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Chaiwat T, Muthitacharoen A, Chaisrilak C. Cognitive Reflection and Social Proof: Navigating Complex Tax Incentives for Retirement Savings. J Aging Soc Policy 2024:1-23. [PMID: 38686661 DOI: 10.1080/08959420.2024.2347808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/07/2024] [Indexed: 05/02/2024]
Abstract
As the population ages, the urgency to ensure financial security in retirement intensifies. Governments have introduced tax incentives to promote retirement savings, but their complexity could pose challenges. Navigating these complex tax incentives often requires both cognitive reflections, the ability to resist impulsive answers and consider an issue thoughtfully, and social proof, the influence of others' endorsements on one's decisions. This study investigates the roles of these factors on the utilization of intricate tax incentives designed for retirement savings. We conduct a survey-based experiment on Thai taxpayers with varied complexity rules and framing message scenarios. Our findings indicate that individuals with higher Cognitive Reflection Test (CRT) scores are more likely to select complex tax incentives. We further illustrate that cognitive reflection has a more substantial impact on the decision to engage in a complex tax incentive than social proof. This highlights the importance of intrinsic cognitive abilities in navigating complex financial decisions. We also establish that the influence of social proof is particularly significant among individuals with lower cognitive reflection scores, signifying a nuanced interplay between individual cognitive abilities and social influences. Our findings highlight the importance of accounting for cognitive abilities and social proof dynamics when crafting retirement saving incentives.
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Affiliation(s)
- Thanee Chaiwat
- Center for Behavioral and Experimental Economics (CBEE) and Faculty of Economics, Chulalongkorn University (Thailand), Bangkok, Thailand
- Faculty of Economics, Chulalongkorn University, Bangkok, Thailand
| | | | - Chanalak Chaisrilak
- Center for Behavioral and Experimental Economics (CBEE) and Faculty of Economics, Chulalongkorn University (Thailand), Bangkok, Thailand
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2
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Dalton AF, Golin CE, Morris C, Kistler CE, Dolor RJ, Bertin KB, Suresh K, Patel SG, Lewis CL. Effect of a Patient Decision Aid on Preferences for Colorectal Cancer Screening Among Older Adults: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2244982. [PMID: 36469317 PMCID: PMC9855297 DOI: 10.1001/jamanetworkopen.2022.44982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Guidelines recommend individualized decision-making for colorectal cancer (CRC) screening among adults aged 76 to 84 years, a process that includes a consideration of health state and patient preference. OBJECTIVE To determine whether a targeted patient decision aid would align older adults' screening preference with their potential to benefit from CRC screening. DESIGN, SETTING, AND PARTICIPANTS This is a prespecified secondary analysis from a randomized clinical trial. Participants aged 70 to 84 years who were not up to date with screening and had an appointment within 6 weeks were purposively sampled by health state (poor, intermediate, or good) at 14 community-based primary care practices and block randomized to receive the intervention or control. Patients were recruited from March 1, 2012, to February 28, 2015, and these secondary analyses were performed from January 15 to March 1, 2022. INTERVENTIONS Patient decision aid targeted to age and sex. MAIN OUTCOMES AND MEASURES The primary outcome of this analysis was patient preference for CRC screening. The a priori hypothesis was that the decision aid (intervention) group would reduce the proportion preferring screening among those in poor and intermediate health compared with the control group. RESULTS Among the 424 participants, the mean (SD) age was 76.8 (4.2) years; 248 (58.5%) of participants were women; and 333 (78.5%) were White. The proportion preferring screening in the intervention group was less than in the control group for those in the intermediate health state (34 of 76 [44.7%] vs 40 of 73 [54.8%]; absolute difference, -10.1% [95% CI, -26.0% to 5.9%]) and in the poor health state (24 of 62 [38.7%] vs 33 of 61 [54.1%]; absolute difference, -15.4% [95% CI, -32.8% to 2.0%]). These differences were not statistically significant. The proportion of those in good health who preferred screening was similar between the intervention and control groups (44 of 74 [59.5%] for intervention vs 46 of 75 [61.3%] for control; absolute difference, -1.9% [95% CI, -17.6% to 13.8%]). CONCLUSIONS AND RELEVANCE The findings of this secondary analysis of a clinical trial did not demonstrate statistically significant differences in patient preferences between the health groups. Additional studies that are appropriately powered are needed to determine the effect of the decision aid on the preferences of older patients for CRC screening by health state. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01575990.
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Affiliation(s)
- Alexandra F. Dalton
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora
| | - Carol E. Golin
- Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill
- Division of General Internal Medicine and Clinical Epidemiology, Department of Medicine, The University of North Carolina at Chapel Hill
- Gillings School of Global Public Health, Department of Health Behavior, The University of North Carolina at Chapel Hill
| | - Carolyn Morris
- Division of Data Sciences Safety and Regulatory, Division of Biostatistics, Department of Research & Development Solutions, IQVIA, Durham, North Carolina
| | - Christine E. Kistler
- Department of Family Medicine, School of Medicine, The University of North Carolina at Chapel Hill
| | - Rowena J. Dolor
- Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina
| | - Kaitlyn B. Bertin
- Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora
| | - Krithika Suresh
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora
| | - Swati G. Patel
- Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora
- Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, Colorado
| | - Carmen L. Lewis
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora
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Reyna VF, Edelson S, Hayes B, Garavito D. Supporting Health and Medical Decision Making: Findings and Insights from Fuzzy-Trace Theory. Med Decis Making 2022; 42:741-754. [PMID: 35735225 PMCID: PMC9283268 DOI: 10.1177/0272989x221105473] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
HIGHLIGHTS Fuzzy-trace theory (FTT) supports practical approaches to improving health and medicine.FTT differs in important respects from other theories of decision making, which has implications for how to help patients, providers, and health communicators.Gist mental representations emphasize categorical distinctions, reflect understanding in context, and help cue values relevant to health and patient care.Understanding the science behind theory is crucial for evidence-based medicine.
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Affiliation(s)
- Valerie F Reyna
- Human Neuroscience Institute and Center for Behavioral Economics and Decision Research, Cornell University, Ithaca, NY, USA
| | - Sarah Edelson
- Human Neuroscience Institute and Center for Behavioral Economics and Decision Research, Cornell University, Ithaca, NY, USA
| | - Bridget Hayes
- Human Neuroscience Institute and Center for Behavioral Economics and Decision Research, Cornell University, Ithaca, NY, USA
| | - David Garavito
- Human Neuroscience Institute and Center for Behavioral Economics and Decision Research, Cornell University, Ithaca, NY, USA
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Yılmaz NG, Timmermans DRM, Portielje J, Van Weert JCM, Damman OC. Testing the effects on information use by older versus younger women of modality and narration style in a hospital report card. Health Expect 2022; 25:567-578. [PMID: 34953006 PMCID: PMC8957735 DOI: 10.1111/hex.13389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/28/2021] [Accepted: 10/05/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Hospital report cards (HRCs) are usually presented in a textual and factual format, likely hampering information processing. OBJECTIVE This study aimed to investigate the effects of audiovisual and narrative information in HRCs on user responses, and to test differences between older and younger women. DESIGN A 2 (modality [textual vs. audiovisual]) × 3 (narration style [factual vs. process narrative vs. experience narrative]) online experiment was conducted. Information about breast cancer care was used as a case example. Age (younger [<65] vs. older [≥65]) was included as a potential effect modifier. SETTING AND PARTICIPANTS A total of 631 disease-naïve women (Mage = 56.06) completed an online survey. The outcomes were perceived cognitive load, satisfaction, comprehension, information recall and decisional conflict. Data were analysed using AN(C)OVAs. RESULTS Audiovisual (vs. textual) information resulted in higher information satisfaction across age groups, but was associated with lower comprehension in older women. An experience narrative (vs. factual information) increased satisfaction with attractiveness and emotional support of the information only in older women. A three-way interaction effect was found, suggesting that older women were most satisfied with the comprehensibility of audiovisual factual or textual process narrative information. Younger women were most satisfied with the comprehensibility of audiovisual process narrative or textual factual information. DISCUSSION AND CONCLUSION Audiovisual and narrative information in an HRC showed beneficial effects on satisfaction measures. In particular, audiovisual information could be incorporated into HRCs to increase satisfaction with information. PUBLIC CONTRIBUTION Lay persons helped in optimizing the visuals used in the stimulus materials by checking for clarity.
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Affiliation(s)
- Nida Gizem Yılmaz
- Department of Public and Occupational HealthAmsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Department of Communication ScienceAmsterdam School of Communication Research/ASCoR, University of AmsterdamAmsterdamThe Netherlands
| | - Danielle R. M. Timmermans
- Department of Public and Occupational HealthAmsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Johanneke Portielje
- Department of Medical OncologyLeiden University Medical CenterLeidenThe Netherlands
| | - Julia C. M. Van Weert
- Department of Communication ScienceAmsterdam School of Communication Research/ASCoR, University of AmsterdamAmsterdamThe Netherlands
| | - Olga C. Damman
- Department of Public and Occupational HealthAmsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
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Huang S, Faul L, Sevinc G, Mwilambwe-Tshilobo L, Setton R, Lockrow AW, Ebner NC, Turner GR, Spreng RN, De Brigard F. Age differences in intuitive moral decision-making: Associations with inter-network neural connectivity. Psychol Aging 2021; 36:902-916. [PMID: 34472915 PMCID: PMC9170131 DOI: 10.1037/pag0000633] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Positions of power involving moral decision-making are often held by older adults (OAs). However, little is known about age differences in moral decision-making and the intrinsic organization of the aging brain. In this study, younger adults (YAs; n = 117, Mage = 22.11) and OAs (n = 82, Mage = 67.54) made decisions in hypothetical moral dilemmas and completed resting-state multi-echo functional magnetic resonance imaging (fMRI) scans. Relative to YAs, OAs were more likely to endorse deontological decisions (i.e., decisions based on adherence to a moral principle or duty), but only when the choice was immediately compelling or intuitive. By contrast, there was no difference between YAs and OAs in utilitarian decisions (i.e., decisions aimed at maximizing collective well-being) when the utilitarian choice was intuitive. Enhanced connections between the posterior medial core of the default network (pmDN) and the dorsal attention network, and overall reduced segregation of pmDN from the rest of the brain, were associated with this increased deontological-intuitive moral decision-making style in OAs. The present study contributes to our understanding of age differences in decision-making styles by taking into account the intuitiveness of the moral choice, and it offers further insights as to how age differences in intrinsic brain connectivity relate to these distinct moral decision-making styles in YAs and OAs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Shenyang Huang
- Center for Cognitive Neuroscience, Duke University, Durham, North Carolina, USA
| | - Leonard Faul
- Center for Cognitive Neuroscience, Duke University, Durham, North Carolina, USA
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
| | - Gunes Sevinc
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, USA
| | | | - Roni Setton
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Amber W. Lockrow
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Natalie C. Ebner
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Gary R. Turner
- Department of Psychology, York University, Toronto, Ontario, Canada
| | - R. Nathan Spreng
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Felipe De Brigard
- Center for Cognitive Neuroscience, Duke University, Durham, North Carolina, USA
- Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
- Department of Philosophy, Duke University, Durham, North Carolina, USA
- Duke Institute for Brain Sciences, Duke University, Durham, North Carolina, USA
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Roth-Cohen O, Levy S, Zigdon A. The Mediated Role of Credibility on Information Sources and Patient Awareness toward Patient Rights. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168628. [PMID: 34444377 PMCID: PMC8392652 DOI: 10.3390/ijerph18168628] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/12/2021] [Accepted: 08/12/2021] [Indexed: 01/10/2023]
Abstract
Although patient rights are an important issue, this remains an understudied research area. Patients are unaware of their rights, lacking control of health care treatments they might deserve. This can contribute to sustaining inequality as well as failure in achieving welfare policy goals. Drawing on channel complementarity theory, the current study explored patients’ awareness toward their rights, and the credibility of information sources related to patient rights. In a web-based survey, 994 Israeli participants, suffering from chronic illness and using health services, were recruited. To examine the study’s theoretical framework and relationships among the constructs and test the hypotheses, a path analysis was conducted using Structural Equation Modeling. The research model depicts direct and indirect relationships between constructs, and the relevant coefficients. The results show a direct and positive interaction between information credibility and patient rights awareness (β = 0.10, p = 0.019). Information credibility partially mediates the relationship between public service information sources and patient rights awareness (bootstrap with 95% CI: 0.01–0.07; p = 0.015). The mass media information sources construct is directly and positively related to information credibility (β = 0.36, p = 0.000). Age was found as a moderator, indicating that information credibility is a factor only at lower ages. Therefore, patient rights should be systematically and reliably accessible in order to raise the awareness and trust of chronic patients regarding information about patient rights. Using planned health communication campaigns mainly via public service sources that are perceived as trustworthy can help contribute to approach patients more effectively and provide them with accessible and detailed information about their rights.
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Affiliation(s)
- Osnat Roth-Cohen
- School of Communication, Ariel University, Science Park, POB 3, Ariel 40700, Israel
- Correspondence:
| | - Shalom Levy
- Department of Economics and Business Administration, Ariel University, Science Park, POB 3, Ariel 40700, Israel;
| | - Avi Zigdon
- Department of Health Systems Management, School of Health Systems, Ariel University, Science Park, POB 3, Ariel 40700, Israel;
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7
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Wang K, Li S. Who Is Willing to Engage in Social Gatherings During the Coronavirus Disease 2019 Lockdown? A Curvilinear Relationship Between Age and Heuristic Processing. Front Psychol 2020; 11:586408. [PMID: 33343459 PMCID: PMC7744585 DOI: 10.3389/fpsyg.2020.586408] [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: 10/01/2020] [Accepted: 11/05/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The Chinese government implemented a lockdown to contain the coronavirus disease 2019 (COVID-19) pandemic during the Chinese Lunar New Year when people have the tradition to visit families and friends. Previous research suggested that heuristic processing increased risky behavioral willingness (e.g., desire to have social gatherings despite the pandemic) and that people's tendency to use heuristic processing varied across different adulthood stages. This study thus investigated the relationships among age, heuristic processing of COVID-19-related information, and the willingness to have social gatherings during the lockdown. METHODS A sample of 1,651 participants was recruited from an online crowdsourcing platform between January 31 and February 04 in 2020, with a mean age of 30.69, 47.9% being women. Participants completed an online questionnaire about heuristic processing of COVID-19-related information, willingness to engage in social gatherings during the lockdown, age, and other demographic information. RESULTS Age was found to have a U-shaped curvilinear relationship with heuristic processing, and heuristic processing was positively correlated with the willingness to have social gatherings. Further analyses showed that heuristic processing curvilinearly mediated the relationship between age and the willingness to have social gatherings. CONCLUSION Compared with young adults, emerging and older adults are more likely to engage in heuristic processing, which in turn, increases the willingness to have social gatherings. Heuristic processing serves as an underlying mechanism to explain the relationship between age and risky behavioral willingness.
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Affiliation(s)
| | - Siyue Li
- College of Media and International Culture, Zhejiang University, Hangzhou, China
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De Looper M, Damman O, Smets E, Timmermans D, Van Weert J. Adapting Online Patient Decision Aids: Effects of Modality and Narration Style on Patients' Satisfaction, Information Recall and Informed Decision Making. JOURNAL OF HEALTH COMMUNICATION 2020; 25:712-726. [PMID: 33256546 DOI: 10.1080/10810730.2020.1840674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Audiovisual and narrative information are often used in online decision aids. However, few studies have tested whether these strategies are more effective compared to other types of information. We tested the effect of these strategies on satisfaction with the information, recall and informed decision-making in a 2 (Modality: audiovisual vs. textual) x 2 (Narration style: narrative vs. factual) experimental design. Data was collected in an online experiment among 262 analogue cancer patients. Since most cancer patients are older people, we also assessed if the effectiveness of these strategies differs depending on the patient's age. Data was analyzed using Structural Equation Modeling. Findings showed audiovisual modality had a positive effect on satisfaction. Moreover, audiovisual modality improved recall, both directly and indirectly via satisfaction, which subsequently resulted in better-informed decision-making. Narratives resulted in more satisfaction, but not better recall or informed decision-making. These effects were found in patients of all ages.
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Affiliation(s)
- Melanie De Looper
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam , Amsterdam, The Netherlands
| | - Olga Damman
- Public and Occupational Health, VU University Medical Center/EMGO+ Institute dor Health and Care Research , Amsterdam, The Netherlands
| | - Ellen Smets
- Medical Psychology, Amsterdam UMC , Amsterdam, The Netherlands
| | - Danielle Timmermans
- Public and Occupational Health, VU University Medical Center/EMGO+ Institute dor Health and Care Research , Amsterdam, The Netherlands
| | - Julia Van Weert
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam , Amsterdam, The Netherlands
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van Weert JCM. Facing frailty by effective digital and patient-provider communication? PATIENT EDUCATION AND COUNSELING 2020; 103:433-435. [PMID: 32143814 DOI: 10.1016/j.pec.2020.02.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, the Netherlands.
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Ankolekar A, Dekker A, Fijten R, Berlanga A. The Benefits and Challenges of Using Patient Decision Aids to Support Shared Decision Making in Health Care. JCO Clin Cancer Inform 2019; 2:1-10. [PMID: 30652607 DOI: 10.1200/cci.18.00013] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Shared decision making (SDM) and patient-centered care require patients to actively participate in the decision-making process. Yet with the increasing number and complexity of cancer treatment options, it can be a challenge for patients to evaluate clinical information and make risk-benefit trade-offs to choose the most appropriate treatment. Clinicians face time constraints and communication challenges, which can further hamper the SDM process. In this article, we review patient decision aids (PDAs) as a means of supporting SDM by presenting clinical information and risk data to patients in a format that is accessible and easy to understand. We outline the benefits and limitations of PDAs as well as the challenges in their development, such as a lengthy and complex development process and implementation obstacles. Lastly, we discuss future trends and how change on multiple levels-PDA developers, clinicians, hospital administrators, and health care insurers-can support the use of PDAs and consequently SDM. Through this multipronged approach, patients can be empowered to take an active role in their health and choose treatments that are in line with their values.
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Affiliation(s)
- Anshu Ankolekar
- Anshu Ankolekar, Andre Dekker, and Rianne Fijten, Maastricht University Medical Centre, Maastricht; and Adriana Berlanga, Maastricht University, Maastricht, the Netherlands
| | - Andre Dekker
- Anshu Ankolekar, Andre Dekker, and Rianne Fijten, Maastricht University Medical Centre, Maastricht; and Adriana Berlanga, Maastricht University, Maastricht, the Netherlands
| | - Rianne Fijten
- Anshu Ankolekar, Andre Dekker, and Rianne Fijten, Maastricht University Medical Centre, Maastricht; and Adriana Berlanga, Maastricht University, Maastricht, the Netherlands
| | - Adriana Berlanga
- Anshu Ankolekar, Andre Dekker, and Rianne Fijten, Maastricht University Medical Centre, Maastricht; and Adriana Berlanga, Maastricht University, Maastricht, the Netherlands
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11
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Developing a patient decision aid for women aged 70 and older with early stage, estrogen receptor positive, HER2 negative, breast cancer. J Geriatr Oncol 2019; 10:980-986. [PMID: 31130442 DOI: 10.1016/j.jgo.2019.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/16/2019] [Accepted: 05/03/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Since women ≥70 years with early stage, estrogen receptor positive (ER+), HER2 negative breast cancer face several preference-sensitive treatment decisions, the investigative team aimed to develop a pamphlet decision aid (DA) for such women. MATERIALS AND METHODS The content of the DA was informed by literature review, international criteria, and expert feedback, and includes information on benefits and risks of lumpectomy versus mastectomy, lymph node surgery, radiotherapy after lumpectomy, and endocrine therapy. It considers women's overall health and was written using low literacy principles. Women from two Boston-based hospitals who were diagnosed in the past 6-24 months were recruited to provide feedback on the DA and its acceptability. The DA was iteratively revised based on their qualitative input. RESULTS Of 48 eligible women contacted, 35 (73%) agreed to participate. Their mean age was 74.3 years; 33 (94%) were non-Hispanic white; and 24 (67%) were college graduates. Overall, 26 (74%) thought the length of the DA was just right, 29 (83%) thought all or most of the information was clear, 32 (91%) found the DA helpful, and 33 (94%) would recommend it. In open ended comments, participants noted that the DA was clear, well-organized, and would help women prepare for and participate in treatment decision-making. CONCLUSIONS The investigative team developed a novel breast cancer treatment DA that is acceptable to women ≥70 years with a history of ER+, HER2-, early stage breast cancer. Next, the DA's efficacy needs to be tested with diverse older women newly diagnosed with breast cancer.
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Abstract
AbstractResearch on decision making and aging has shown that some decision-making skills decrease with age. Despite these age-related declines, no study has yet investigated the possibility of promoting improvements in decision-making skills in older adults. The present study was designed to address this gap in literature by examining the efficacy of a metacognitive-strategy decision-making training on practiced and non-practiced tasks. The training was based on the use of specific metacognitive principles and analytical strategies for promoting an analytical mode of thinking in the decision-making process. We examined 66 older adults (Mage= 67.52 years, SD = 5.38; age range 60-81) assigned to two training groups: a metacognitive-strategy decision-making training group and an active control group involved in a strategic memory intervention. Both training groups attended four 2-hour training sessions conducted once a week. Results showed that, after intervention, the decision-making training group improved their decision-making skills significantly more than the active control training group. Crucially, the positive effect of the training was evident in both practiced and non-practiced decision-making tasks. This is the first study investigating the efficacy of a decision-making training in older adults based on metacognitive and strategic principles.
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Pieterse AH, Bomhof-Roordink H, Stiggelbout AM. On how to define and measure SDM. PATIENT EDUCATION AND COUNSELING 2018; 101:1307-1309. [PMID: 29937154 DOI: 10.1016/j.pec.2018.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
| | - Hanna Bomhof-Roordink
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
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14
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Tranvåg EJ, Norheim OF, Ottersen T. Clinical decision making in cancer care: a review of current and future roles of patient age. BMC Cancer 2018; 18:546. [PMID: 29743048 PMCID: PMC5944161 DOI: 10.1186/s12885-018-4456-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 04/30/2018] [Indexed: 01/01/2023] Open
Abstract
Background Patient age is among the most controversial patient characteristics in clinical decision making. In personalized cancer medicine it is important to understand how individual characteristics do affect practice and how to appropriately incorporate such factors into decision making. Some argue that using age in decision making is unethical, and how patient age should guide cancer care is unsettled. This article provides an overview of the use of age in clinical decision making and discusses how age can be relevant in the context of personalized medicine. Methods We conducted a scoping review, searching Pubmed for English references published between 1985 and May 2017. References concerning cancer, with patients above the age of 18 and that discussed age in relation to diagnostic or treatment decisions were included. References that were non-medical or concerning patients below the age of 18, and references that were case reports, ongoing studies or opinion pieces were excluded. Additional references were collected through snowballing and from selected reports, guidelines and articles. Results Three hundred and forty-seven relevant references were identified. Patient age can have many and diverse roles in clinical decision making: Contextual roles linked to access (age influences how fast patients are referred to specialized care) and incidence (association between increasing age and increasing incidence rates for cancer); patient-relevant roles linked to physiology (age-related changes in drug metabolism) and comorbidity (association between increasing age and increasing number of comorbidities); and roles related to interventions, such as treatment (older patients receive substandard care) and outcome (survival varies by age). Conclusions Patient age is integrated into cancer care decision making in a range of ways that makes it difficult to claim age-neutrality. Acknowledging this and being more transparent about the use of age in decision making are likely to promote better clinical decisions, irrespective of one’s normative viewpoint. This overview also provides a starting point for future discussions on the appropriate role of age in cancer care decision making, which we see as crucial for harnessing the full potential of personalized medicine. Electronic supplementary material The online version of this article (10.1186/s12885-018-4456-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eirik Joakim Tranvåg
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. .,Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Bergen, Norway.
| | - Ole Frithjof Norheim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Trygve Ottersen
- Oslo Group on Global Health Policy, Department of Community Medicine and Global Health and Centre for Global Health, University of Oslo, Oslo, Norway.,Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
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15
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Seng EK, Grinberg AS, Fraenkel L. Willingness to trade-off: An intermediate factor in patient decision-making regarding escalating care. Health Psychol Open 2018; 5:2055102918767718. [PMID: 29662681 PMCID: PMC5892793 DOI: 10.1177/2055102918767718] [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] [Indexed: 11/23/2022] Open
Abstract
This study aimed to evaluate treatment necessity, treatment concern, and willingness to engage in decisional trade-offs in the context of treatment escalation decision-making. Participants (n = 147) recruited online were randomized to read a vignette about escalating care in psoriasis in a 2 (high treatment concern vs moderate treatment concern) × 2 (high perceived treatment necessity vs moderate perceived treatment necessity) design. High treatment concern was associated with choosing to defer treatment escalation and being unwilling to engage in decisional trade-offs if disease risk changed. Results highlight the importance of treatment concern and willingness trade-off in treatment escalation decision-making.
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Affiliation(s)
- Elizabeth K Seng
- Yeshiva University, USA.,Albert Einstein College of Medicine, USA
| | - Amy S Grinberg
- Yeshiva University, USA.,VA Connecticut Healthcare System, USA
| | - Liana Fraenkel
- VA Connecticut Healthcare System, USA.,Yale School of Medicine, USA
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16
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Braun RT, Barnes AJ, Hanoch Y, Federman AD. Health Literacy and Plan Choice: Implications for Medicare Managed Care. Health Lit Res Pract 2018; 2:e40-e54. [PMID: 31294276 PMCID: PMC6608906 DOI: 10.3928/24748307-20180201-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 01/24/2018] [Indexed: 11/20/2022] Open
Abstract
Background: Older adults with inadequate health literacy may have difficulty selecting optimal coverage when faced with multiple health insurance plans to choose from. Objective: This study sought to examine how health literacy affects which Medicare Advantage plans seniors select. Methods: We surveyed 311 Medicare beneficiaries who did not have concurrent Medicaid coverage. Participants chose from three Medicare Advantage plans: (1) lower-premium, less coverage; (2) higher-premium, more coverage; and (3) an intermediate option. Adjusted associations between health literacy, plan choice, and the importance of plan attributes in decision-making were tested using ordered and multinomial logistic regressions. Key Results: Beneficiaries with inadequate health literacy chose the lower-premium, less coverage plan over the higher-premium, more coverage option compared to beneficiaries with adequate health literacy (p < .05) perhaps because participants with inadequate health literacy tended to rank the importance of plan attributes differently than those with adequate health literacy (p < .05). Conclusions: This evidence suggests there may be a disconnect among those with inadequate health literacy between attributes that were ranked as important and the plans they chose, resulting in choices that are not consistent with their preferences. Beneficiaries with inadequate health literacy may be at increased risk of selecting plans that do not meet their health needs, resulting in reduced access and higher costs. Medicare and consumer groups should support interventions to raise literacy levels and those that reduce the reliance on literacy when plan shopping. [HLRP: Health Literacy Research and Practice. 2018;2(1):e40–e54.] Plain Language Summary: We examined how health literacy affects seniors' choice of Medicare Advantage plans. Results indicate that beneficiaries with inadequate health literacy chose the lower-premium, less coverage plan over the higher-premium, more coverage option compared to beneficiaries with adequate health literacy. Beneficiaries with inadequate health literacy tended to rank the importance of plan attributes differently than those with adequate health literacy.
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Affiliation(s)
- Robert T. Braun
- Address correspondence to Robert T. Braun, MS, Virginia Commonwealth University, 830 E. Main Street, 9th Floor, Richmond, VA 23219;
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17
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Izadi S, Pachur T, Wheeler C, McGuire J, Waters EA. Spontaneous mental associations with the words "side effect": Implications for informed and shared decision making. PATIENT EDUCATION AND COUNSELING 2017; 100:1928-1933. [PMID: 28583721 PMCID: PMC5573624 DOI: 10.1016/j.pec.2017.05.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 04/17/2017] [Accepted: 05/21/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To gain insight into patients' medical decisions by exploring the content of laypeople's spontaneous mental associations with the term "side effect." METHODS An online cross-sectional survey asked 144 women aged 40-74, "What are the first three things you think of when you hear the words 'side effect?"' Data were analyzed using content analysis, chi-square, and Fisher's exact tests. RESULTS 17 codes emerged and were grouped into 4 themes and a Miscellaneous category: Health Problems (70.8% of participants), Decision-Relevant Evaluations (52.8%), Negative Affect (30.6%), Practical Considerations (18.1%) and Miscellaneous (9.7%). The 4 most frequently identified codes were: Risk (36.1%), Health Problems-Specific Symptoms (35.4%), Health Problems-General Terms (32.6%), and Negative Affect-Strong (19.4%). Code and theme frequencies were generally similar across demographic groups (ps>0.05). CONCLUSION The term "side effect" spontaneously elicited comments related to identifying health problems and expressing negative emotions. This might explain why the mere possibility of side effects triggers negative affect for people making medical decisions. Some respondents also mentioned decision-relevant evaluations and practical considerations in response to side effects. PRACTICE IMPLICATIONS Addressing commonly-held associations and acknowledging negative affects provoked by side effects are first steps healthcare providers can take towards improving informed and shared patient decision making.
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Affiliation(s)
- Sonya Izadi
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, USA
| | - Thorsten Pachur
- Center for Adaptive Behavior and Cognition, Max Planck Institute for Human Development, Berlin, Germany
| | - Courtney Wheeler
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, USA
| | - Jaclyn McGuire
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, USA
| | - Erika A Waters
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, USA.
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18
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Lyons KD, Li HH, Mader EM, Stewart TM, Morley CP, Formica MK, Perrapato SD, Seigne JD, Hyams ES, Irwin BH, Mosher T, Hegel MT. Cognitive and Affective Representations of Active Surveillance as a Treatment Option for Low-Risk Prostate Cancer. Am J Mens Health 2016; 11:63-72. [PMID: 27365211 DOI: 10.1177/1557988316657041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Benefits of early diagnosis and treatment remain debatable for men with low-risk prostate cancer. Active surveillance (AS) is an alternative to treatment. The goal of AS is to identify patients whose cancer is progressing rapidly while avoiding treatment in the majority of patients. The purpose of this study was to explore cognitive and affective representations of AS within a clinical environment that promotes AS a viable option for men with low-risk prostate cancer. Participants included patients for whom AS and active treatment were equally viable options, as well as practitioners who were involved in consultations for prostate cancer. Data were generated from semistructured interviews and audits of consultation notes and were analyzed using thematic analysis. Nineteen patients and 16 practitioners completed a semistructured interview. Patients generally viewed AS as a temporary strategy that was largely equated with inaction. There was variation in the degree to which inaction was viewed as warranted or favorable. Patient perceptions of AS were generally malleable and able to be influenced by information from trusted sources. Encouraging slow deliberation and multiple consultations may facilitate greater understanding and acceptance of AS as a viable treatment option for low-risk prostate cancer.
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Affiliation(s)
| | - Hsin H Li
- 2 SUNY Upstate Medical University, Syracuse, NY, USA
| | - Emily M Mader
- 2 SUNY Upstate Medical University, Syracuse, NY, USA
| | | | | | | | | | - John D Seigne
- 1 Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Elias S Hyams
- 1 Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Brian H Irwin
- 3 University of Vermont College of Medicine, Burlington, VT, USA
| | - Terry Mosher
- 1 Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Mark T Hegel
- 1 Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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19
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Hopmans W, Damman OC, Senan S, Hartemink KJ, Smit EF, Timmermans DRM. A patient perspective on shared decision making in stage I non-small cell lung cancer: a mixed methods study. BMC Cancer 2015; 15:959. [PMID: 26673216 PMCID: PMC4682255 DOI: 10.1186/s12885-015-1974-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 12/05/2015] [Indexed: 12/25/2022] Open
Abstract
Background Surgery and stereotactic ablative radiotherapy (SABR) are both curative treatment options for patients with a stage I non-small cell lung cancer (NSCLC). Consequently, there is growing interest in studying the role of patients in treatment decision making. We studied how patients with stage I NSCLC perceived shared decision making (SDM) in general, and how they viewed different aspects of SDM. Methods A sequential mixed methods design was used, consisting of qualitative interviews (N = 11), as well as a survey study (N = 76) focusing on different SDM-related aspects. Participants were interviewed to understand their own experience with treatment decision making. In the survey study, patients rated the importance of 20 aspects of shared decision making that were identified during interviews. Descriptive analysis and explorative factor analysis were performed. Results We assessed six qualitative themes covering SDM aspects that were determined by patients to be important. The survey identified four SDM-related factors with sufficient internal consistency, namely (1) ‘guidance by clinician’ (α = .741), (2) ‘conduct of clinician’ (α = .774); (3) ‘preparation for treatment decision making’ (α = .864); and (4) ‘active role of patient in treatment decision making’ (α = .782). Of these, clinician guidance was rated as most important by patients (M = 3.61; SD = .44). Only 28.9 % of patients in the survey study reported that both treatment options were discussed with them. Conclusions Patients with a stage I NSCLC found clinician guidance to be important when making treatment decisions. Nevertheless, the majority of patients reported not being offered both treatment options, which might have influenced this finding.
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Affiliation(s)
- Wendy Hopmans
- Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. .,Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Olga C Damman
- Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Suresh Senan
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, The Netherlands.
| | - Koen J Hartemink
- Department of Surgery, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
| | - Egbert F Smit
- Department of Pulmonary Diseases, VU University Medical Center, Amsterdam, The Netherlands. .,Department of Thoracic Oncology, Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
| | - Danielle R M Timmermans
- Department of Public and Occupational Health, EMGO+ Institute for Health and care research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
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Abstract
IMPORTANCE Guidelines recommend individualizing screening mammography decisions for women aged 75 years and older. However, little pragmatic guidance is available to help counsel patients. OBJECTIVE To provide an evidence-based approach for individualizing decision-making about screening mammography in older women. EVIDENCE ACQUISITION We searched PubMed for English-language studies in peer-reviewed journals published from January 1, 1990, to February 1, 2014, to identify risk factors for late-life breast cancer in women aged 65 years and older and to quantify the benefits and harms of screening mammography for women aged 75 years and older. FINDINGS Age is the major risk factor for developing and dying from breast cancer. Breast cancer risk factors that reflect hormonal exposures in the distant past, such as age at first birth or age at menarche, are less predictive of late-life breast cancer than factors indicating recent hormonal exposures such as high bone mass or obesity. Randomized trials of the benefits of screening mammography did not include women older than 74 years. Thus it is not known if screening mammography benefits older women. Observational studies favor extending screening mammography to older women who have a life expectancy of more than 10 years. Modeling studies estimate 2 fewer breast cancer deaths/1000 women who in their 70s continue biennial screening for 10 years instead of stopping screening at age 69. Potential harms of continued screening over 10 years include false-positive mammograms in approximately 200/1000 women screened and overdiagnosis (ie, finding breast cancer that would not have clinically surfaced otherwise) in approximately 13/1000 women screened. Providing information about life expectancy along with potential benefits and harms of screening may help older women's decision-making about screening mammography. CONCLUSIONS AND RELEVANCE For women with less than a 10-year life expectancy, recommendations to stop screening mammography should emphasize increased potential harms from screening and highlight health promotion measures likely to be beneficial over the short term. For women with a life expectancy of more than 10 years, deciding whether potential benefits of screening outweigh harms becomes a value judgment for patients, requiring a realistic understanding of screening outcomes.
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Affiliation(s)
- Louise C. Walter
- University of California, San Francisco and the San Francisco VA Medical Center, Boston, MA
| | - Mara A. Schonberg
- Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA
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21
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Schonberg MA, Hamel MB, Davis RB, Griggs MC, Wee CC, Fagerlin A, Marcantonio ER. Development and evaluation of a decision aid on mammography screening for women 75 years and older. JAMA Intern Med 2014; 174:417-24. [PMID: 24378846 PMCID: PMC4017368 DOI: 10.1001/jamainternmed.2013.13639] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
IMPORTANCE Guidelines recommend that women 75 years and older should be informed of the benefits and risks of mammography before being screened. However, few are adequately informed. OBJECTIVES To develop and evaluate a mammography screening decision aid (DA) for women 75 years and older. DESIGN We designed the DA using international standards. Between July 14, 2010, and April 10, 2012, participants completed a pretest survey and read the DA before an appointment with their primary care physician. They completed a posttest survey after their appointment. Medical records were reviewed for follow-up information. SETTING AND PARTICIPANTS Boston, Massachusetts, academic primary care practice. Eligible women were aged 75 to 89 years, English speaking, had not had a mammogram in 9 months but had been screened within the past 3 years, and did not have a history of dementia or invasive or noninvasive breast cancer. Of 84 women approached, 27 declined to participate, 12 were unable to complete the study for logistical reasons, and 45 participated. INTERVENTIONS The DA includes information on breast cancer risk, life expectancy, competing mortality risks, possible outcomes of screening, and a values clarification exercise. MAIN OUTCOMES AND MEASURES Knowledge of the benefits and risks of screening, decisional conflict, and screening intentions; documentation in the medical record of a discussion of the risks and benefits of mammography with a primary care physician within 6 months; and the receipt of screening within 15 months. We used the Wilcoxon signed rank test and McNemar test to compare pretest-posttest information. RESULTS The median age of participants was 79 years, 69% (31 of 45) were of non-Hispanic white race/ethnicity, and 60% (27 of 45) had attended at least some college. Comparison of posttest results with pretest results demonstrated 2 findings. First, knowledge of the benefits and risks of screening improved (P < .001). Second, fewer participants intended to be screened (56% [25 of 45] afterward compared with 82% [37 of 45] before, P = .03). Decisional conflict declined but not significantly (P = .10). In the following 6 months, 53% (24 of 45) of participants had a primary care physician note that documented the discussion of the risks and benefits of screening compared with 11% (5 of 45) in the previous 5 years (P < .001). While 84% (36 of 43) had been screened within 2 years of participating, 60% (26 of 43) were screened within 15 months after participating (≥ 2 years since their last mammogram) (P = .01). Overall, 93% (42 of 45) found the DA helpful. CONCLUSIONS AND RELEVANCE A DA may improve older women's decision making about mammography screening.
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Affiliation(s)
- Mara A Schonberg
- Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mary Beth Hamel
- Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Roger B Davis
- Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - M Cecilia Griggs
- Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Christina C Wee
- Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Angela Fagerlin
- Center for Bioethics and Social Sciences in Medicine, Departments of Internal Medicine and Psychology, University of Michigan, and Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan
| | - Edward R Marcantonio
- Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, and Beth Israel Deaconess Medical Center, Boston, Massachusetts
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22
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Cao S, Liu Y. Effects of concurrent tasks on diagnostic decision making: An experimental investigation. ACTA ACUST UNITED AC 2013. [DOI: 10.1080/19488300.2013.858378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Walsh LA, Stock ML, Peterson LM, Gerrard M. Women's sun protection cognitions in response to UV photography: the role of age, cognition, and affect. J Behav Med 2013; 37:553-63. [PMID: 23624642 DOI: 10.1007/s10865-013-9512-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 04/15/2013] [Indexed: 11/26/2022]
Abstract
This study examined the impact of ultraviolet (UV) photography, cognition versus affect, and age on women's sun-related cognitions and a proxy measure of sun protection behavior. Participants (N = 114) were recruited via public advertisements and came to the lab to view a photo showing their UV damage. In addition, some participants received instructions to focus on either their thoughts (cognition) or feelings (affect) about their photograph before completing the survey. Women in the affect condition reported the lowest perceived vulnerability to skin cancer and highest absent/exempt beliefs (beliefs that one is unlikely to develop skin cancer if she hasn't already). Condition by age interactions showed that, among those in the cognition and control (no instructions) conditions, older women reported higher perceived vulnerability and lower absent/exempt beliefs, and took more sunscreen than younger women. However, older women reported higher absent/exempt beliefs and higher sun-risk willingness than younger women in the affect condition.
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Affiliation(s)
- Laura A Walsh
- Department of Psychology, The George Washington University, Washington, DC, 20052, USA,
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Zwijnenberg NC, Hendriks M, Damman OC, Bloemendal E, Wendel S, de Jong JD, Rademakers J. Understanding and using comparative healthcare information; the effect of the amount of information and consumer characteristics and skills. BMC Med Inform Decis Mak 2012; 12:101. [PMID: 22958295 PMCID: PMC3483238 DOI: 10.1186/1472-6947-12-101] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Accepted: 08/23/2012] [Indexed: 12/03/2022] Open
Abstract
Background Consumers are increasingly exposed to comparative healthcare information (information about the quality of different healthcare providers). Partly because of its complexity, the use of this information has been limited. The objective of this study was to examine how the amount of presented information influences the comprehension and use of comparative healthcare information when important consumer characteristics and skills are taken into account. Methods In this randomized controlled experiment, comparative information on total hip or knee surgery was used as a test case. An online survey was distributed among 800 members of the NIVEL Insurants Panel and 76 hip- or knee surgery patients. Participants were assigned to one of four subgroups, who were shown 3, 7, 11 or 15 quality aspects of three hospitals. We conducted Kruskall-Wallis tests, Chi-square tests and hierarchical multiple linear regression analyses to examine relationships between the amount of information and consumer characteristics and skills (literacy, numeracy, active choice behaviour) on one hand, and outcome measures related to effectively using information (comprehension, perceived usefulness of information, hospital choice, ease of making a choice) on the other hand. Results 414 people (47%) participated. Regression analysis showed that the amount of information slightly influenced the comprehension and the perceived usefulness of comparative healthcare information. It did not affect consumers’ hospital choice and ease of making this choice. Consumer characteristics (especially age) and skills (especially literacy) were the most important factors affecting the comprehension of information and the ease of making a hospital choice. For the perceived usefulness of comparative information, active choice behaviour was the most influencing factor. Conclusion The effects of the amount of information were not unambiguous. It remains unclear what the ideal amount of quality information to be presented would be. Reducing the amount of information will probably not automatically result in more effective use of comparative healthcare information by consumers. More important, consumer characteristics and skills appeared to be more influential factors contributing to information comprehension and use. Consequently, we would suggest that more emphasis on improving consumers’ skills is needed to enhance the use of comparative healthcare information.
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Affiliation(s)
- Nicolien C Zwijnenberg
- NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, Utrecht 3500 BN, the Netherlands.
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26
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Diefenbach MA, Mohamed NE, Butz BP, Bar-Chama N, Stock R, Cesaretti J, Hassan W, Samadi D, Hall SJ. Acceptability and preliminary feasibility of an internet/CD-ROM-based education and decision program for early-stage prostate cancer patients: randomized pilot study. J Med Internet Res 2012; 14:e6. [PMID: 22246148 PMCID: PMC3846339 DOI: 10.2196/jmir.1891] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 09/26/2011] [Accepted: 09/27/2011] [Indexed: 11/17/2022] Open
Abstract
Background Prostate cancer is the most common cancer affecting men in the United States. Management options for localized disease exist, yet an evidence-based criterion standard for treatment still has to emerge. Although 5-year survival rates approach 98%, all treatment options carry the possibility for significant side effects, such as erectile dysfunction and urinary incontinence. It is therefore recommended that patients be actively involved in the treatment decision process. We have developed an Internet/CD-ROM-based multimedia Prostate Interactive Educational System (PIES) to enhance patients’ treatment decision making. PIES virtually mirrors a health center to provide patients with information about prostate cancer and its treatment through an intuitive interface, using videos, animations, graphics, and texts. Objectives (1) To examine the acceptability and feasibility of the PIES intervention and to report preliminary outcomes of the program in a pilot trial among patients with a new prostate cancer diagnosis, and (2) to explore the potential impact of tailoring PIES treatment information to participants’ information-seeking styles on study outcomes. Methods Participants (n = 72) were patients with newly diagnosed localized prostate cancer who had not made a treatment decision. Patients were randomly assigned to 3 experimental conditions: (1) control condition (providing information through standard National Cancer Institute brochures; 26%), and PIES (2) with tailoring (43%) and (3) without tailoring to a patient’s information-seeking style (31%). Questionnaires were administrated before (t1) and immediately after the intervention (t2). Measurements include evaluation and acceptability of the PIES intervention, monitoring/blunting information-seeking style, psychological distress, and decision-related variables (eg, decisional confidence, feeling informed about prostate cancer and treatment, and treatment preference). Results The PIES program was well accepted by patients and did not interfere with the clinical routine. About 79% of eligible patients (72/91) completed the pre- and post-PIES intervention assessments. Patients in the PIES groups compared with those in the control condition were significantly more likely to report higher levels of confidence in their treatment choices, higher levels of helpfulness of the information they received in making a treatment decision, and that the information they received was emotionally reassuring. Patients in the PIES groups compared with those in the control condition were significantly less likely to need more information about treatment options, were less anxious about their treatment choices, and thought the information they received was clear (P < .05). Tailoring PIES information to information-seeking style was not related to decision-making variables. Conclusions This pilot study confirms that the implementation of PIES within a clinical practice is feasible and acceptable to patients with a recent diagnosis of prostate cancer. PIES improved key decision-making process variables and reduced the emotional impact of a difficult medical decision.
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Affiliation(s)
- Michael A Diefenbach
- Mount Sinai School of Medicine, Departments of Urology & Oncological Sciences, Mount Sinai School of Medicine, New York, NY 10029-0751, United States.
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Pieters HC, Heilemann MV, Maliski S, Dornig K, Mentes J. Instrumental Relating and Treatment Decision Making Among Older Women With Early-Stage Breast Cancer. Oncol Nurs Forum 2011; 39:E10-9. [DOI: 10.1188/12.onf.e10-e19] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Physiciansʼ communication of Down syndrome screening test results: The influence of physician numeracy. Genet Med 2011; 13:744-9. [DOI: 10.1097/gim.0b013e31821a370f] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Strohschein FJ, Bergman H, Carnevale FA, Loiselle CG. Patient decision making among older individuals with cancer. QUALITATIVE HEALTH RESEARCH 2011; 21:900-926. [PMID: 21343431 DOI: 10.1177/1049732311399778] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Patient decision making is an area of increasing inquiry. For older individuals experiencing cancer, variations in health and functional status, physiologic aspects of aging, and tension between quality and quantity of life present unique challenges to treatment-related decision making. We used the pragmatic utility method to analyze the concept of patient decision making in the context of older individuals with cancer. We first evaluated its maturity in existing literature and then posed analytical questions to clarify aspects found to be only partially mature. In this context, we found patient decision making to be an ongoing process, changing with time, reflecting individual and relational components, as well as analytical and emotional ones. Assumptions frequently associated with patient decision making were not consistent with the empirical literature. Careful attention to the multifaceted components of patient decision making among older individuals with cancer provides guidance for research, supportive interventions, and targeted follow-up care.
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Cunningham CE, Deal K, Chen Y. Adaptive choice-based conjoint analysis: a new patient-centered approach to the assessment of health service preferences. THE PATIENT 2010; 3:257-73. [PMID: 22273433 PMCID: PMC3580138 DOI: 10.2165/11537870-000000000-00000] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Conjoint analysis (CA) has emerged as an important approach to the assessment of health service preferences. This article examines Adaptive Choice-Based Conjoint Analysis (ACBC) and reviews available evidence comparing ACBC with conventional approaches to CA. ACBC surveys more closely approximate the decision-making processes that influence real-world choices. Informants begin ACBC surveys by completing a build-your-own (BYO) task identifying the level of each attribute that they prefer. The ACBC software composes a series of attribute combinations clustering around each participant's BYO choices. During the Screener section, informants decide whether each of these concepts is a possibility or not. Probe questions determine whether attribute levels consistently included in or excluded from each informant's Screener section choices reflect 'Unacceptable' or 'Must Have' simplifying heuristics. Finally, concepts identified as possibilities during the Screener section are carried forward to a Choice Tournament. The winning concept in each Choice Tournament set advances to the next choice set until a winner is determined.A review of randomized trials and cross-over studies suggests that, although ACBC surveys require more time than conventional approaches to CA, informants find ACBC surveys more engaging. In most studies, ACBC surveys yield lower standard errors, improved prediction of hold-out task choices, and better estimates of real-world product decisions than conventional choice-based CA surveys.
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Affiliation(s)
- Charles E. Cunningham
- />McMaster Children’s Hospital, Hamilton, Ontario Canada
- />Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario Canada
| | - Ken Deal
- />Strategic Market Leadership and Health Services Management, DeGroote School of Business, McMaster University, Hamilton, Ontario Canada
| | - Yvonne Chen
- />Health Research Methodology, Department of Health Science, McMaster University, Hamilton, Ontario Canada
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Bellizzi KM, Mustian KM, Bowen DJ, Resnick B, Miller SM. Aging in the context of cancer prevention and control : perspectives from behavioral medicine. Cancer 2009; 113:3479-83. [PMID: 19058144 DOI: 10.1002/cncr.23937] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Keith M Bellizzi
- Human Development and Family Studies, University of Connecticut, Storrs, Connecticut 06269-2058, USA.
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