1
|
Nadanovsky P, Oliveira BHD, Lira-Junior R, Santos APPD. Randomized trial of dentists' understanding: treatment benefit in absolute numbers vs relative risk reduction. Braz Oral Res 2024; 38:e070. [PMID: 39109767 PMCID: PMC11376625 DOI: 10.1590/1807-3107bor-2024.vol38.0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 11/11/2023] [Indexed: 09/20/2024] Open
Abstract
This study aimed to assess whether dentists correctly understand the benefit of a dental treatment when it is presented using absolute numbers or relative risk reduction (RRR). This parallel-group randomized controlled trial recruited dentists from 3 postgraduate courses in Rio de Janeiro, Brazil. Participants received, in sequentially numbered sealed opaque envelopes, the description of a hypothetical scenario of the benefit (avoidance of multiple tooth loss) of nonsurgical periodontal treatment without or with antibiotics. Treatment benefit was presented in 2 different formats: absolute numbers or RRR. Dentists were given 10 minutes to read the treatment scenario and answer 5 questions. The final sample for analysis included 101 dentists. When asked to estimate the number of patients out of 100 who would avoid multiple tooth loss without antibiotics, 17 dentists (33%) in the absolute numbers group and 12 (25%) in the RRR group provided the correct response (p = 0.39). Regarding treatment with antibiotics, 26 dentists (50%) in the absolute numbers group and 14 (29%) in the RRR group provided the correct response (p = 0.04). Only 16 dentists (31%) in the absolute numbers group and 12 (25%) in the RRR group gave correct answers for both questions (p = 0.51). Most dentists did not correctly understand the benefit of the treatment, irrespective of the format it was presented. Slightly more dentists correctly understood the benefit of the treatment when it was presented as absolute numbers than as RRR.
Collapse
Affiliation(s)
- Paulo Nadanovsky
- Fundação Oswaldo Cruz - Fiocruz, National School of Public Health, Department of Epidemiology, Rio de Janeiro, RJ, Brazil
| | - Branca Heloisa de Oliveira
- Universidade do Estado do Rio de Janerio - UERJ, School of Dentistry, Department of Community and Preventive Dentistry, Rio de Janeiro, RJ, Brazil
| | | | - Ana Paula Pires Dos Santos
- Universidade do Estado do Rio de Janerio - UERJ, School of Dentistry, Department of Community and Preventive Dentistry, Rio de Janeiro, RJ, Brazil
| |
Collapse
|
2
|
Prakash V, Gore K, Shukla G, Tapiawala P, Thakkar S. Does the format of result presentation and type of conclusion in Cochrane plain language summaries matter? A randomised controlled trial. BMJ Evid Based Med 2024; 29:96-103. [PMID: 37879889 DOI: 10.1136/bmjebm-2023-112433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVES This study aimed to investigate whether the format and type of conclusion in Cochrane plain language summaries (PLSs) influence readers' perception of treatment benefit and decision-making. DESIGN An online parallel group, three-arm randomised controlled trial was conducted. SETTING The study was conducted online. PARTICIPANTS The participants were physiotherapy students. INTERVENTIONS The participants read two Cochrane PLSs, one with a positive conclusion (strong evidence of benefit) and another with a negative conclusion (strong evidence of non-benefit). Each participant read the results of both reviews presented in one of three formats: (1) numerical, (2) textual or (3) numerical and textual. MAIN OUTCOME MEASURES The primary outcome measure was the participants' perception of treatment benefit. RESULTS All three groups of participants perceived the treatment to have positive effects when the Cochrane PLS had a positive conclusion, regardless of the format of presentation (mean perception of treatment benefit score: textual 7.7 (SD 2.3), numerical 7.9 (SD 1.8), numerical and textual 7.7 (SD 1.7), p=0.362). However, when the Cochrane PLS had a negative conclusion, all three groups of participants failed to perceive a negative effect (mean perception of treatment benefit score: textual 5.5 (SD 3.3), numerical 5.6 (SD 2.7), numerical and textual 5.9 (SD 2.8), p=0.019). CONCLUSIONS The format of Cochrane PLSs does not appear to significantly impact physiotherapy students' perception of treatment benefit, understanding of evidence, persuasiveness or confidence in their decision. However, participants' perception of treatment benefit does not align with the conclusion when the Cochrane PLS indicates strong evidence of non-benefit from the intervention. TRIAL REGISTRATION NUMBER CTRI/2022/10/046476.
Collapse
Affiliation(s)
- V Prakash
- Ashok & Rita Patel Institute of Physiotherapy, Charotar University of Science and Technology, Anand, Gujarat, India
| | - Kirti Gore
- Ashok & Rita Patel Institute of Physiotherapy, Charotar University of Science and Technology, Anand, Gujarat, India
| | - Gunjan Shukla
- Ashok & Rita Patel Institute of Physiotherapy, Charotar University of Science and Technology, Anand, Gujarat, India
| | - Priyanshi Tapiawala
- Ashok & Rita Patel Institute of Physiotherapy, Charotar University of Science and Technology, Anand, Gujarat, India
| | - Smit Thakkar
- Ashok & Rita Patel Institute of Physiotherapy, Charotar University of Science and Technology, Anand, Gujarat, India
| |
Collapse
|
3
|
Fallon E, Bargary N, Quinn F, Leavy A, Hannigan A. Words and numbers: a comparative study of medical and journalism students' descriptors of risk, numeracy and preferences for health risk communication. BMC MEDICAL EDUCATION 2024; 24:84. [PMID: 38263114 PMCID: PMC10807177 DOI: 10.1186/s12909-024-05048-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024]
Abstract
BACKGROUND Given the complementary roles of health professionals and journalists in communicating health risks to patients and the public, there have been calls for physicians to work with journalists to improve the quality of health information received by the public. Understanding the preferences of medical and journalism students for the way in which health risks are communicated and their understanding of words used to describe risk is an important first step to inform interdisciplinary learning. METHODS Medical and journalism students (n = 203) completed an online survey where they were given qualitative descriptors of risk such as 'a chance', 'probably' and 'unlikely', and asked to assign a number that represents what the word means to them. Different formats of communicating risk (percentages, natural frequency and visual aids) were provided and students were asked to select and explain their preference. A thematic analysis of reasons was conducted. Numeracy and perceived mathematics ability were measured. RESULTS Numbers assigned to the descriptor 'A chance' had the highest variability for medical students. Numbers assigned to the descriptor 'Probably' had the highest variability for journalism students. Using visual aids was the most popular format for risk communication for both courses (56% of medical students and 40% of journalism students). Using percentages was twice as popular with journalism students compared to medical students (36% vs. 18%). Perceived mathematics ability was lower in students with a preference for natural frequencies and in journalism students, however performance on an objective numeracy scale was similar for all three formats (percentages, natural frequency and visual aids). Reasons for choosing a preferred format included good communication, eliciting a response, or learning style. CONCLUSIONS Education on health risk communication for medical and journalism students should emphasize the need for qualitative descriptors of risk to be combined with the best available number. Students are already considering their role as future communicators of health risks and open to tailoring the mode of presentation to their audience. Further research is required on the design and evaluation of interdisciplinary workshops in health risk communication for medical and journalism students to maximise the opportunities for future inter-professional working.
Collapse
Affiliation(s)
- Eleanor Fallon
- Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
- Centre for Research Training in Foundations of Data Science, University of Limerick, Limerick, Ireland
| | - Norma Bargary
- Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
- Centre for Research Training in Foundations of Data Science, University of Limerick, Limerick, Ireland
| | - Fergal Quinn
- School of English, Irish and Communication, University of Limerick, Limerick, Ireland
| | - Aisling Leavy
- Department of STEM Education, Mary Immaculate College, Limerick, Ireland
| | - Ailish Hannigan
- School of Medicine, University of Limerick, Limerick, Ireland.
- Health Research Institute, University of Limerick, Limerick, Ireland.
| |
Collapse
|
4
|
Hashim MJ. Verbal Probability Terms for Communicating Clinical Risk - a Systematic Review. THE ULSTER MEDICAL JOURNAL 2024; 93:18-23. [PMID: 38707974 PMCID: PMC11067312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Verbal probability expressions such as 'likely' and 'possible' are commonly used to communicate uncertainty in diagnosis, treatment effectiveness as well as the risk of adverse events. Probability terms that are interpreted consistently can be used to standardize risk communication. A systematic review was conducted. Research studies that evaluated numeric meanings of probability terms were reviewed. Terms with consistent numeric interpretation across studies were selected and were used to construct a Visual Risk Scale. Five probability terms showed reliable interpretation by laypersons and healthcare professionals in empirical studies. 'Very Likely' was interpreted as 90% chance (range 80 to 95%); 'Likely/Probable,' 70% (60 to 80%); 'Possible,' 40% (30 to 60%); 'Unlikely,' 20% (10 to 30%); and 'Very Unlikely' with 10% chance (5% to 15%). The corresponding frequency terms were: Very Frequently, Frequently, Often, Infrequently, and Rarely, respectively. Probability terms should be presented with their corresponding numeric ranges during discussions with patients. Numeric values should be presented as X-in-100 natural frequency statements, even for low values; and not as percentages, X-in-1000, X-in-Y, odds, fractions, 1-in-X, or as number needed to treat (NNT). A Visual Risk Scale was developed for use in clinical shared decision making.
Collapse
Affiliation(s)
- M Jawad Hashim
- College of Medicine and Health Sciences, United Arab Emirates University Tawam Hospital Campus Al Ain 17666, United Arab Emirates
| |
Collapse
|
5
|
Foreman D. Lessons from studies of medication reduction in psychosis: giving participants accurate information about risk in psychiatric research trials. J Psychiatry Neurosci 2024; 49:E81-E86. [PMID: 38428969 PMCID: PMC10911823 DOI: 10.1503/jpn.230137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/22/2023] [Accepted: 11/13/2023] [Indexed: 03/03/2024] Open
Abstract
All research needs ethical regulation, which is institutionalized in research ethics committees. The patient information sheet, approved by a research ethics committee, sets out what patients need to know to make an informed choice about research participation. However, guidance from research ethics committees is much less explicit about risk communication. In this commentary, the balance of risk in the patient information sheets from protocols of 2 randomized controlled trials (RCTs) of medication reduction in psychosis was compared with numbers needed to treat and harm from the literature. The patient information sheet omitted risk of excess death and incomplete recovery following relapse, and overestimated the anticipated benefits. All of these risks were demonstrated in the published results of 1 of the 2 RCTs. Quantifying and tabulating risk might improve patient information sheets.
Collapse
Affiliation(s)
- David Foreman
- From the Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology & Neuroscience, London, UK
| |
Collapse
|
6
|
Riera R, de Oliveira Cruz Latorraca C, Padovez RCM, Pacheco RL, Romão DMM, Barreto JOM, Machado MLT, Gomes R, da Silva SF, Martimbianco ALC. Strategies for communicating scientific evidence on healthcare to managers and the population: a scoping review. Health Res Policy Syst 2023; 21:71. [PMID: 37430348 DOI: 10.1186/s12961-023-01017-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/14/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Health evidence needs to be communicated and disseminated in a manner that is clearly understood by decision-makers. As an inherent component of health knowledge translation, communicating results of scientific studies, effects of interventions and health risk estimates, in addition to understanding key concepts of clinical epidemiology and interpreting evidence, represent a set of essential instruments to reduce the gap between science and practice. The advancement of digital and social media has reshaped the concept of health communication, introducing new, direct and powerful communication platforms and gateways between researchers and the public. The objective of this scoping review was to identify strategies for communicating scientific evidence in healthcare to managers and/or population. METHODS We searched Cochrane Library, Embase®, MEDLINE® and other six electronic databases, in addition to grey literature, relevant websites from related organizations for studies, documents or reports published from 2000, addressing any strategy for communicating scientific evidence on healthcare to managers and/or population. RESULTS Our search identified 24 598 unique records, of which 80 met the inclusion criteria and addressed 78 strategies. Most strategies focused on risk and benefit communication in health, were presented by textual format and had been implemented and somehow evaluated. Among the strategies evaluated and appearing to yield some benefit are (i) risk/benefit communication: natural frequencies instead of percentages, absolute risk instead relative risk and number needed to treat, numerical instead nominal communication, mortality instead survival; negative or loss content appear to be more effective than positive or gain content; (ii) evidence synthesis: plain languages summaries to communicate the results of Cochrane reviews to the community were perceived as more reliable, easier to find and understand, and better to support decisions than the original summaries; (iii) teaching/learning: the Informed Health Choices resources seem to be effective for improving critical thinking skills. CONCLUSION Our findings contribute to both the knowledge translation process by identifying communication strategies with potential for immediate implementation and to future research by recognizing the need to evaluate the clinical and social impact of other strategies to support evidence-informed policies. Trial registration protocol is prospectively available in MedArxiv (doi.org/10.1101/2021.11.04.21265922).
Collapse
Affiliation(s)
- Rachel Riera
- Hospital Sírio-Libanês, Rua Barata Ribeiro, 142, 2O andar, São Paulo, SP, 01308-000, Brazil
- Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil
| | - Carolina de Oliveira Cruz Latorraca
- Hospital Sírio-Libanês, Rua Barata Ribeiro, 142, 2O andar, São Paulo, SP, 01308-000, Brazil
- Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil
| | | | - Rafael Leite Pacheco
- Hospital Sírio-Libanês, Rua Barata Ribeiro, 142, 2O andar, São Paulo, SP, 01308-000, Brazil.
- Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.
| | - Davi Mamblona Marques Romão
- Hospital Sírio-Libanês, Rua Barata Ribeiro, 142, 2O andar, São Paulo, SP, 01308-000, Brazil
- Instituto Veredas, São Paulo, Brazil
| | - Jorge Otávio Maia Barreto
- Hospital Sírio-Libanês, Rua Barata Ribeiro, 142, 2O andar, São Paulo, SP, 01308-000, Brazil
- Fundação Oswaldo Cruz, Brasília, Brazil
| | - Maria Lúcia Teixeira Machado
- Hospital Sírio-Libanês, Rua Barata Ribeiro, 142, 2O andar, São Paulo, SP, 01308-000, Brazil
- Universidade Federal de São Carlos, São Carlos, Brazil
| | - Romeu Gomes
- Hospital Sírio-Libanês, Rua Barata Ribeiro, 142, 2O andar, São Paulo, SP, 01308-000, Brazil
- Fundação Oswaldo Cruz, Brasília, Brazil
| | | | - Ana Luiza Cabrera Martimbianco
- Hospital Sírio-Libanês, Rua Barata Ribeiro, 142, 2O andar, São Paulo, SP, 01308-000, Brazil
- Universidade Metropolitna de Santo (Unimes), Santos, Brazil
| |
Collapse
|
7
|
Tran T, Ho-Le T, Bliuc D, Abrahamsen B, Hansen L, Vestergaard P, Center JR, Nguyen TV. 'Skeletal Age' for mapping the impact of fracture on mortality. eLife 2023; 12:e83888. [PMID: 37188349 PMCID: PMC10188111 DOI: 10.7554/elife.83888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 03/31/2023] [Indexed: 05/17/2023] Open
Abstract
Background Fragility fracture is associated with an increased risk of mortality, but mortality is not part of doctor-patient communication. Here, we introduce a new concept called 'Skeletal Age' as the age of an individual's skeleton resulting from a fragility fracture to convey the combined risk of fracture and fracture-associated mortality for an individual. Methods We used the Danish National Hospital Discharge Register which includes the whole-country data of 1,667,339 adults in Denmark born on or before January 1, 1950, who were followed up to December 31, 2016 for incident low-trauma fracture and mortality. Skeletal age is defined as the sum of chronological age and the number of years of life lost (YLL) associated with a fracture. Cox's proportional hazards model was employed to determine the hazard of mortality associated with a specific fracture for a given risk profile, and the hazard was then transformed into YLL using the Gompertz law of mortality. Results During the median follow-up period of 16 years, there had been 307,870 fractures and 122,744 post-fracture deaths. A fracture was associated with between 1 and 7 years of life lost, with the loss being greater in men than women. Hip fractures incurred the greatest loss of life years. For instance, a 60-year-old individual with a hip fracture is estimated to have a skeletal age of 66 for men and 65 for women. Skeletal Age was estimated for each age and fracture site stratified by gender. Conclusions We propose 'Skeletal Age' as a new metric to assess the impact of a fragility fracture on an individual's life expectancy. This approach will enhance doctor-patient risk communication about the risks associated with osteoporosis. Funding National Health and Medical Research Council in Australia and Amgen Competitive Grant Program 2019.
Collapse
Affiliation(s)
- Thach Tran
- School of Biomedical Engineering, University of Technology SydneySydneyAustralia
- Garvan Institute of Medical ResearchSydneyAustralia
- Faculty of Medicine, UNSW SydneyNew South WalesAustralia
| | - Thao Ho-Le
- School of Biomedical Engineering, University of Technology SydneySydneyAustralia
| | - Dana Bliuc
- Garvan Institute of Medical ResearchSydneyAustralia
- Faculty of Medicine, UNSW SydneyNew South WalesAustralia
| | - Bo Abrahamsen
- Department of Medicine, Holbæk HospitalHolbækDenmark
- Department of Clinical Research, Odense Patient Data Explorative Network, University of Southern DenmarkOdenseDenmark
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of OxfordOxfordUnited Kingdom
| | | | - Peter Vestergaard
- Department of Clinical Medicine, Aalborg UniversityAalborgDenmark
- Department of Endocrinology, Aalborg University HospitalAalborgDenmark
- Steno Diabetes Center North JutlandAalborgDenmark
| | - Jacqueline R Center
- Garvan Institute of Medical ResearchSydneyAustralia
- Faculty of Medicine, UNSW SydneyNew South WalesAustralia
- School of Medicine Sydney, University of Notre Dame AustraliaSydneyAustralia
| | - Tuan V Nguyen
- School of Biomedical Engineering, University of Technology SydneySydneyAustralia
- School of Medicine Sydney, University of Notre Dame AustraliaSydneyAustralia
- School of Population Health, UNSW Medicine, UNSW SydneyKensingtonAustralia
| |
Collapse
|
8
|
Feufel MA, Keller N, Kendel F, Spies CD. Boosting for insight and/or boosting for agency? How to maximize accurate test interpretation with natural frequencies. BMC MEDICAL EDUCATION 2023; 23:75. [PMID: 36747214 PMCID: PMC9903474 DOI: 10.1186/s12909-023-04025-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 01/11/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Many physicians do not know how to accurately interpret test results using Bayes' rule. As a remedy, two kinds of interventions have been shown effective: boosting insight and boosting agency with natural frequencies. To boost insight, test statistics are provided in natural frequencies (rather than conditional probabilities), without instructions on how to use them. To boost agency, a training is provided on how to translate probabilities into natural frequencies and apply them in Bayes' rule. What has not been shown is whether boosting agency is sufficient or if representing test statistics in natural frequencies may additionally boost insight to maximize accurate test interpretation. METHODS We used a pre/posttest design to assess test interpretation accuracy of 577 medical students before and after a training on two Bayesian reasoning tasks, one providing conditional probabilities, the other natural frequencies. The pretest assessed baseline abilities versus the effect of natural frequencies to boost insight. After participants received a training on how to translate conditional probabilities into natural frequencies and how to apply them in Bayes' rule, test interpretation skills were assessed using the same tasks again, comparing the effects of training-induced agency with versus without additionally boosting insight (i.e., test statistics in natural frequencies versus conditional probabilities). RESULTS Compared to the test question formatted in conditional probabilities (34% correct answers), natural frequencies facilitated Bayesian reasoning without training (68%), that is, they increased insight. The training on how to use natural frequencies improved performance for tasks formatted in conditional probabilities (64%). Performance was maximal after training and with test statistics formatted in natural frequencies, that is, with a combination of boosting insight and agency (89%). CONCLUSIONS Natural frequencies should be used to boost insight and agency to maximize effective use of teaching resources. Thus, mandating that test statistics are provided in natural frequencies and adopting short trainings on how to translate conditional probabilities into natural frequencies and how to apply them in Bayes' rule will help to maximize accurate test interpretation. TRIAL REGISTRATION The study was a registered with the German Clinical Trial Registry ( DRKS00008723 ; 06/03/2015).
Collapse
Affiliation(s)
- Markus A Feufel
- Division of Ergonomics in the Department of Psychology and Ergonomics (IPA), Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany.
- Simply Rational GmbH, Berlin, Germany.
- Institute for Gender in Medicine at Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
- Department of Anesthesiology and Operative Intensive Care Medicine at Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Niklas Keller
- Division of Ergonomics in the Department of Psychology and Ergonomics (IPA), Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany
- Institute for Gender in Medicine at Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Anesthesiology and Operative Intensive Care Medicine at Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Friederike Kendel
- Division of Ergonomics in the Department of Psychology and Ergonomics (IPA), Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany
- Institute for Gender in Medicine at Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Anesthesiology and Operative Intensive Care Medicine at Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Claudia D Spies
- Division of Ergonomics in the Department of Psychology and Ergonomics (IPA), Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany
- Simply Rational GmbH, Berlin, Germany
- Institute for Gender in Medicine at Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Anesthesiology and Operative Intensive Care Medicine at Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| |
Collapse
|
9
|
Zacher S, Berger-Höger B, Lühnen J, Steckelberg A. Development and Piloting of a Web-Based Tool to Teach Relative and Absolute Risk Reductions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192316086. [PMID: 36498161 PMCID: PMC9739880 DOI: 10.3390/ijerph192316086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/23/2022] [Accepted: 11/29/2022] [Indexed: 05/10/2023]
Abstract
Interpreting study results is an essential component of decision-making. Both laypeople and healthcare professionals often misinterpret treatment effects that are presented as relative risk reduction. Therefore, we developed and piloted a web-based tool to teach the difference between relative and absolute risk reductions. This project follows the UKMRC-guidance for complex interventions. The tool was developed based on adult learning and design theories. This was followed by a qualitative feasibility study focusing on acceptance, applicability, and comprehensibility with healthcare professionals and laypersons. We conducted think-aloud and semi-structured interviews and analysed them using qualitative content analysis. In addition, we explored calculation skills. Between January 2020 and April 2021, we conducted 22 interviews with 8 laypeople and 14 healthcare professionals from different settings. Overall, the tool proved to be feasible and relevant. With regard to comprehension, we observed an awareness of the interpretation of risk reduction, presented therapy effects were questioned more critically, and the influence of relative effects was recognized. Nevertheless, there were comprehension problems in some of the participants, especially with calculations in connection with low mathematical skills. The tool can be used to improve the interpretation of risk reductions in various target groups and to supplement existing educational programs.
Collapse
Affiliation(s)
- Sandro Zacher
- Institute of Health and Nursing Science, Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany
- Correspondence:
| | - Birte Berger-Höger
- Institute of Health and Nursing Science, Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany
- Institute for Public Health and Nursing Research, University of Bremen, 28359 Bremen, Germany
| | - Julia Lühnen
- Institute of Health and Nursing Science, Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany
| | - Anke Steckelberg
- Institute of Health and Nursing Science, Martin Luther University Halle-Wittenberg, 06112 Halle (Saale), Germany
| |
Collapse
|
10
|
Kamineni A, Doria-Rose VP, Chubak J, Inadomi JM, Corley DA, Haas JS, Kobrin SC, Winer RL, Lafata JE, Beaber EF, Yudkin JS, Zheng Y, Skinner CS, Schottinger JE, Ritzwoller DP, Croswell JM, Burnett-Hartman AN. Evaluation of Harms Reporting in U.S. Cancer Screening Guidelines. Ann Intern Med 2022; 175:1582-1590. [PMID: 36162112 PMCID: PMC9903969 DOI: 10.7326/m22-1139] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Cancer screening should be recommended only when the balance between benefits and harms is favorable. This review evaluated how U.S. cancer screening guidelines reported harms, within and across organ-specific processes to screen for cancer. OBJECTIVE To describe current reporting practices and identify opportunities for improvement. DESIGN Review of guidelines. SETTING United States. PATIENTS Patients eligible for screening for breast, cervical, colorectal, lung, or prostate cancer according to U.S. guidelines. MEASUREMENTS Information was abstracted on reporting of patient-level harms associated with screening, diagnostic follow-up, and treatment. The authors classified harms reporting as not mentioned, conceptual, qualitative, or quantitative and noted whether literature was cited when harms were described. Frequency of harms reporting was summarized by organ type. RESULTS Harms reporting was inconsistent across organ types and at each step of the cancer screening process. Guidelines did not report all harms for any specific organ type or for any category of harm across organ types. The most complete harms reporting was for prostate cancer screening guidelines and the least complete for colorectal cancer screening guidelines. Conceptualization of harms and use of quantitative evidence also differed by organ type. LIMITATIONS This review considers only patient-level harms. The authors did not verify accuracy of harms information presented in the guidelines. CONCLUSION The review identified opportunities for improving conceptualization, assessment, and reporting of screening process-related harms in guidelines. Future work should consider nuances associated with each organ-specific process to screen for cancer, including which harms are most salient and where evidence gaps exist, and explicitly explore how to optimally weigh available evidence in determining net screening benefit. Improved harms reporting could aid informed decision making, ultimately improving cancer screening delivery. PRIMARY FUNDING SOURCE National Cancer Institute.
Collapse
Affiliation(s)
- Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - V. Paul Doria-Rose
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Jessica Chubak
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - John M. Inadomi
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Douglas A. Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Jennifer S. Haas
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA
| | - Sarah C. Kobrin
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | - Rachel L. Winer
- Department of Epidemiology, University of Washington, Seattle, WA
| | - Jennifer Elston Lafata
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy and UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC; Henry Ford Health System, Detroit, MI
| | - Elisabeth F. Beaber
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Joshua S. Yudkin
- University of Texas Health Science Center at Houston, Houston, TX
| | - Yingye Zheng
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Celette Sugg Skinner
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX; Simmons Comprehensive Cancer Center, Dallas, TX
| | | | | | - Jennifer M. Croswell
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
| | | |
Collapse
|
11
|
Bhat S, Wang AT, Wood F, Orgill DP. Visual Preoperative Risk Depiction Tools for Shared Decision-making: A Pilot Study from the Surgeon's Perspective. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4690. [PMID: 36467117 PMCID: PMC9708169 DOI: 10.1097/gox.0000000000004690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/04/2022] [Indexed: 01/25/2023]
Abstract
Shared decision-making (SDM) and effective risk communication improve patient satisfaction, adherence to treatment, and understanding of perioperative care pathways. Available risk calculators are less relevant for low-risk operations. The aim of this pilot study was to develop graphical risk visualization tools to enhance surgical SDM discussions preoperatively. Methods Complications for reduction mammoplasty and skin grafting in a burns setting were sourced from the American College of Surgeons National Surgical Quality Improvement Program Surgical Risk Calculator, the American Society of Plastic Surgeons website, peer-reviewed literature, and available clinical data. Pre- and postoperative patient satisfaction data were collected from the published literature on Breast-Q patient-reported outcomes for reduction mammoplasty. Everyday risk comparisons were collected from a general online database search. Three distinct risk depiction tools (spiral, tile, and scatter plot) were developed in the Microsoft Office Suite. Anonymous REDCap surveys were sent to healthcare practitioners for feedback. Results Twenty-six survey results were collected. Twenty-four respondents (92%) agreed these graphics would be useful for SDM discussions. Nineteen respondents (73%) either agreed or strongly agreed that these graphics depicted risk in a meaningful way. Fifteen respondents (58%) indicated they would use these graphics in daily practice. The majority of respondents preferred the spiral design (58%). Areas for improvement included design simplification and written explanations to accompany graphics. Feedback from the survey was incorporated into the spiral design. Conclusions Risk visualization tools meaningfully depict surgical risks to improve communication in SDM. This study proposes a tool that can be adapted for many surgical procedures.
Collapse
Affiliation(s)
- Saiuj Bhat
- From the Department of Plastic Surgery, Royal Perth Hospital, Victoria Square, Perth, Western Australia
- School of Medicine, The University of Western of Australia, Crawley, Western Australia
| | | | - Fiona Wood
- School of Medicine, The University of Western of Australia, Crawley, Western Australia
- Burns Injury Research Unit, The University of Western Australia, Crawley, Western Australia
- Burns Service of Western Australia, Fiona Stanley Hospital, Murdoch, Western Australia
| | - Dennis P. Orgill
- Harvard Medical School, Boston, Mass
- Division of Plastic Surgery, Brigham and Women’s Hospital, Boston, Mass
| |
Collapse
|
12
|
Brinkmann M, Fricke LM, Diedrich L, Robra BP, Krauth C, Dreier M. Attributes in stated preference elicitation studies on colorectal cancer screening and their relative importance for decision-making among screenees: a systematic review. HEALTH ECONOMICS REVIEW 2022; 12:49. [PMID: 36136248 PMCID: PMC9494881 DOI: 10.1186/s13561-022-00394-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The SIGMO study (Sigmoidoscopy as an evidence-based colorectal cancer screening test - a possible option?) examines screening eligible populations' preferences for colorectal cancer (CRC) screening in Germany using a discrete choice experiment (DCE). Attribute identification and selection are essential for the construction of choice tasks and should be evidence-based. As a part of the SIGMO study this systematic review provides an overview of attributes included in studies eliciting stated preferences for CRC screening tests and their relative importance for decision-making. METHODS Systematic search (November 2021) for English-language studies published since January 2000 in PubMed, Embase, Web of Science, Biomedical Reference Collection: Corporate Edition, LIVIVO and PsycINFO. DCEs and conjoint analysis ranking or rating tasks on screening eligible populations' preferences for stool testing, sigmoidoscopy, and/or colonoscopy were included. Attributes were extracted and their relative importance was calculated and ranked. Risk of bias (RoB) of included studies was assessed using a modified GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Study selection and RoB rating were carried out independently by two reviewers. Data were extracted by one reviewer and checked by another one. RESULTS A total of 23 publications on 22 studies were included. Overall RoB was rated as serious/critical for 21 studies and as moderate for 2 studies. Main reasons for high RoB were non-random sampling, low response rates, lack of non-responder analyses, and, to a lesser extent, weaknesses in the measurement instrument and data analysis. Extracted attributes (n = 120) referred to procedure-related characteristics (n = 42; 35%), structural characteristics of health care (n = 24; 20%), test characteristics (n = 23; 19%), harms (n = 16; 13%), benefits (n = 13; 11%), and level of evidence (n = 2; 2%). Most important attributes were reduction in CRC mortality (and incidence) (n = 7), test sensitivity (n = 7), out-of-pocket costs (n = 4), procedure (n = 3), and frequency (n = 2). CONCLUSIONS Health preference studies on CRC were found to have a high RoB. The composition of choice tasks revealed a lack of attributes on patient-important outcomes (like incidence reduction), while attributes not considered relevant for individual screening decisions (like sensitivity) were frequently used. Future studies eliciting stated preferences in cancer screening should apply the principles of informed decision-making in attribute identification and selection.
Collapse
Affiliation(s)
- Melanie Brinkmann
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany.
| | - Lara Marleen Fricke
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Leonie Diedrich
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Bernt-Peter Robra
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Christian Krauth
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Maren Dreier
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| |
Collapse
|
13
|
Beaudart C, Hiligsmann M, Li N, Lewiecki EM, Silverman S. Effective communication regarding risk of fracture for individuals at risk of fragility fracture: a scoping review. Osteoporos Int 2022; 33:13-26. [PMID: 34559256 PMCID: PMC8758611 DOI: 10.1007/s00198-021-06151-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 09/03/2021] [Indexed: 12/28/2022]
Abstract
Two scoping reviews were conducted to review recommendations and guidelines for communication regarding general health risk, and to investigate communication strategies regarding risk of fracture. Healthcare professionals are invited to apply these recommendations to optimize a patient-centered approach to reducing risk of fracture. INTRODUCTION To conduct a scoping review of the medical literature regarding recommendations and tools for effective communication between healthcare professionals and patients regarding general health risk and risk of fracture. METHODS The scoping review was divided into two parts to search for (1) studies presenting recommendations and guidelines for communication regarding general health risk; (2) studies investigating communication regarding risk of fracture for individuals at risk for fractures. Medline was searched in April 2020 to identify relevant studies. RESULTS The scoping review included 43 studies on communication with regard to general health risk and 25 studies about communication regarding risk of fracture. Recommendations for effective communication with regard to risk are presented. Communication of numeric data on risk should be adapted to the literacy and numeracy levels of the individual patient. Patient understanding of numerical data can be enhanced with appropriate use of visual aids (e.g., pie charts, icon arrays, bar charts, pictograms). The FRAX® tool is the most recommended and most used tool for assessing risk of fracture. Communication sent as individualized letters to patients following DXA scans has been studied, although patient understanding of their risk of fracture is often reported as low using this technique. Use of visual aids may improve patient understanding. CONCLUSION Healthcare professionals are encouraged to apply recommendations presented in this scoping review in their clinical practice. Patient understanding of risk of fracture should be confirmed by making sure that patients feel free to ask questions and express their concerns. This will contribute to an optimal patient-centered approach. Developing online tools to convert the probability of fracture into patient-friendly visual presentations could facilitate communication between healthcare professionals and patients about risk of fracture.
Collapse
Affiliation(s)
- Charlotte Beaudart
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
| | - Mickael Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Nannan Li
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | | | - Stuart Silverman
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA
| |
Collapse
|
14
|
Franconeri SL, Padilla LM, Shah P, Zacks JM, Hullman J. The Science of Visual Data Communication: What Works. Psychol Sci Public Interest 2021; 22:110-161. [PMID: 34907835 DOI: 10.1177/15291006211051956] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Effectively designed data visualizations allow viewers to use their powerful visual systems to understand patterns in data across science, education, health, and public policy. But ineffectively designed visualizations can cause confusion, misunderstanding, or even distrust-especially among viewers with low graphical literacy. We review research-backed guidelines for creating effective and intuitive visualizations oriented toward communicating data to students, coworkers, and the general public. We describe how the visual system can quickly extract broad statistics from a display, whereas poorly designed displays can lead to misperceptions and illusions. Extracting global statistics is fast, but comparing between subsets of values is slow. Effective graphics avoid taxing working memory, guide attention, and respect familiar conventions. Data visualizations can play a critical role in teaching and communication, provided that designers tailor those visualizations to their audience.
Collapse
Affiliation(s)
| | - Lace M Padilla
- Department of Cognitive and Information Sciences, University of California, Merced
| | - Priti Shah
- Department of Psychology, University of Michigan
| | - Jeffrey M Zacks
- Department of Psychological & Brain Sciences, Washington University in St. Louis
| | | |
Collapse
|
15
|
Furukawa Y. Understanding the lung cancer mortality reductions produced by low-dose CT screening. THE LANCET REGIONAL HEALTH. EUROPE 2021; 11:100255. [PMID: 34778861 PMCID: PMC8577122 DOI: 10.1016/j.lanepe.2021.100255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yuki Furukawa
- Tokyo Musashino Hospital, Tokyo, Japan; Department of Neuropsychiatry, University of Tokyo Hospital, Tokyo, Japan
| |
Collapse
|
16
|
Furukawa Y, Saito H, Hasegawa K, Ichikawa M. Assessing the quality of cancer screening leaflets using the International Patient Decision Aids Standards instrument: A cross-sectional content analysis. PATIENT EDUCATION AND COUNSELING 2021; 104:3100-3103. [PMID: 33846033 DOI: 10.1016/j.pec.2021.03.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/26/2021] [Accepted: 03/30/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To assess the quality of national cancer screening program leaflets in Japan from the informed-decision perspective. METHODS Cross-sectional content analysis of invitation leaflets issued by centralized organizations and used nationwide in Japan was conducted. Three members independently evaluated the materials using International Patient Decision Aids Standards six-item minimum criteria for qualifying patient decision aids. PATIENT PUBLIC INVOLVEMENT Co-author KH is a cancer patient himself. We also sought feedbacks from three other cancer survivors and two bereaved family members. RESULTS Inter-rater agreement was substantial (Fleiss' kappa=0.62). The median score was 2 out of 6 (range: 2-3). All leaflets described the cancer (Q1: 7/7) and screening modality (Q2: 7/7). None stated not undergoing screening as an option. One stated another screening modality (Q3: 1/7). None stated both the positive and negative features of multiple options (Q4: 0/7. Q5: 0/7). One described the psychological and social experience of screening but only its positive side (Q6: 1/7). CONCLUSIONS There is room for improvement in the content of the public cancer screening invitation leaflets in Japan from informed-decision perspective. PRACTICE IMPLICATIONS Cancer screening leaflets should provide evidence-based, well-balanced, easy-to-understand information to educate people on cancer screening while maintaining people's autonomy.
Collapse
Affiliation(s)
- Yuki Furukawa
- Department of Neuropsychiatry, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Hiroko Saito
- Teikyo University Graduate School of Public Health, 2-11-1, Kaga, Itabashi-ku, Tokyo 173-8605, Japan
| | - Kazuo Hasegawa
- Non-Profit Organization Lung Cancer Patient Group ONE STEP, 1-38-9, Sakuragaoka, Hodogaya-ku, Yokohama-shi, Kanagawa 240-0011, Japan
| | | |
Collapse
|
17
|
Swierz MJ, Storman D, Zajac J, Koperny M, Weglarz P, Staskiewicz W, Gorecka M, Skuza A, Wach A, Kaluzinska K, Bochenek-Cibor J, Johnston BC, Bala MM. Similarities, reliability and gaps in assessing the quality of conduct of systematic reviews using AMSTAR-2 and ROBIS: systematic survey of nutrition reviews. BMC Med Res Methodol 2021; 21:261. [PMID: 34837960 PMCID: PMC8627612 DOI: 10.1186/s12874-021-01457-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/03/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AMSTAR-2 ('A Measurement Tool to Assess Systematic Reviews, version 2') and ROBIS ('Risk of Bias in Systematic Reviews') are independent instruments used to assess the quality of conduct of systematic reviews/meta-analyses (SR/MAs). The degree of overlap in methodological constructs together with the reliability and any methodological gaps have not been systematically assessed and summarized in the field of nutrition. METHODS We performed a systematic survey of MEDLINE, EMBASE, and the Cochrane Library for SR/MAs published between January 2010 and November 2018 that examined the effects of any nutritional intervention/exposure for cancer prevention. We followed a systematic review approach including two independent reviewers at each step of the process. For AMSTAR-2 (16 items) and ROBIS (21 items), we assessed the similarities, the inter-rater reliability (IRR) and any methodological limitations of the instruments. Our protocol for the survey was registered in PROSPERO (CRD42019121116). RESULTS We found 4 similar domain constructs based on 11 comparisons from a total of 12 AMSTAR-2 and 14 ROBIS items. Ten comparisons were considered fully overlapping. Based on Gwet's agreement coefficients, six comparisons provided almost perfect (> 0.8), three substantial (> 0.6), and one a moderate level of agreement (> 0.4). While there is considerable overlap in constructs, AMSTAR-2 uniquely addresses explaining the selection of study designs for inclusion, reporting on excluded studies with justification, sources of funding of primary studies, and reviewers' conflict of interest. By contrast, ROBIS uniquely addresses appropriateness and restrictions within eligibility criteria, reducing risk of error in risk of bias (RoB) assessments, completeness of data extracted for analyses, the inclusion of all necessary studies for analyses, and adherence to predefined analysis plan. CONCLUSIONS Among the questions on AMSTAR-2 and ROBIS, 70.3% (26/37 items) address the same or similar methodological constructs. While the IRR of these constructs was moderate to perfect, there are unique methodological constructs that each instrument independently addresses. Notably, both instruments do not address the reporting of absolute estimates of effect or the overall certainty of the evidence, items that are crucial for users' wishing to interpret the importance of SR/MA results.
Collapse
Affiliation(s)
- Mateusz J Swierz
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kopernika 7 Street 31-034, Krakow, Poland
| | - Dawid Storman
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kopernika 7 Street 31-034, Krakow, Poland
| | - Joanna Zajac
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kopernika 7 Street 31-034, Krakow, Poland
| | - Magdalena Koperny
- Chair of Epidemiology and Preventive Medicine, Department of Epidemiology Jagiellonian University Medical College , Kopernika 7 Street 31-034, Krakow, Poland
| | - Paulina Weglarz
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kopernika 7 Street 31-034, Krakow, Poland
| | - Wojciech Staskiewicz
- Students' Scientific Research Group of Systematic Reviews, Jagiellonian University Medical College, Krakow, Poland
| | - Magdalena Gorecka
- Students' Scientific Research Group of Systematic Reviews, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Skuza
- Students' Scientific Research Group of Systematic Reviews, Jagiellonian University Medical College, Krakow, Poland
| | - Adam Wach
- Students' Scientific Research Group of Systematic Reviews, Jagiellonian University Medical College, Krakow, Poland
| | - Klaudia Kaluzinska
- Students' Scientific Research Group of Systematic Reviews, Jagiellonian University Medical College, Krakow, Poland
| | | | - Bradley C Johnston
- Departments of Nutrition, Epidemiology and Biostatistics, Texas A&M University, College Station, College Station, TX, USA.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Malgorzata M Bala
- Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kopernika 7 Street 31-034, Krakow, Poland.
| |
Collapse
|
18
|
Effect of different visual presentations on the comprehension of prognostic information: a systematic review. BMC Med Inform Decis Mak 2021; 21:249. [PMID: 34433455 PMCID: PMC8390199 DOI: 10.1186/s12911-021-01612-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background Understanding prognostic information can help patients know what may happen to their health over time and make informed decisions. However, communicating prognostic information well can be challenging. Purpose To conduct a systematic review to identify and synthesize research that has evaluated visual presentations that communicate quantitative prognostic information to patients or the public. Data sources MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC and the Cochrane Central Register of Controlled Trials (CENTRAL) (from inception to December 2020), and forward and backward citation search. Study selection Two authors independently screened search results and assessed eligibility. To be eligible, studies required a quantitative design and comparison of at least one visual presentation with another presentation of quantitative prognostic information. The primary outcome was comprehension of the presented information. Secondary outcomes were preferences for or satisfaction with the presentations viewed, and behavioral intentions. Data extraction Two authors independently assessed risk of bias and extracted data. Data synthesis Eleven studies (all randomized trials) were identified. We grouped studies according to the presentation type evaluated. Bar graph versus pictograph (3 studies): no difference in comprehension between the groups. Survival vs mortality curves (2 studies): no difference in one study; higher comprehension in survival curve group in another study. Tabular format versus pictograph (4 studies): 2 studies reported similar comprehension between groups; 2 found higher comprehension in pictograph groups. Tabular versus free text (3 studies): 2 studies found no difference between groups; 1 found higher comprehension in a tabular group. Limitations Heterogeneity in the visual presentations and outcome measures, precluding meta-analysis. Conclusions No visual presentation appears to be consistently superior to communicate quantitative prognostic information. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01612-9.
Collapse
|
19
|
Raittio E, Raittio L. Verbal communication of effect-sizes, possible comparators, and uncertainty of evidence in the Finnish clinical practice guidelines: Omitting effect-sizes and comparators without expressing much uncertainty. J Eval Clin Pract 2021; 27:759-766. [PMID: 33084201 DOI: 10.1111/jep.13499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 11/27/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Our aim was to investigate verbal representations of intervention effect-size, uncertainty of evidence, and possible intervention comparators in statements concerning effects of interventions in Finnish clinical practice guidelines. METHOD We selected 10 clinical practice guidelines on common diseases and risk factors published by The Finnish Medical Society Duodecim. All the statements that considered beneficial effects of interventions and that were graded with a level of evidence (levels A, high, to D, very low) were included in analyses. We assessed whether the statements verbally represented intervention effect-size, uncertainty of evidence or a possible comparator, and the reported outcome. RESULTS Of 385 statements, verbal representation of beneficial effect-sizes occurred in 25 (6%) statements. Most (72%) statements indicated that intervention had a beneficial effect, but did not specify effect-size. Less than half (42%) of the statements represented uncertainty verbally. Comparisons to placebo or no-treatment were rare (3%) and 18% of the statements compared interventions to other treatments. Against instructions, a considerable part (35%) of statements with B-level evidence did not represent uncertainty. CONCLUSION Communicating beneficial intervention effects, effect-sizes, possible comparators, and uncertainty of evidence require much broader attention in the clinical practice guideline context.
Collapse
Affiliation(s)
- Eero Raittio
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.,Oral Health Care, City of Tampere, Tampere, Finland
| | - Lauri Raittio
- The Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| |
Collapse
|
20
|
Nguyen C, Naunton M, Thomas J, Todd L, McEwen J, Bushell M. Availability and use of number needed to treat (NNT) based decision aids for pharmaceutical interventions. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2021; 2:100039. [PMID: 35481125 PMCID: PMC9032485 DOI: 10.1016/j.rcsop.2021.100039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 06/11/2021] [Accepted: 06/22/2021] [Indexed: 01/13/2023] Open
Abstract
Background The number needed to treat (NNT) is a medical statistic used to gauge the efficacy of therapeutic interventions. The versatility of this absolute effect measure has allowed its use in the formulation of many decision aids to support patients and practitioners in making informed healthcare choices. With the rising number of tools available to health professionals, this review synthesizes what is known of the current NNT-based tools which depict the efficacy of pharmaceutical interventions. Objectives To explore the current spectrum of NNT-based decision aids accessible to health professionals with a focus on the potential utility of these devices by pharmacist practitioners. Methods A literature review was performed in MEDLINE, CINAHL, Web of Science, PsychINFO and Cochrane Library (CENTRAL, Cochrane Database of Systematic Reviews and the Cochrane Methodology Register) for studies published between January 1st 2000 and August 29th 2019. The language was restricted to English unless an appropriate translation existed. Studies that reported NNT-based decision aids of pharmaceutical or therapeutic interventions were included. One author performed study selection and data extraction. Results A total of 365 records were identified, of which 19 NNT-based tools met the eligibility criteria, comprising of 8 tool databases and 11 individual decision aids. Decision aids appeared in multiple forms: databases, pictograms, graphs, interactive applications, calculators and charts. All aids were accessible online with a printer-friendly option, and very few came at a cost (e.g. requiring a subscription or access fee). The main tool innovators were the United Kingdom (UK) and United States (US), with English being the language of choice. Conclusions Evidence that NNT-based decision aids can contribute to greater satisfaction and involvement of patients in medical decision making is limited and inconclusive. A case for the utilization of these tools by pharmacists has yet to be fully examined in the medical research. NNT tools may provide a valuable resource to upskill pharmacists in communication of research evidence.
Collapse
Affiliation(s)
- Cassandra Nguyen
- University of Canberra, Discipline of Pharmacy, Faculty of Health, Australia
| | - Mark Naunton
- University of Canberra, Discipline of Pharmacy, Faculty of Health, Australia
| | - Jackson Thomas
- University of Canberra, Discipline of Pharmacy, Faculty of Health, Australia
| | - Lyn Todd
- University of Canberra, Discipline of Pharmacy, Faculty of Health, Australia
| | - John McEwen
- University of Canberra, Discipline of Pharmacy, Faculty of Health, Australia
| | - Mary Bushell
- University of Canberra, Discipline of Pharmacy, Faculty of Health, Australia
| |
Collapse
|
21
|
Friederichs H, Birkenstein R, Becker JC, Marschall B, Weissenstein A. Risk literacy assessment of general practitioners and medical students using the Berlin Numeracy Test. BMC FAMILY PRACTICE 2020; 21:143. [PMID: 32664885 PMCID: PMC7362657 DOI: 10.1186/s12875-020-01214-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 07/07/2020] [Indexed: 11/24/2022]
Abstract
Background The responsibility for helping patients understand potential health benefits and risks, especially regarding screening tests, falls largely to general practitioners (GPs). The Berlin Numeracy Test (BNT) specifically measures risk literacy (i.e., the ability to understand different aspects of statistical numeracy associated with accurate interpretation of information about risks). This study explored the association between risk literacy levels and clinical experience in GPs vs. medical students. Additionally, the effect of GP risk literacy on evaluation of the predictive value of screening tests was examined. Methods The participants were 84 GPs and 92 third-year medical students who completed the BNT (total score range 0–4 points). The GPs received an additional case scenario on mammography screening as a simple measure of performance in applying numeracy skills. Results Despite having an average of 25.9 years of clinical experience, GPs scored no better than medical students on risk literacy (GPs: 2.33 points, 95% confidence interval [CI] 2.08–2.59; students: 2.34, 95% CI 2.07–2.61; P = .983). Of all GPs, 71.6% (n = 58) greatly overestimated the real predictive value. Conclusions In this study, we found no difference in risk literacy between current students and current GPs. GPs lack risk literacy and consequently do not fully understand numeric estimates of probability in routine screening procedures.
Collapse
Affiliation(s)
- Hendrik Friederichs
- Study Hospital Münster, Institute for Education and Student Affairs, Medical Faculty of Münster, Malmedyweg 17-19, D-48149, Münster, Germany.
| | - Roman Birkenstein
- Study Hospital Münster, Institute for Education and Student Affairs, Medical Faculty of Münster, Malmedyweg 17-19, D-48149, Münster, Germany
| | - Jan C Becker
- Study Hospital Münster, Institute for Education and Student Affairs, Medical Faculty of Münster, Malmedyweg 17-19, D-48149, Münster, Germany
| | - Bernhard Marschall
- Study Hospital Münster, Institute for Education and Student Affairs, Medical Faculty of Münster, Malmedyweg 17-19, D-48149, Münster, Germany
| | - Anne Weissenstein
- Department of Internal Medicine, Marien-Hospital, Erftstadt, NRW, Germany
| |
Collapse
|
22
|
Abstract
IMPORTANCE The US Preventive Services Task Force recommends that individuals at high risk for lung cancer consider benefits and harms before pursuing lung cancer screening. Medical centers develop websites for their lung cancer screening programs, but to date little is known about the websites' portrayal of benefits and harms or what next steps they recommend for individuals considering screening. OBJECTIVE To assess the presentation of potential benefits and harms and recommended next steps on lung cancer screening program websites. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional content analysis of 162 lung cancer screening program websites of academic medical centers (n = 81) and state-matched community medical centers (n = 81) that were randomly selected from American College of Radiology lung cancer screening-designated centers was conducted. The study was performed from December 1, 2018, to January 31, 2019. MAIN OUTCOMES AND MEASURES Website presentation of screening-associated benefits and harms was the primary outcome. Benefit was defined as any description related to the potential reduction in lung cancer mortality. Harms were based on the US Preventive Services Task Force recommendations and included false positives, false negatives, overdiagnosis, radiation exposure, and incidental findings. The secondary outcome was next steps that are recommended by websites. RESULTS Overall, the 162 lung cancer screening program websites described the potential benefits more frequently than they described any potential harms (159 [98%] vs 78 [48%], P < .01). False-positive findings were the most frequently reported (72 [44%]) potential harm. Community centers were less likely than academic centers to report any potential harm (32 [40%] vs 46 [57%], P = .03), potential harm from radiation (20 [25%] vs 35 [43%], P = .01), and overdiagnosis (0% vs 11 [14%], P < .01). One hundred nineteen websites (73%) did not explicitly recommend that individuals personally consider the potential benefits and harms of screening; community centers were less likely than academic centers to give this recommendation (15 [19%] vs 28 [35%], P = .02). Most institutions (157 [97%]) listed follow-up steps for screening, but few institutions (35 [22%]) recommended that individuals discuss benefits and harms with a health care professional. CONCLUSIONS AND RELEVANCE Information on public-facing websites of US lung cancer screening programs appears to lack balance with respect to portrayal of potential benefits and harms of screening. Important harms, such as overdiagnosis, were commonly ignored in the sites evaluated, and most of the centers did not explicitly guide individuals toward a guideline-recommended, shared decision-making discussion of harms and benefits.
Collapse
Affiliation(s)
- Stephen D Clark
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.,Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill
| | - Daniel S Reuland
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.,Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill
| | - Chineme Enyioha
- Department of Family Medicine, University of North Carolina at Chapel Hill
| | - Daniel E Jonas
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill.,Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill
| |
Collapse
|
23
|
Colombo C, Confalonieri P, Rovaris M, La Mantia L, Galeazzi P, Silena Trevisan, Pariani A, Gerevini S, De Stefano N, Guglielmino R, Caserta C, Mosconi P, Filippini G. The IN-DEEP project "INtegrating and Deriving Evidence, Experiences, Preferences": a web information model on magnetic resonance imaging for people with multiple sclerosis. J Neurol 2020; 267:2421-2431. [PMID: 32361839 DOI: 10.1007/s00415-020-09864-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The IN-DEEP project aims to provide people with multiple sclerosis (PwMS) with evidence-based information on magnetic resonance imaging (MRI) in diagnosis and monitoring the disease through a website, and to collect their opinions on the clarity of the website's contents and its usefulness. METHODS AND ANALYSIS A multidisciplinary advisory board committee was set up. We investigated the experience, attitude and information needs on MRI through three meetings with 24 PwMS, facilitated by an expert researcher and an observer. We developed the website on the basis of input from PwMS and systematic reviews and guidelines, assessed with AMSTAR and AGREE II. We sought feedback from nine PwMS who pilot-tested the beta-version of the website, during a meeting and through phone interviews and judged whether the contents were clear, understandable and useful, and the website was easily navigable. The website is in Italian. RESULTS The website ( https://www.istituto-besta.it/in-deep-risonanza-magnetica2 ) provides two levels of information, different layouts and visualization of data covering MRI diagnostic accuracy, sensitivity and specificity, contents on how MRI can monitor PwMS over time to determine changes in the condition and evaluate treatment effects, practical information on how to prepare for the exam, educational tools and a glossary. The website was judged clear and useful by a sample of PwMS. CONCLUSIONS The website is a tool to address PwMS information needs on the role of MRI. It could be used by neurologists to facilitate communication with PwMS.
Collapse
Affiliation(s)
- Cinzia Colombo
- Laboratory of Research and Consumer Involvement, Department of Public Health, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156, Milan, Italy.
| | - Paolo Confalonieri
- Multiple Sclerosis Centre, Unit of Neuroimmunology and Neuromuscular Diseases, Fondazione IRCCS, Istituto Neurologico Carlo Besta, via Celoria 11, 20133, Milan, Italy
| | - Marco Rovaris
- IRCCS Don C. Gnocchi Foundation ONLUS, Via Capecelatro 66, 20148, Milan, Italy
| | - Loredana La Mantia
- IRCCS Don C. Gnocchi Foundation ONLUS, Via Capecelatro 66, 20148, Milan, Italy
| | | | | | | | - Simonetta Gerevini
- Unit of Neuroradiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery, and Neurosciences, University of Siena, Siena, Italy
| | - Roberta Guglielmino
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Via Operai 40, 16149, Genoa, Italy
| | - Cinzia Caserta
- Multiple Sclerosis Center, Policlinico G. Rodolico, University of Catania, Catania, Italy
| | - Paola Mosconi
- Laboratory of Research and Consumer Involvement, Department of Public Health, Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156, Milan, Italy
| | - Graziella Filippini
- Scientific Direction, Carlo Besta Foundation and Neurological Institute, via Celoria 11, 20133, Milan, Italy
| |
Collapse
|
24
|
Chapman E, Haby MM, Toma TS, de Bortoli MC, Illanes E, Oliveros MJ, Barreto JOM. Knowledge translation strategies for dissemination with a focus on healthcare recipients: an overview of systematic reviews. Implement Sci 2020; 15:14. [PMID: 32131861 PMCID: PMC7057470 DOI: 10.1186/s13012-020-0974-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 02/17/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND While there is an ample literature on the evaluation of knowledge translation interventions aimed at healthcare providers, managers, and policy-makers, there has been less focus on patients and their informal caregivers. Further, no overview of the literature on dissemination strategies aimed at healthcare users and their caregivers has been conducted. The overview has two specific research questions: (1) to determine the most effective strategies that have been used to disseminate knowledge to healthcare recipients, and (2) to determine the barriers (and facilitators) to dissemination of knowledge to this group. METHODS This overview used systematic review methods and was conducted according to a pre-defined protocol. A comprehensive search of ten databases and five websites was conducted. Both published and unpublished reviews in English, Spanish, or Portuguese were included. A methodological quality assessment was conducted; low-quality reviews were excluded. A narrative synthesis was undertaken, informed by a matrix of strategy by outcome measure. The Health System Evidence taxonomy for "consumer targeted strategies" was used to separate strategies into one of six categories. RESULTS We identified 44 systematic reviews that describe the effective strategies to disseminate health knowledge to the public, patients, and caregivers. Some of these reviews also describe the most important barriers to the uptake of these effective strategies. When analyzing those strategies with the greatest potential to achieve behavioral changes, the majority of strategies with sufficient evidence of effectiveness were combined, frequent, and/or intense over time. Further, strategies focused on the patient, with tailored interventions, and those that seek to acquire skills and competencies were more effective in achieving these changes. In relation to barriers and facilitators, while the lack of health literacy or e-literacy could increase inequities, the benefits of social media were also emphasized, for example by widening access to health information for ethnic minorities and lower socioeconomic groups. CONCLUSIONS Those interventions that have been shown to be effective in improving knowledge uptake or health behaviors should be implemented in practice, programs, and policies-if not already implemented. When implementing strategies, decision-makers should consider the barriers and facilitators identified by this overview to ensure maximum effectiveness. PROTOCOL REGISTRATION PROSPERO: CRD42018093245.
Collapse
Affiliation(s)
| | - Michelle M. Haby
- Departamento de Ciencias Químico Biológicas, Universidad de Sonora, Hermosillo, Sonora Mexico
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC Australia
| | - Tereza Setsuko Toma
- Instituto de Saúde, Secretaria de Estado da Saúde de São Paulo, São Paulo, Brazil
| | | | | | - Maria Jose Oliveros
- Departamento de Medicina Interna, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
| | | |
Collapse
|
25
|
Brick C, McDowell M, Freeman ALJ. Risk communication in tables versus text: a registered report randomized trial on 'fact boxes'. ROYAL SOCIETY OPEN SCIENCE 2020; 7:190876. [PMID: 32269779 PMCID: PMC7137953 DOI: 10.1098/rsos.190876] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 02/27/2020] [Indexed: 06/09/2023]
Abstract
OBJECTIVES identifying effective summary formats is fundamental to multiple fields including science communication, systematic reviews, evidence-based policy and medical decision-making. This study tested whether table or text-only formats lead to better comprehension of the potential harms and benefits of different options, here in a medical context. DESIGN pre-registered, longitudinal experiment: between-subjects factorial 2 (message format) × 2 topic (therapeutic or preventative intervention) on comprehension and later recall (CONSORT-SPI 2018). SETTING longitudinal online survey experiment. PARTICIPANTS 2305 census-matched UK residents recruited through the survey panel firm YouGov. PRIMARY OUTCOME MEASURE comprehension of harms and benefits and knowledge recall after six weeks. RESULTS fact boxes-simple tabular messages-led to more comprehension (d = 0.39) and slightly more knowledge recall after six weeks (d = 0.12) compared to the same information in text. These patterns of results were consistent between the two medical topics and across all levels of objective numeracy and education. Fact boxes were rated as more engaging than text, and there were no differences between formats in treatment decisions, feeling informed or trust. CONCLUSIONS the brief table format of the fact box improved the comprehension of harms and benefits relative to the text-only control. Effective communication supports informed consent and decision-making and brings ethical and practical advantages. Fact boxes and other summary formats may be effective in a wide range of communication contexts.
Collapse
Affiliation(s)
- Cameron Brick
- Winton Centre for Risk and Evidence Communication, Centre for Mathematical Sciences, University of Cambridge, Wilberforce Road, Cambridge, CB3 0WA, UK
- Department of Psychology, University of Amsterdam, 1012 WX Amsterdam, The Netherlands
| | - Michelle McDowell
- Harding Center for Risk Literacy, University of Potsdam, 14469 Potsdam, Germany
- Max Planck Institute for Human Development, 14195 Berlin, Germany
| | - Alexandra L. J. Freeman
- Winton Centre for Risk and Evidence Communication, Centre for Mathematical Sciences, University of Cambridge, Wilberforce Road, Cambridge, CB3 0WA, UK
| |
Collapse
|
26
|
Okan Y, Smith SG, Bruine de Bruin W. How is cervical cancer screening information communicated in UK websites? Cross-sectional analysis of content and quantitative presentation formats. BMJ Open 2019; 9:e029551. [PMID: 31662361 PMCID: PMC6830680 DOI: 10.1136/bmjopen-2019-029551] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 09/03/2019] [Accepted: 09/13/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To investigate whether UK websites about cervical cancer screening targeted to the public include (1) information about benefits and risks of screening, possible screening results and cervical cancer statistics, (2) quantitative presentation formats recommended in the risk communication literature and (3) appeals for participation and/or informed decision-making. DESIGN Cross-sectional analysis of websites using a comprehensive checklist of information items on screening benefits, risks, possible results and cervical cancer statistics. OUTCOME MEASURES We recorded the number of websites that contained each of the information items, and the presentation format used for probabilistic information (no quantification provided, verbal quantifiers only, different types of numerical formats and/or graphs). We also recorded the number of websites containing appeals for participation and/or informed decision-making. SETTING Websites were identified through the most common Google search terms used in the UK to find information on cervical screening, according to GoogleTrends and a commercial internet-monitoring programme. Two additional websites were identified by the authors as relevant. RESULTS After applying exclusion criteria, 14 websites were evaluated, including websites of public and private health service providers, charities, a medical society and a pharmacy. The websites mentioned different benefits, risks of screening and possible results. However, specific content varied between websites. Probabilistic information was often presented using non-recommended formats, including relative risk reductions to express screening benefits, and verbal quantifiers without numbers to express risks. Appeals for participation were present in most websites, with almost half also mentioning informed decision-making. CONCLUSIONS UK websites about cervical cancer screening were generally balanced. However, benefits and risks were presented using different formats, potentially hindering comparisons. Additionally, recommendations from the literature to facilitate understanding of quantitative information and facilitate informed decisions were often not followed. Designing websites that adhere to existing recommendations may support informed screening uptake.
Collapse
Affiliation(s)
- Yasmina Okan
- Centre for Decision Research, Leeds University Business School, University of Leeds, Leeds, UK
| | - Samuel G Smith
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Wändi Bruine de Bruin
- Centre for Decision Research, Leeds University Business School, University of Leeds, Leeds, UK
- Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
27
|
Benefits and harms of selective oestrogen receptor modulators (SERMs) to reduce breast cancer risk: a cross-sectional study of methods to communicate risk in primary care. Br J Gen Pract 2019; 69:e836-e842. [PMID: 31636127 DOI: 10.3399/bjgp19x706841] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 08/19/2019] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND In Australia, evidence-based guidelines recommend that women consider taking selective oestrogen receptor modulators (SERMs) to reduce their risk of breast cancer. In practice, this requires effective methods for communicating the harms and benefits of taking SERMs so women can make an informed choice. AIM To evaluate how different risk presentations influence women's decisions to consider taking SERMs. DESIGN AND SETTING Cross-sectional, correlational study of Australian women in general practice. METHOD Three risk communication formats were developed that included graphics, numbers, and text to explain the reduction in breast cancer risk and risk of side effects for women taking SERMs (raloxifene or tamoxifen). Women aged 40-74 years in two general practices were shown the risk formats using vignettes of hypothetical women at moderate or high risk of breast cancer and asked to choose 'If this was you, would you consider taking a SERM?' Descriptive statistics and predictors (risk format, level of risk, and type of SERM) of choosing SERMs were determined by logistic regression. RESULTS A total of 288 women were recruited (an 88% response rate) between March and May 2017. The risk formats that showed a government statement and an icon array were associated with a greater likelihood of considering SERMs relative to one that showed a novel expected frequency tree. Risk formats for raloxifene and for the high-risk vignettes were also more strongly associated with choosing to consider SERMs. No associations were found with any patient demographics. CONCLUSION Specific risk formats may lead to more women considering taking SERMs to reduce breast cancer risk, especially if they are at high risk of the condition. Raloxifene may be a more acceptable SERM to patients.
Collapse
|
28
|
Sullivan HW, O'Donoghue AC, Lynch M, Johnson M, Davis C, Rupert DJ. The Effect of Including Quantitative Information on Multiple Endpoints in Direct-to-Consumer Prescription Drug Television Advertisements. Med Decis Making 2019; 39:975-985. [PMID: 31583947 DOI: 10.1177/0272989x19875946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Previous research found that adding a single piece of quantitative information about prescription drug benefits to direct-to-consumer (DTC) ads helps consumers understand how well the drug works. However, drug information often includes quantitative information on multiple benefit outcomes and risks. Thus, we examined whether consumer understanding was similarly improved when DTC television ads include varying amounts of quantitative information. Methods. We randomly assigned participants (945 Internet panelists ≥ 60 years old) to view 1 of 9 fictitious prescription drug television ads that varied the presentation of quantitative information for benefits (none, single outcome, 2 outcomes) and risks (none, 1 risk category, 3 risk categories) and then measured gist and verbatim recall/estimation and drug perceptions. Results. Adding a single benefit outcome and a single risk category replicated past results. Compared with an ad containing no quantitative information, presenting 2 benefit outcomes and multiple risk categories increased gist and verbatim recall and affected drug perceptions. Compared with presenting a single benefit outcome, presenting 2 benefit outcomes increased verbatim recall for the second outcome but decreased verbatim recall for the first outcome. Likewise, compared with presenting a single risk category, presenting multiple risk categories increased gist and verbatim recall for the multiple risk categories but decreased gist recall for a concept more closely associated with the single risk category. Adding multiple risk categories decreased risk perceptions even more than did the single risk category. Limitations. This study may have limited generalizability because it examined an ad for only 1 medical condition. Conclusions. There are tradeoffs to adding multiple quantitative benefit outcomes in DTC ads. However, presenting multiple quantitative risk categories helps consumers better understand a drug's risks.
Collapse
Affiliation(s)
| | | | - Molly Lynch
- RTI International, Research Triangle Park, NC, USA
| | | | | | | |
Collapse
|
29
|
Bodnar LM, Himes KP, Hutcheon JA. Optimal Gestational Weight Gain. JAMA 2019; 322:1106-1107. [PMID: 31529002 PMCID: PMC7257993 DOI: 10.1001/jama.2019.10946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Lisa M Bodnar
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Katherine P Himes
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jennifer A Hutcheon
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada
| |
Collapse
|
30
|
McDowell M, Gigerenzer G, Wegwarth O, Rebitschek FG. Effect of Tabular and Icon Fact Box Formats on Comprehension of Benefits and Harms of Prostate Cancer Screening: A Randomized Trial. Med Decis Making 2019; 39:41-56. [PMID: 30799691 DOI: 10.1177/0272989x18818166] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Fact boxes employ evidence-based guidelines on risk communication to present benefits and harms of health interventions in a balanced and transparent format. However, little is known about their short- and long-term efficacy and whether designing fact boxes to present multiple outcomes with icon arrays would increase their efficacy. METHOD In study 1, 120 men (30-75 y) completed a lab study. Participants were randomly assigned to 1 of 3 fact box formats on prostate cancer screening: a tabular fact box with numbers, a fact box with numbers and icon array, and a fact box with numbers, separate icon arrays, and text to describe each benefit and harm. Comprehension of information (while materials were present) and short-term knowledge recall were assessed. Study 2 recruited an online sample of 244 German men (40-75 y). Participants were randomly assigned to 1 of the 3 fact box formats or widely distributed health information, and knowledge was assessed at baseline, shortly after presentation, and at 6-mo follow-up, along with comprehension while materials were present. RESULTS In both studies, comprehension and knowledge-recall scores were similar when comparing tabular and icon fact boxes. In the 6-mo follow-up, this positive effect on knowledge recall disappeared. Fact boxes increased knowledge relative to baseline but did not affect decision intentions or perceptions of having complete information to make decisions. CONCLUSIONS This study shows that fact boxes with and without icon arrays are equally effective at improving comprehension and knowledge recall over the short-term and are simple formats that can improve on current health information. Specifically, if fact boxes are used at the time or immediately before a decision is made, they promote informed decisions about prostate cancer screening.
Collapse
Affiliation(s)
- Michelle McDowell
- Harding Center for Risk Literacy, Max Planck Institute for Human Development, Berlin, Germany
| | - Gerd Gigerenzer
- Harding Center for Risk Literacy, Max Planck Institute for Human Development, Berlin, Germany
| | - Odette Wegwarth
- Center for Adaptive Rationality, Max Planck Institute for Human Development, Berlin, Germany
| | - Felix G Rebitschek
- Harding Center for Risk Literacy, Max Planck Institute for Human Development, Berlin, Germany
| |
Collapse
|
31
|
Baccini M, Ghirardi L, Farinella D, Biggeri A. Comparison of two statistical indicators in communicating epidemiological results to the population: a randomized study in a high environmental risk area of Italy. BMC Public Health 2019; 19:733. [PMID: 31186020 PMCID: PMC6560769 DOI: 10.1186/s12889-019-7003-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 05/17/2019] [Indexed: 11/17/2022] Open
Abstract
Background When communicating risks to the general population, the format of the epidemiological results may affect individual reactions. In environmental epidemiology, no study has compared the use of different statistical formats in communicating results to the population. The aim of this paper is to investigate whether the degree of concern expressed by residents of a high environmental risk site, regarding epidemiological results on cancer mortality in the area where they live, is influenced by the statistical indicator used in communication. Methods A sample of residents in the high environmental risk area of Livorno (Italy) was randomized to respond to different questionnaires, in which the same epidemiological results were expressed by two alternative risk indexes: percent excess risk and time needed to harm, defined as the number of days that one has to wait for, on average, to observe 1 death in excess in respect to the baseline. Participants were asked to express their concern on a quantitative scale or to rank different diseases according to their impressions. The statistical analysis was performed using an Inverse Probability of Treatment Weighting approach based on propensity score, in order to account for sample stratification and adjust for unbalance between groups occurring despite randomization. Results The probability of high concern levels was larger under time needed to harm than under percent excess, with a difference between proportions of 6.7% (95% Confidence Interval, 0.6,12.8%). Mortality from sexual glands cancer was ranked as more worrisome and mortality from thyroid gland cancer as less worrisome under time needed to harm than under percent excess. No rank change was found for lung cancer. Larger differences between the two indicators arose in subjects with higher education or better numerical skills. Conclusions Communicating epidemiological results to the population is not a neutral task. The degree of concern and judgments when comparing results on different diseases may depend on the risk indicators used. Translating scientific results into lay language should not exempt from careful evaluation of the impact of this translation on lay people. Electronic supplementary material The online version of this article (10.1186/s12889-019-7003-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Michela Baccini
- Department of Statistics, Computer Science, Applications, University of Florence, Viale Morgagni 59, 50134, Florence, Italy. .,Biostatistics Unit, ISPO - Cancer Prevention and Research Institute, Via Cosimo Il Vecchio 2, 50139, Florence, Italy.
| | - Laura Ghirardi
- Department of Statistics, Computer Science, Applications, University of Florence, Viale Morgagni 59, 50134, Florence, Italy.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, SE-171 77, Stockholm, Sweden
| | - Domenica Farinella
- Department of Political Sciences and Law, University of Messina, Via T. Cannizzaro 278, 98122, Messina, Italy
| | - Annibale Biggeri
- Department of Statistics, Computer Science, Applications, University of Florence, Viale Morgagni 59, 50134, Florence, Italy.,Biostatistics Unit, ISPO - Cancer Prevention and Research Institute, Via Cosimo Il Vecchio 2, 50139, Florence, Italy
| |
Collapse
|
32
|
Diendéré G, Dansokho SC, Rocque R, Julien AS, Légaré F, Côté L, Mahmoudi S, Jacob P, Casais NA, Pilote L, Grad R, Giguère AMC, Witteman HO. How often do both core competencies of shared decision making occur in family medicine teaching clinics? CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2019; 65:e64-e75. [PMID: 30765371 PMCID: PMC6515489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To assess how often risk communication and values clarification occur in routine family medicine practice and to explore factors associated with their occurrence. DESIGN Qualitative and quantitative cross-sectional study. SETTING Five university-affiliated family medicine teaching clinics across Quebec. PARTICIPANTS Seventy-one health professionals (55% physicians, 35% residents, 10% nurses or dietitians) and 238 patients (76% women; age range 16 to 82 years old). MAIN OUTCOME MEASURES The presence or absence of risk communication and values clarification during visits in which decisions were made was determined. Factors associated with the primary outcome (both competencies together) were identified. The OPTION5 (observing patient involvement in decision making) instrument was used to validate the dichotomous outcome. RESULTS The presence of risk communication and values clarification during visits was associated with OPTION5 scores (area under the curve of 0.80, 95% CI 0.75 to 0.86, P < .001). Both core competencies of shared decision making occurred in 150 of 238 (63%) visits (95% CI 54% to 70%). Such an occurrence was more likely when the visit included discussion about beginning something new, treatment options, or postponing a decision, as well as when health professionals preferred a collaborative decision-making style and when the visit included more decisions or was longer. Alone, risk communication occurred in 203 of 238 (85%) visits (95% CI 82% to 96%) and values clarification in 162 of 238 (68%) visits (95% CI 61% to 75%). CONCLUSION Health professionals in family medicine are making an effort to engage patients in shared decision making in routine daily practice, especially when there is time to do so. The greatest potential for improvement might lie in values clarification; that is, discussing what matters to patients and families.
Collapse
Affiliation(s)
- Gisèle Diendéré
- Clinical research coordinator at the Jewish General Hospital in Montreal, Que
| | - Selma Chipenda Dansokho
- Research associate in the Research Unit of the Office of Education and Professional Development at Laval University in Quebec city, Que
| | - Rhéa Rocque
- Doctoral student in psychology at Laval University
| | - Anne-Sophie Julien
- Biostatistician in the Clinical Research Platform of the Research Centre of the CHU de Québec in Quebec city
| | - France Légaré
- Practising family physician and Full Professor in the Department of Family and Emergency Medicine at Laval University, Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Scientific Co-director of the Canadian Cochrane Network Site at Laval University, and a researcher at the Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL)
| | - Luc Côté
- Professor in the Department of Family and Emergency Medicine and a researcher in the Office of Education and Professional Development in the Faculty of Medicine at Laval University
| | - Sonia Mahmoudi
- Medical student in the Faculty of Medicine at Laval University
| | | | - Natalia Arias Casais
- Consultant with the Pan American Health Organization and the World Health Organization in Washington, DC
| | - Laurie Pilote
- Oncologist in the Division of Radiation Oncology in the Department of Medicine at the CHU de Québec-Laval University
| | - Roland Grad
- Family physician in the Herzl Family Practice Centre in Montreal, and Associate Professor in the Department of Family Medicine and Director of the Clinician Scholar Program in the Department of Family Medicine at McGill University in Montreal
| | - Anik M C Giguère
- Associate Professor in the Department of Family and Emergency Medicine and a researcher in the Office of Education and Professional Development at Laval University, the Centre d'excellence sur le vieillissement de Québec at the Research Centre of the CHU de Québec, and the CERSSPL-UL
| | - Holly O Witteman
- Associate Professor in the Department of Family and Emergency Medicine and a researcher in the Office of Education and Professional Development at Laval University, Population Health and Optimal Health Practices at the Research Centre of the CHU de Québec, the Ottawa Hospital Research Institute in Ontario, and the CERSSPL-UL.
| |
Collapse
|
33
|
Gidlow CJ, Ellis NJ, Cowap L, Riley V, Crone D, Cottrell E, Grogan S, Chambers R, Clark-Carter D. A qualitative study of cardiovascular disease risk communication in NHS Health Check using different risk calculators: protocol for the RIsk COmmunication in NHS Health Check (RICO) study. BMC FAMILY PRACTICE 2019; 20:11. [PMID: 30642267 PMCID: PMC6332912 DOI: 10.1186/s12875-018-0897-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 12/26/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND NHS Health Check is a national cardiovascular disease (CVD) risk assessment programme for 40-74 year olds in England, in which practitioners should assess and communicate CVD risk, supported by appropriate risk-management advice and goal-setting. This requires effective communication, to equip patients with knowledge and intention to act. Currently, the QRISK®2 10-year CVD risk score is most common way in which CVD risk is estimated. Newer tools, such as JBS3, allow manipulation of risk factors and can demonstrate the impact of positive actions. However, the use, and relative value, of these tools within CVD risk communication is unknown. We will explore practitioner and patient CVD risk perceptions when using QRISK®2 or JBS3, the associated advice or treatment offered by the practitioner, and patients' responses. METHODS RIsk COmmunication in NHS Health Check (RICO) is a qualitative study with quantitative process evaluation. Twelve general practices in the West Midlands of England will be randomised to one of two groups: usual practice, in which practitioners use QRISK®2 to assess and communicate CVD risk; intervention, in which practitioners use JBS3. Twenty Health Checks per practice will be video-recorded (n = 240, 120 per group), with patients stratified by age, gender and ethnicity. Post-Health Check, video-stimulated recall (VSR) interviews will be conducted with 48 patients (n = 24 per group) and all practitioners (n = 12-18), using video excerpts to enhance participant recall/reflection. Patient medical record reviews will detect health-protective actions in the first 12-weeks following a Health Check (e.g., lifestyle referrals, statin prescription). Risk communication, patient response and intentions for health-protective behaviours in each group will be explored through thematic analysis of video-recorded Health Checks (using Protection Motivation Theory as a framework) and VSR interviews. Process evaluation will include between-group comparisons of quantitatively coded Health Check content and post-Health Check patient outcomes. Finally, 10 patients with the most positive intentions or behaviours will be selected for case study analysis (using all data sources). DISCUSSION This study will produce novel insights about the utility of QRISK®2 and JBS3 to promote patient and practitioner understanding and perception of CVD risk and associated implications for patient intentions with respect to health-protective behaviours (and underlying mechanisms). Recommendations for practice will be developed. TRIAL REGISTRATION ISRCTN ISRCTN10443908 . Registered 7th February 2017.
Collapse
Affiliation(s)
| | - Naomi J. Ellis
- Staffordshire University, Brindley Building, Leek Road, Stoke-on-Trent, ST4 2DF UK
| | - Lisa Cowap
- Staffordshire University, Brindley Building, Leek Road, Stoke-on-Trent, ST4 2DF UK
| | - Victoria Riley
- Staffordshire University, Brindley Building, Leek Road, Stoke-on-Trent, ST4 2DF UK
| | - Diane Crone
- Cardiff Metropolitan University, Cyncoed Campus, Cyncoed Road, Cardiff, CF23 6XD UK
| | | | - Sarah Grogan
- Manchester Metropolitan University, Manchester Campus, Bonsall Street, Manchester, M15 6GX UK
| | - Ruth Chambers
- Stoke-on-Trent Clinical Commissioning Group, Smithfield One Building, Stoke-on-Trent, ST1 4FA UK
| | - David Clark-Carter
- Staffordshire University, The Science Centre, Leek Road, Stoke-on-Trent, ST4 2DF UK
| |
Collapse
|
34
|
Miller YD, Holdaway W. How communication about risk and role affects women's decisions about birth after caesarean. PATIENT EDUCATION AND COUNSELING 2019; 102:68-76. [PMID: 30213641 DOI: 10.1016/j.pec.2017.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 09/05/2017] [Accepted: 09/26/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVE This study investigated how health care provider communication of risk information, and women's role in decision-making, influenced women's preferences for mode of birth after a previous caesarean birth. METHODS Women (N = 669) were randomised to one of eight conditions in a 2 (selectivity of risk information) × 2 (format of risk information) × 2 (role in decision making) experimental design. After exposure to a hypothetical decision scenario that varied information communicated by an obstetrician to a pregnant woman with a previous caesarean birth across the three factors, women were asked to decide their preferred hypothetical childbirth preference. RESULTS Women provided with selective information (incomplete/biased toward repeat caesarean) and relative risk formats (ratio of incidence being compared e.g. 2.5 times higher), perceived lower risk for caesarean and were significantly more likely to prefer repeat caesarean birth than those provided with non-selective information (complete/unbiased) and absolute risk formats (incidence rate e.g. 0.01 per 100). Role in decision-making did not significantly influence childbirth preferences CONCLUSIONS: Modifiable aspects of healthcare provider communication may influence women's decision-making about childbirth preferences PRACTICE IMPLICATIONS: Optimised communication about risks of all options may have an impact on over-use of repeat CS.
Collapse
Affiliation(s)
- Yvette D Miller
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Victoria Park Road, Kelvin Grove, 4059, Queensland, Australia.
| | - Wendy Holdaway
- School of Psychology and Counselling, Queensland University of Technology, Queensland, Australia.
| |
Collapse
|
35
|
Are we truly irrational and almost impossible to educate? Analyzing the scientific evidence behind libertine paternalism. ACTA PSYCHOLOGICA SINICA 2019. [DOI: 10.3724/sp.j.1041.2019.00395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
36
|
Petrova D, Joeris A, Sánchez MJ, Salamanca-Fernández E, Garcia-Retamero R. How are risk ratios reported in orthopaedic surgery journals? A descriptive study of formats used to report absolute risks. BMJ Open 2018; 8:e025047. [PMID: 30478128 PMCID: PMC6254491 DOI: 10.1136/bmjopen-2018-025047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/18/2018] [Accepted: 10/19/2018] [Indexed: 12/03/2022] Open
Abstract
PURPOSE The numerical format in which risks are communicated can affect risk comprehension and perceptions of medical professionals. We investigated what numerical formats are used to report absolute risks in empirical articles, estimated the frequency of biasing formats and rated the quality of figures used to display the risks. DESIGN Descriptive study of reporting practices. METHOD We randomly sampled articles published in seven leading orthopaedic surgery journals during a period of 13 years. From these, we selected articles that reported group comparisons on a binary outcome (eg, revision rates in two groups) and recorded the numerical format used to communicate the absolute risks in the results section. The quality of figures was assessed according to published guidelines for transparent visual aids design. OUTCOME MEASURES Prevalence of information formats and quality of figures. RESULTS The final sample consisted of 507 articles, of which 14% reported level 1 evidence, 13% level 2 and 73% level 3 or lower. The majority of articles compared groups of different sizes (90%), reported both raw numbers and percentages (64%) and did not report the group sizes alongside (50%). Fifteen per cent of articles used two formats identified as biasing: only raw numbers (8%, '90 patients vs 100 patients') or raw numbers reported alongside different group sizes (7%, '90 out of 340 patients vs 100 out of 490 patients'). The prevalence of these formats decreased in more recent publications. Figures (n=79) had on average two faults that could distort comprehension, and the majority were rated as biasing. CONCLUSION Authors use a variety of formats to report absolute risks in scientific articles and are likely not aware of how some formats and graph design features can distort comprehension. Biases can be reduced if journals adopt guidelines for transparent risk communication but more research is needed into the effects of different formats.
Collapse
Affiliation(s)
- Dafina Petrova
- Escuela Andaluza de Salud Pública, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Universidad de Granada, Granada, Spain
| | - Alexander Joeris
- AO Clinical Investigation and Documentation, Duebendorf, Switzerland
| | - María-José Sánchez
- Escuela Andaluza de Salud Pública, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Universidad de Granada, Granada, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Elena Salamanca-Fernández
- Escuela Andaluza de Salud Pública, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Universidad de Granada, Granada, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Rocio Garcia-Retamero
- Mind, Brain, and Behavior Reseach Center (CIMCYC), Department of Experimental Psychology, University of Granada, Granada, Spain
- Harding Center for Risk Literacy, Max Planck Institute for Human Development, Berlin, Germany
| |
Collapse
|
37
|
Berglund E, Westerling R, Sundström J, Lytsy P. Length of time periods in treatment effect descriptions and willingness to initiate preventive therapy: a randomised survey experiment. BMC Med Inform Decis Mak 2018; 18:106. [PMID: 30458757 PMCID: PMC6247706 DOI: 10.1186/s12911-018-0662-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 09/27/2018] [Indexed: 12/01/2022] Open
Abstract
Background Common measures used to describe preventive treatment effects today are proportional, i.e. they compare the proportions of events in relative or absolute terms, however they are not easily interpreted from the patient’s perspective and different magnitudes do not seem to clearly discriminate between levels of effect presented to people. Methods In this randomised cross-sectional survey experiment, performed in a Swedish population-based sample (n = 1041, response rate 58.6%), the respondents, aged between 40 and 75 years were given information on a hypothetical preventive cardiovascular treatment. Respondents were randomised into groups in which the treatment was described as having the effect of delaying a heart attack for different periods of time (Delay of Event, DoE): 1 month, 6 months or 18 months. Respondents were thereafter asked about their willingness to initiate such therapy, as well as questions about how they valued the proposed therapy. Results Longer DoE:s were associated with comparatively greater willingness to initiate treatment. The proportions accepting treatment were 81, 71 and 46% when postponement was 18 months, 6 months and 1 month respectively. In adjusted binary logistic regression models the odds ratio for being willing to take therapy was 4.45 (95% CI 2.72–7.30) for a DoE of 6 months, and 6.08 (95% CI 3.61–10.23) for a DoE of 18 months compared with a DoE of 1 month. Greater belief in the necessity of medical treatment increased the odds of being willing to initiate therapy. Conclusions Lay people’s willingness to initiate preventive therapy was sensitive to the magnitude of the effect presented as DoE. The results indicate that DoE is a comprehensible effect measure, of potential value in shared clinical decision-making.
Collapse
Affiliation(s)
- Erik Berglund
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, SE-751 22, UPPSALA, Sweden.
| | - Ragnar Westerling
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, SE-751 22, UPPSALA, Sweden
| | - Johan Sundström
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Per Lytsy
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, SE-751 22, UPPSALA, Sweden
| |
Collapse
|
38
|
Oxman AD, Chalmers I, Austvoll-Dahlgren A. Key Concepts for assessing claims about treatment effects and making well-informed treatment choices. F1000Res 2018; 7:1784. [PMID: 30631443 PMCID: PMC6290969 DOI: 10.12688/f1000research.16771.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2018] [Indexed: 11/20/2022] Open
Abstract
Background: The Informed Health Choices (IHC) Key Concepts are standards for judgement, or principles for evaluating the trustworthiness of treatment claims and treatment comparisons (evidence) used to support claims, and for making treatment choices. The list of concepts provides a framework, or starting point, for teachers, journalists and other intermediaries for identifying and developing resources (such as longer explanations, examples, games and interactive applications) to help people to understand and apply the concepts. The first version of the list was published in 2015 and has been updated yearly since then. We report here the changes that have been made from when the list was first published up to the current (2018) version. Methods: We developed the IHC Key Concepts by searching the literature and checklists written for the public, journalists, and health professionals; and by considering concepts related to assessing the certainty of evidence about the effects of treatments. We have revised the Key Concepts yearly, based on feedback and suggestions; and learning from using the IHC Key Concepts, other relevant frameworks, and adaptation of the IHC Key Concepts to other types of interventions besides treatments. Results: We have made many changes since the Key Concepts were first published in 2015. There are now 44 Key Concepts compared to the original 32; the concepts have been reorganised from six to three groups; we have added higher-level concepts in each of those groups; we have added short titles; and we have made changes to many of the concepts. Conclusions: We will continue to revise the IHC Key Concepts in response to feedback. Although we and others have found them helpful since they were first published, we anticipate that there are still ways in which they can be further improved. We welcome suggestions for how to do this.
Collapse
Affiliation(s)
- Andrew David Oxman
- Centre for Informed Health Choices, Norwegian Institute of Public Health, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Iain Chalmers
- Centre for Informed Health Choices, Norwegian Institute of Public Health, Oslo, Norway
- James Lind Initiative, Oxford, UK
| | - Astrid Austvoll-Dahlgren
- Centre for Informed Health Choices, Norwegian Institute of Public Health, Oslo, Norway
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Informed Health Choices group
- Centre for Informed Health Choices, Norwegian Institute of Public Health, Oslo, Norway
- University of Oslo, Oslo, Norway
- James Lind Initiative, Oxford, UK
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| |
Collapse
|
39
|
Oxman AD, Chalmers I, Austvoll-Dahlgren A. Key Concepts for assessing claims about treatment effects and making well-informed treatment choices. F1000Res 2018; 7:1784. [PMID: 30631443 DOI: 10.5281/zenodo.661193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2019] [Indexed: 05/25/2023] Open
Abstract
Background: The Informed Health Choices (IHC) Key Concepts are standards for judgement, or principles for evaluating the trustworthiness of treatment claims and treatment comparisons (evidence) used to support claims, and for making treatment choices. The list of concepts provides a framework, or starting point, for teachers, journalists and other intermediaries for identifying and developing resources (such as longer explanations, examples, games and interactive applications) to help people to understand and apply the concepts. The first version of the list was published in 2015 and has been updated yearly since then. We report here the changes that have been made from when the list was first published up to the current (2018) version. Methods: We developed the IHC Key Concepts by searching the literature and checklists written for the public, journalists, and health professionals; and by considering concepts related to assessing the certainty of evidence about the effects of treatments. We have revised the Key Concepts yearly, based on feedback and suggestions; and learning from using the IHC Key Concepts, other relevant frameworks, and adaptation of the IHC Key Concepts to other types of interventions besides treatments. Results: We have made many changes since the Key Concepts were first published in 2015. There are now 44 Key Concepts compared to the original 32; the concepts have been reorganised from six to three groups; we have added higher-level concepts in each of those groups; we have added short titles; and we have made changes to many of the concepts. Conclusions: The IHC Key Concepts have proven useful in designing learning resources, evaluating them, and organising them. We will continue to revise the IHC Key Concepts in response to feedback. We welcome suggestions for how to do this.
Collapse
Affiliation(s)
- Andrew David Oxman
- Centre for Informed Health Choices, Norwegian Institute of Public Health, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Iain Chalmers
- Centre for Informed Health Choices, Norwegian Institute of Public Health, Oslo, Norway
- James Lind Initiative, Oxford, UK
| | - Astrid Austvoll-Dahlgren
- Centre for Informed Health Choices, Norwegian Institute of Public Health, Oslo, Norway
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| |
Collapse
|
40
|
Oxman AD, Chalmers I, Austvoll-Dahlgren A. Key Concepts for assessing claims about treatment effects and making well-informed treatment choices. F1000Res 2018; 7:1784. [PMID: 30631443 PMCID: PMC6290969 DOI: 10.12688/f1000research.16771.2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2019] [Indexed: 01/25/2023] Open
Abstract
Background: The Informed Health Choices (IHC) Key Concepts are standards for judgement, or principles for evaluating the trustworthiness of treatment claims and treatment comparisons (evidence) used to support claims, and for making treatment choices. The list of concepts provides a framework, or starting point, for teachers, journalists and other intermediaries for identifying and developing resources (such as longer explanations, examples, games and interactive applications) to help people to understand and apply the concepts. The first version of the list was published in 2015 and has been updated yearly since then. We report here the changes that have been made from when the list was first published up to the current (2018) version. Methods: We developed the IHC Key Concepts by searching the literature and checklists written for the public, journalists, and health professionals; and by considering concepts related to assessing the certainty of evidence about the effects of treatments. We have revised the Key Concepts yearly, based on feedback and suggestions; and learning from using the IHC Key Concepts, other relevant frameworks, and adaptation of the IHC Key Concepts to other types of interventions besides treatments. Results: We have made many changes since the Key Concepts were first published in 2015. There are now 44 Key Concepts compared to the original 32; the concepts have been reorganised from six to three groups; we have added higher-level concepts in each of those groups; we have added short titles; and we have made changes to many of the concepts. Conclusions: The IHC Key Concepts have proven useful in designing learning resources, evaluating them, and organising them. We will continue to revise the IHC Key Concepts in response to feedback. We welcome suggestions for how to do this.
Collapse
Affiliation(s)
- Andrew David Oxman
- Centre for Informed Health Choices, Norwegian Institute of Public Health, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Iain Chalmers
- Centre for Informed Health Choices, Norwegian Institute of Public Health, Oslo, Norway
- James Lind Initiative, Oxford, UK
| | - Astrid Austvoll-Dahlgren
- Centre for Informed Health Choices, Norwegian Institute of Public Health, Oslo, Norway
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Informed Health Choices group
- Centre for Informed Health Choices, Norwegian Institute of Public Health, Oslo, Norway
- University of Oslo, Oslo, Norway
- James Lind Initiative, Oxford, UK
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| |
Collapse
|
41
|
Forcino RC, Yen RW, Aboumrad M, Barr PJ, Schubbe D, Elwyn G, Durand MA. US-based cross-sectional survey of clinicians' knowledge and attitudes about shared decision-making across healthcare professions and specialties. BMJ Open 2018; 8:e022730. [PMID: 30341128 PMCID: PMC6196864 DOI: 10.1136/bmjopen-2018-022730] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE In this study, we aim to compare shared decision-making (SDM) knowledge and attitudes between US-based physician assistants (PAs), nurse practitioners (NPs) and physicians across surgical and family medicine specialties. SETTING We administered a cross-sectional, web-based survey between 20 September 2017 and 1 November 2017. PARTICIPANTS 272 US-based NPs, PA and physicians completed the survey. 250 physicians were sent a generic email invitation to participate, of whom 100 completed the survey. 3300 NPs and PAs were invited, among whom 172 completed the survey. Individuals who met the following exclusion criteria were excluded from participation: (1) lack of English proficiency; (2) area of practice other than family medicine or surgery; (3) licensure other than physician, PA or NP; (4) practicing in a country other than the US. RESULTS We found few substantial differences in SDM knowledge and attitudes across clinician types, revealing positive attitudes across the sample paired with low to moderate knowledge. Family medicine professionals (PAs) were most knowledgeable on several items. Very few respondents (3%; 95% CI 1.5% to 6.2%) favoured a paternalistic approach to decision-making. CONCLUSIONS Recent policy-level promotion of SDM may have influenced positive clinician attitudes towards SDM. Positive attitudes despite limited knowledge warrant SDM training across occupations and specialties, while encouraging all clinicians to promote SDM. Given positive attitudes and similar knowledge across clinician types, we recommend that SDM is not confined to the patient-physician dyad but instead advocated among other health professionals.
Collapse
Affiliation(s)
- Rachel C Forcino
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Renata West Yen
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Maya Aboumrad
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
- White River Junction VA Medical Center, White River Junction, Vermont, USA
| | - Paul J Barr
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Danielle Schubbe
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| | - Marie-Anne Durand
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, New Hampshire, USA
| |
Collapse
|
42
|
Carey M, Herrmann A, Hall A, Mansfield E, Fakes K. Exploring health literacy and preferences for risk communication among medical oncology patients. PLoS One 2018; 13:e0203988. [PMID: 30226878 PMCID: PMC6143261 DOI: 10.1371/journal.pone.0203988] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 09/02/2018] [Indexed: 11/27/2022] Open
Abstract
Objective To explore adult medical oncology outpatients’ understanding of and preferences for the format of health risk information. Methods Two surveys, one assessing sociodemographic characteristics and a second survey examining perceptions of risk information. Results Of the 361 (74%) consenting patients, 210 completed at least one question on risk communication. 17% to 65% of patients understood numeric risk information, depending on the format of the information. More than 50% of people interpreted a “very good” chance of remission as greater than 80%, greater than 90% or 100%. The most preferred format of information was in both words and numbers (38% to 43%) followed by words alone (28% to 30%). Conclusion Numeric risk information is understood by 17% to 65% of respondents, depending on the format. Interpretation of verbal risk information is highly variable, posing a risk of misunderstanding. Provision of information in both words and numbers may assist in aiding comprehension.
Collapse
Affiliation(s)
- Mariko Carey
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- * E-mail:
| | - Anne Herrmann
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Alix Hall
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Elise Mansfield
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Kristy Fakes
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| |
Collapse
|
43
|
Austvoll‐Dahlgren A, Johansen M. "A waste of time without patients": The views of patient representatives attending a workshop in evidence-based practice. J Evid Based Med 2018; 11:191-199. [PMID: 29938926 PMCID: PMC6175114 DOI: 10.1111/jebm.12303] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 01/23/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Shared decision-making is a central element of evidence-based practice (EBP). Training in EBP has traditionally focused on providers, but there is an increasing interest in developing such educational resources for patients. The aim of this study is to explore the views of patient representatives attending a workshop in EBP. METHODS We conducted three focus groups with participants attending EBP workshops in 2013, 2014, and 2015. We used the framework method for content analysis. We reviewed the transcribed interviews independently and assigned initial codes and final categories to the transcriptions. We created an analytical framework and a flow diagram to visualize the category hierarchy and the relationship between categories. RESULTS We identified two main themes; "How to facilitate training in evidence-based practice for patients," and "Outputs of training in evidence based practice for patients." Training in EBP for patient representatives "should reflect the principles EBP," and include interaction with both health professionals and other representatives. The educational needs of representatives are much the same as those of health professionals, and the training should therefore be "on a par with professionals." The relevance of such training may depend on the representatives' mandate, and costs might be an important barrier. Important outputs of such training include "becoming a knowledge manager," "enabling participation and informed decisions" and "re-defining the patient representatives' role." CONCLUSIONS The findings of this study suggest that training in EBP is attractive to patient representatives with outputs perceived important. Organizers should consider the principles of EBP when planning such training.
Collapse
|
44
|
Damhus CS, Byskov Petersen G, Ploug T, Brodersen J. Informed or misinformed choice? Framing effects in a national information pamphlet on colorectal cancer screening. HEALTH RISK & SOCIETY 2018. [DOI: 10.1080/13698575.2018.1499877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | | | - Thomas Ploug
- Centre for Applied Ethics and Philosophy of Science, Department of Communication, Aalborg University Copenhagen, Denmark
| | - John Brodersen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
- The Primary Health Care Research Unit, Zealand Region, Denmark
| |
Collapse
|
45
|
Abstract
Supplemental Digital Content is available in the text. A small number of studies have investigated breast cancer (BC) risk among women with a history of false-positive recall (FPR) in BC screening, but none of them has used time-to-event analysis while at the same time quantifying the effect of false-negative diagnostic assessment (FNDA). FNDA occurs when screening detects BC, but this BC is missed on diagnostic assessment (DA). As a result of FNDA, screenings that detected cancer are incorrectly classified as FPR. Our study linked data recorded in the Flemish BC screening program (women aged 50–69 years) to data from the national cancer registry. We used Cox proportional hazards models on a retrospective cohort of 298 738 women to assess the association between FPR and subsequent BC, while adjusting for potential confounders. The mean follow-up was 6.9 years. Compared with women without recall, women with a history of FPR were at an increased risk of developing BC [hazard ratio=2.10 (95% confidence interval: 1.92–2.31)]. However, 22% of BC after FPR was due to FNDA. The hazard ratio dropped to 1.69 (95% confidence interval: 1.52–1.87) when FNDA was excluded. Women with FPR have a subsequently increased BC risk compared with women without recall. The risk is higher for women who have a FPR BI-RADS 4 or 5 compared with FPR BI-RADS 3. There is room for improvement of diagnostic assessment: 41% of the excess risk is explained by FNDA after baseline screening.
Collapse
|
46
|
Yepes-Nuñez JJ, Morgan RL, Mbuagbaw L, Carrasco-Labra A, Chang S, Hempel S, Shekelle P, Helfand M, Baldeh T, Schünemann HJ. Two alternatives versus the standard Grading of Recommendations Assessment, Development and Evaluation (GRADE) summary of findings (SoF) tables to improve understanding in the presentation of systematic review results: a three-arm, randomised, controlled, non-inferiority trial. BMJ Open 2018; 8:e015623. [PMID: 29362242 PMCID: PMC5786134 DOI: 10.1136/bmjopen-2016-015623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 11/13/2017] [Accepted: 11/28/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Summary of findings (SoF) tables present results of systematic reviews in a concise and explicit format. Adopted by many review groups including the Cochrane Collaboration and the Agency for Healthcare Research and Quality (AHRQ), optimal understanding of SoF table may be influenced by the type of information being conveyed and objectives or preferences of the end user. This study aims to compare three SoF table formats in terms of understanding, accessibility, satisfaction and preference with systematic review users. METHODS The primary objective of this three-arm randomised controlled non-inferiority trial is to investigate whether an alternative Grading of Recommendations Assessment, Development and Evaluation (GRADE) SoF table or Evidence-based Practice Center SoF table is non-inferior to the current GRADE SoF table in the understanding of the information presented to systematic review users, particularly for descriptive findings. Researchers, clinical practice guideline developers, policy-makers or knowledge transfer professionals will be recruited. Data will be collected electronically at baseline and after randomisation. Non-inferiority would be declared if the difference in the proportion of participants who understand the information displayed in the alternative SoF table is 10% or less. ETHICS AND DISSEMINATION The Hamilton Integrated Research Ethics Board reviewed this protocol. The findings from this study will be disseminated through a publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT02813941.
Collapse
Affiliation(s)
- Juan José Yepes-Nuñez
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
- School of Medicine, University of Antioquia, Medellín, Colombia
| | - Rebecca L Morgan
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Alonso Carrasco-Labra
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Stephanie Chang
- Agency for Healthcare Research and Quality, Rockville, Maryland, USA
| | - Susanne Hempel
- Southern California Evidence-based Practice Center, RAND Corporation, Santa Monica, California, USA
| | - Paul Shekelle
- Southern California Evidence-based Practice Center, RAND Corporation, Santa Monica, California, USA
| | - Mark Helfand
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Tejan Baldeh
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
47
|
ASADA YUKIKO, ABEL HANNAH, SKEDGEL CHRIS, WARNER GRACE. On Effective Graphic Communication of Health Inequality: Considerations for Health Policy Researchers. Milbank Q 2017; 95:801-835. [PMID: 29226437 PMCID: PMC5723719 DOI: 10.1111/1468-0009.12300] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Policy Points: Effective graphs can be a powerful tool in communicating health inequality. The choice of graphs is often based on preferences and familiarity rather than science. According to the literature on graph perception, effective graphs allow human brains to decode visual cues easily. Dot charts are easier to decode than bar charts, and thus they are more effective. Dot charts are a flexible and versatile way to display information about health inequality. Consistent with the health risk communication literature, the captions accompanying health inequality graphs should provide a numerical, explicitly calculated description of health inequality, expressed in absolute and relative terms, from carefully thought-out perspectives. CONTEXT Graphs are an essential tool for communicating health inequality, a key health policy concern. The choice of graphs is often driven by personal preferences and familiarity. Our article is aimed at health policy researchers developing health inequality graphs for policy and scientific audiences and seeks to (1) raise awareness of the effective use of graphs in communicating health inequality; (2) advocate for a particular type of graph (ie, dot charts) to depict health inequality; and (3) suggest key considerations for the captions accompanying health inequality graphs. METHODS Using composite review methods, we selected the prevailing recommendations for improving graphs in scientific reporting. To find the origins of these recommendations, we reviewed the literature on graph perception and then applied what we learned to the context of health inequality. In addition, drawing from the numeracy literature in health risk communication, we examined numeric and verbal formats to explain health inequality graphs. FINDINGS Many disciplines offer commonsense recommendations for visually presenting quantitative data. The literature on graph perception, which defines effective graphs as those allowing the easy decoding of visual cues in human brains, shows that with their more accurate and easier-to-decode visual cues, dot charts are more effective than bar charts. Dot charts can flexibly present a large amount of information in limited space. They also can easily accommodate typical health inequality information to describe a health variable (eg, life expectancy) by an inequality domain (eg, income) with domain groups (eg, poor and rich) in a population (eg, Canada) over time periods (eg, 2010 and 2017). The numeracy literature suggests that a health inequality graph's caption should provide a numerical, explicitly calculated description of health inequality expressed in absolute and relative terms, from carefully thought-out perspectives. CONCLUSIONS Given the ubiquity of graphs, the health inequality field should learn from the vibrant multidisciplinary literature how to construct effective graphic communications, especially by considering to use dot charts.
Collapse
|
48
|
Castle JC, Chalmers I, Atkinson P, Badenoch D, Oxman AD, Austvoll-Dahlgren A, Nordheim L, Krause LK, Schwartz LM, Woloshin S, Burls A, Mosconi P, Hoffmann T, Cusack L, Albarqouni L, Glasziou P. Establishing a library of resources to help people understand key concepts in assessing treatment claims-The "Critical thinking and Appraisal Resource Library" (CARL). PLoS One 2017; 12:e0178666. [PMID: 28738058 PMCID: PMC5524286 DOI: 10.1371/journal.pone.0178666] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 05/18/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND People are frequently confronted with untrustworthy claims about the effects of treatments. Uncritical acceptance of these claims can lead to poor, and sometimes dangerous, treatment decisions, and wasted time and money. Resources to help people learn to think critically about treatment claims are scarce, and they are widely scattered. Furthermore, very few learning-resources have been assessed to see if they improve knowledge and behavior. OBJECTIVES Our objectives were to develop the Critical thinking and Appraisal Resource Library (CARL). This library was to be in the form of a database containing learning resources for those who are responsible for encouraging critical thinking about treatment claims, and was to be made available online. We wished to include resources for groups we identified as 'intermediaries' of knowledge, i.e. teachers of schoolchildren, undergraduates and graduates, for example those teaching evidence-based medicine, or those communicating treatment claims to the public. In selecting resources, we wished to draw particular attention to those resources that had been formally evaluated, for example, by the creators of the resource or independent research groups. METHODS CARL was populated with learning-resources identified from a variety of sources-two previously developed but unmaintained inventories; systematic reviews of learning-interventions; online and database searches; and recommendations by members of the project group and its advisors. The learning-resources in CARL were organised by 'Key Concepts' needed to judge the trustworthiness of treatment claims, and were made available online by the James Lind Initiative in Testing Treatments interactive (TTi) English (www.testingtreatments.org/category/learning-resources).TTi English also incorporated the database of Key Concepts and the Claim Evaluation Tools developed through the Informed Healthcare Choices (IHC) project (informedhealthchoices.org). RESULTS We have created a database of resources called CARL, which currently contains over 500 open-access learning-resources in a variety of formats: text, audio, video, webpages, cartoons, and lesson materials. These are aimed primarily at 'Intermediaries', that is, 'teachers', 'communicators', 'advisors', 'researchers', as well as for independent 'learners'. The resources included in CARL are currently accessible at www.testingtreatments.org/category/learning-resources. CONCLUSIONS We hope that ready access to CARL will help to promote the critical thinking about treatment claims, needed to help improve healthcare choices.
Collapse
Affiliation(s)
| | | | | | | | - Andrew D. Oxman
- Global Health Unit, Institute of Public Health, Oslo, Norway
| | | | - Lena Nordheim
- Høgskulen på Vestlandet, Centre for Evidence-Based practice, Bergen, Norway
| | - L. Kendall Krause
- Global Development Program, Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
| | - Lisa M. Schwartz
- Medicine in the Media Program, The Dartmouth Institute, Hanover, New Hampshire, United States of America
| | - Steven Woloshin
- Medicine in the Media Program, The Dartmouth Institute, Hanover, New Hampshire, United States of America
| | - Amanda Burls
- School of Health Sciences, City University London, London, United Kingdom
| | - Paola Mosconi
- Laboratorio di ricerca sul coinvolgimento dei cittadini in sanità, Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy
| | - Tammy Hoffmann
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine Bond University, Queensland, Australia
| | - Leila Cusack
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine Bond University, Queensland, Australia
| | - Loai Albarqouni
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine Bond University, Queensland, Australia
| | - Paul Glasziou
- Centre for Research in Evidence-Based Practice, Faculty of Health Sciences and Medicine Bond University, Queensland, Australia
| |
Collapse
|
49
|
Abstract
BACKGROUND Rheumatoid arthritis is a systemic auto-immune disorder that causes widespread and persistent inflammation of the synovial lining of joints and tendon sheaths. Presently, there is no cure for rheumatoid arthritis and treatment focuses on managing symptoms such as pain, stiffness and mobility, with the aim of achieving stable remission and improving mobility. Celecoxib is a selective non-steroidal anti-inflammatory drug (NSAID) used for treatment of people with rheumatoid arthritis. OBJECTIVES To assess the benefits and harms of celecoxib in people with rheumatoid arthritis. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and clinical trials registers (ClinicalTrials.gov and the World Health Organization trials portal) to May 18, 2017. We also searched the reference and citation lists of included studies. SELECTION CRITERIA We included prospective randomized controlled trials (RCTs) that compared oral celecoxib (200 mg and 400 mg daily) versus no intervention, placebo or a traditional NSAID (tNSAID) in people with confirmed rheumatoid arthritis, of any age and either sex. We excluded studies with fewer than 50 participants in each arm or had durations of fewer than four weeks treatment. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by The Cochrane Collaboration. MAIN RESULTS We included eight RCTs with durations of 4 to 24 weeks, published between 1998 and 2014 that involved a total of 3988 adults (mean age = 54 years), most of whom were women (73%). Participants had rheumatoid arthritis for an average of 9.2 years. All studies were assessed at high or unclear risk of bias in at least one domain. Overall, evidence was assessed as moderate-to-low quality. Five studies were funded by pharmaceutical companies. Celecoxib versus placeboWe included two studies (N = 873) in which participants received 200 mg daily or 400 mg daily or placebo. Participants who received celecoxib showed significant clinical improvement compared with those receiving placebo (15% absolute improvement; 95% CI 7% to 25%; RR 1.53, 95% CI 1.25 to 1.86; number needed to treat to benefit (NNTB) = 7, 95% CI 5 to 13; 2 studies, 873 participants; moderate to low quality evidence).Participants who received celecoxib reported less pain than placebo-treated people (11% absolute improvement; 95% CI 8% to 14%; NNTB = 4, 95% CI 3 to 6; 1 study, 706 participants) but results were inconclusive for improvement in physical function (MD -0.10, 95% CI 0.29 to 0.10; 1 study, 706 participants).In the celecoxib group, 15/293 participants developed ulcers, compared with 4/99 in the placebo group (Peto OR 1.26, 95% CI 0.44 to 3.63; 1 study, 392 participants; low quality evidence). Nine (of 475) participants in the celecoxib group developed short-term serious adverse events, compared with five (of 231) in the placebo group (Peto OR 0.87 (0.28 to 2.69; 1 study, 706 participants; low quality evidence).There were fewer withdrawals among people who received celecoxib (163/475) compared with placebo (130/231) (22% absolute change; 95% CI 16% to 27%; RR 0.61, 95% CI 0.52 to 0.72; 1 study, 706 participants).Cardiovascular events (myocardial infarction, stroke) were not reported. However, regulatory agencies warn of increased cardiovascular event risk associated with celecoxib. Celecoxib versus tNSAIDsSeven studies (N = 2930) compared celecoxib and tNSAIDs (amtolmetin guacyl, diclofenac, ibuprofen, meloxicam, nabumetone, naproxen, pelubiprofen); one study included comparisons of both placebo and tNSAIDs (N = 1149).There was a small improvement, which may not be clinically significant, in numbers of participants achieving ACR20 criteria response in the celecoxib group compared to tNSAIDs (4% absolute improvement; 95% CI 0% less improvement to 8% more improvement; RR 1.10, 95% CI 0.99 to 1.23; 4 studies, 1981 participants). There was a lack of evidence of difference between participants in the celecoxib and tNSAID groups in terms of pain or physical function. Results were assessed at moderate-to-low quality evidence (downgraded due to risk of bias and inconsistency).People who received celecoxib had a lower incidence of gastroduodenal ulcers ≥ 3 mm (34/870) compared with those who received tNSAIDs (116/698). This corresponded to 12% absolute change (95% CI 11% to 13%; RR 0.22, 95% CI 0.15 to 0.32; 5 studies, 1568 participants; moderate quality evidence). There were 7% fewer withdrawals among people who received celecoxib (95% CI 4% to 9%; RR 0.73, 95% CI 0.62 to 0.86; 6 studies, 2639 participants).Results were inconclusive for short-term serious adverse events and cardiovascular events (low quality evidence). There were 17/918 serious adverse events in people taking celecoxib compared to 42/1236 among people who received placebo (Peto OR 0.71; 95% CI 0.39 to 1.28; 5 studies, 2154 participants). Cardiovascular events were reported in both celecoxib and placebo groups in one study (149 participants). AUTHORS' CONCLUSIONS Celecoxib may improve clinical symptoms, alleviate pain and contribute to little or no difference in physical function compared with placebo. Celecoxib was associated with fewer numbers of participant withdrawals. Results for incidence of gastroduodenal ulcers (≥ 3 mm) and short-term serious adverse events were uncertain; however, there were few reported events for either.Celecoxib may slightly improve clinical symptoms compared with tNSAIDs. Results for reduced pain and improved physical function were uncertain. Particpants taking celecoxib had lower incidence of gastroduodenal ulcers (≥ 3 mm) and there were fewer withdrawals from trials. Results for cardiovascular events and short-term serious adverse events were also uncertain.Uncertainty about the rate of cardiovascular events between celecoxib and tNSAIDs could be due to risk of bias; another factor is that these were small, short-term trials. It has been reported previously that both celecoxib and tNSAIDs increase cardiovascular event rates. Our confidence in results about harms is therefore low. Larger head-to-head clinical trials comparing celecoxib to other tNSAIDs is needed to better inform clinical practice.
Collapse
Affiliation(s)
- Mahir Fidahic
- University of TuzlaMedical facultyUniverzitetska 1TuzlaCanton TuzlaBosnia and Herzegovina75000
| | - Antonia Jelicic Kadic
- Cochrane Croatia, University of Split School of MedicineSoltanska 2SplitCroatia
- University Hospital SplitDepartment of PediatricsSpinciceva 1SplitCroatia21 000
| | - Mislav Radic
- University Hospital Split, School of Medicine, Cochrane CroatiaDivision of Rheumatology and Clinical ImmunologyŠoltanska 2SplitCroatia21000
| | - Livia Puljak
- University of Split School of MedicineCochrane CroatiaSoltanska 2SplitCroatia21000
| | | |
Collapse
|
50
|
Abstract
BACKGROUND Osteoarthritis (OA) is the most common form of arthritis and is caused by degeneration of the joint cartilage and growth of new bone, cartilage and connective tissue. It is often associated with major disability and impaired quality of life. There is currently no consensus on the best treatment to improve OA symptoms. Celecoxib is a selective non-steroidal anti-inflammatory drug (NSAID). OBJECTIVES To assess the clinical benefits (pain, function, quality of life) and safety (withdrawals due to adverse effects, serious adverse effects, overall discontinuation rates) of celecoxib in osteoarthritis (OA). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase and clinical trials registers up to April 11, 2017, as well as reference and citation lists of included studies. Pharmaceutical companies and authors of published articles were contacted. SELECTION CRITERIA We included published studies (full reports in a peer reviewed journal) of prospective randomized controlled trials (RCTs) that compared oral celecoxib versus no intervention, placebo or another traditional NSAID (tNSAID) in participants with clinically- or radiologically-confirmed primary OA of the knee or hip, or both knee and hip. DATA COLLECTION AND ANALYSIS Two authors independently performed data extraction, quality assessment, and compared results. Main analyses for patient-reported outcomes of pain and physical function were conducted on studies with low risk of bias for sequence generation, allocation concealment and blinding of participants and personnel. MAIN RESULTS We included 36 trials that provided data for 17,206 adults: 9402 participants received celecoxib 200 mg/day, and 7804 were assigned to receive either tNSAIDs (N = 1869) or placebo (N = 5935). Celecoxib was compared with placebo (32 trials), naproxen (6 trials) and diclofenac (3 trials). Studies were published between 1999 and 2014. Studies included participants with knee, hip or both knee and hip OA; mean OA duration was 7.9 years. Most studies included predominantly white participants whose mean age was 62 (± 10) years; most participants were women. There were no concerns about risk of bias for performance and detection bias, but selection bias was poorly reported in most trials. Most trials had high attrition bias, and there was evidence of selective reporting in a third of the studies. Celecoxib versus placeboCompared with placebo celecoxib slightly reduced pain on a 500-point Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain scale, accounting for 3% absolute improvement (95% CI 2% to 5% improvement) or 12% relative improvement (95% CI 7% to 18% improvement) (4 studies, 1622 participants). This improvement may not be clinically significant (high quality evidence).Compared with placebo celecoxib slightly improved physical function on a 1700-point WOMAC scale, accounting for 4% absolute improvement (95% CI 2% to 6% improvement), 12% relative improvement (95% CI 5% to 19% improvement) (4 studies, 1622 participants). This improvement may not be clinically significant (high quality evidence).There was no evidence of an important difference for withdrawals due to adverse events (Peto OR 0.99, 95% CI 0.85 to 1.15) (moderate quality evidence due to study limitations).Results were inconclusive for numbers of participants experiencing any serious AEs (SAEs) (Peto OR 0.95, 95% CI 0.66 to 1.36), gastro-intestinal events (Peto OR 1.91, 95% CI 0.24 to 14.90) and cardiovascular events (Peto OR 3.40, 95% CI 0.73 to 15.88) (very low quality evidence due to serious imprecision and study limitations). However, regulatory agencies have warned of increased cardiovascular events for celecoxib. Celecoxib versus tNSAIDsThere were inconclusive results regarding the effect on pain between celecoxib and tNSAIDs on a 100-point visual analogue scale (VAS), showing 5% absolute improvement (95% CI 11% improvement to 2% worse), 11% relative improvement (95% CI 26% improvement to 4% worse) (2 studies, 1180 participants, moderate quality evidence due to publication bias).Compared to a tNSAID celecoxib slightly improved physical function on a 100-point WOMAC scale, showing 6% absolute improvement (95% CI 6% to 11% improvement) and 16% relative improvement (95% CI 2% to 30% improvement). This improvement may not be clinically significant (low quality evidence due to missing data and few participants) (1 study, 264 participants).Based on low or very low quality evidence (downgraded due to missing data, high risk of bias, few events and wide confidence intervals) results were inconclusive for withdrawals due to AEs (Peto OR 0.97, 95% CI 0.74 to 1.27), number of participants experiencing SAEs (Peto OR 0.92, 95% CI 0.66 to 1.28), gastro-intestinal events (Peto OR 0.61, 0.15 to 2.43) and cardiovascular events (Peto OR 0.47, 95% CI 0.17 to 1.25).In comparisons of celecoxib and placebo there were no differences in pooled analyses between our main analysis with low risk of bias and all eligible studies. In comparisons of celecoxib and tNSAIDs, only one outcome showed a difference between studies at low risk of bias and all eligible studies: physical function (6% absolute improvement in low risk of bias, no difference in all eligible studies).No studies included in the main comparisons measured quality of life. Of 36 studies, 34 reported funding by drug manufacturers and in 34 studies one or more study authors were employees of the sponsor. AUTHORS' CONCLUSIONS We are highly reserved about results due to pharmaceutical industry involvement and limited data. We were unable to obtain data from three studies, which included 15,539 participants, and classified as awaiting assessment. Current evidence indicates that celecoxib is slightly better than placebo and some tNSAIDs in reducing pain and improving physical function. We are uncertain if harms differ among celecoxib and placebo or tNSAIDs due to risk of bias, low quality evidence for many outcomes, and that some study authors and Pfizer declined to provide data from completed studies with large numbers of participants. To fill the evidence gap, we need to access existing data and new, independent clinical trials to investigate benefits and harms of celecoxib versus tNSAIDs for people with osteoarthritis, with longer follow-up and more direct head-to-head comparisons with other tNSAIDs.
Collapse
Affiliation(s)
- Livia Puljak
- University of Split School of MedicineCochrane CroatiaSoltanska 2SplitCroatia21000
| | | | - Davorka Vrdoljak
- School of Medicine in SplitDepartment of Family MedicineSoltanska 2SplitCroatia21000
| | - Filipa Markotic
- University Clinical Hospital MostarCentre for Clinical PharmacologyKralja Tvrtka b.b.MostarBosnia and Herzegovina88000
| | - Ana Utrobicic
- University of Split, School of MedicineCentral Medical LibrarySoltanska 2SplitCroatia21000
| | - Peter Tugwell
- Faculty of Medicine, University of OttawaDepartment of MedicineOttawaONCanadaK1H 8M5
| | | |
Collapse
|