the Life Sciences/Hannover Medical School, Institute for History, Ethics and Philosophy of Medicine, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Gabriele Seidel
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Daniel Strech
- CELLS – Centre for Ethics and Law in the Life Sciences/Hannover Medical School, Institute for History, Ethics and Philosophy of Medicine, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Hilda Bastian
- U.S. National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, 8600 Rockville Pike, Bethesda, MD 20894, USA
| | - Marie-Luise Dierks
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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448
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von Roten FC, de Roten Y. Statistics in science and in society: From a state-of-the-art to a new research agenda. PUBLIC UNDERSTANDING OF SCIENCE (BRISTOL, ENGLAND) 2013; 22:768-784. [PMID: 24048621 DOI: 10.1177/0963662513495769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Statistics occupies a prominent role in science and citizens' daily life. This article provides a state-of-the-art of the problems associated with statistics in science and in society, structured along the three paradigms defined by Bauer, Allum and Miller (2007). It explores in more detail medicine and public understanding of science on the one hand, and risks and surveys on the other. Statistics has received a good deal of attention; however, very often handled in terms of deficit - either of scientists or of citizens. Many tools have been proposed to improve statistical literacy, the image of and trust in statistics, but with little understanding of their roots, with little coordination among stakeholders and with few assessments of impacts. These deficiencies represent as many new and promising directions in which the PUS research agenda could be expanded.
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449
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Hart PS. The role of numeracy in moderating the influence of statistics in climate change messages. PUBLIC UNDERSTANDING OF SCIENCE (BRISTOL, ENGLAND) 2013; 22:785-798. [PMID: 23825290 DOI: 10.1177/0963662513482268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In recent years, researchers have examined how numerical ability may moderate an individual's response to different types of numeric information, but there is scant research examining how numerical ability may moderate responses to non-numeric vs. numeric information. The present study uses an experiment (complete data for 120 participants) to examine a moderated-mediation model that tests how numeracy may moderate the impact of numeric and non-numeric descriptions of climate change risks on worry and concern for victims, which may, in turn, impact willingness to donate to relevant organizations. The inclusion of numeric instead of non-numeric descriptors significantly increased both concern for victims and willingness to donate for low numerate individuals while there was no difference for highly numerate individuals.
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Affiliation(s)
- P Sol Hart
- University of Michigan, Ann Arbor, MI, USA
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450
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Garcia-Retamero R, Cokely ET. Communicating Health Risks With Visual Aids. CURRENT DIRECTIONS IN PSYCHOLOGICAL SCIENCE 2013. [DOI: 10.1177/0963721413491570] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Informed decision making requires that people understand health risks. Unfortunately, many people are not risk literate and are biased by common risk communication practices. In this article, we review a collection of studies investigating the benefits of visual aids for communicating health risks to diverse vulnerable people (e.g., varying in abilities, ages, risk characteristics, and cultural backgrounds). These studies show that appropriately designed visual aids are often highly effective, transparent, and ethically desirable tools for improving decision making, changing attitudes, and reducing risky behavior. Theoretical mechanisms, open questions, and emerging applications are discussed.
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Affiliation(s)
| | - Edward T. Cokely
- Max Planck Institute for Human Development
- Michigan Technological University
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