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Ancker JS, Benda NC, Zikmund-Fisher BJ. Insufficient evidence for interactive or animated graphics for communicating probability. J Am Med Inform Assoc 2024:ocae123. [PMID: 38904366 DOI: 10.1093/jamia/ocae123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/17/2024] [Accepted: 05/15/2024] [Indexed: 06/22/2024] Open
Abstract
OBJECTIVES We sought to analyze interactive visualizations and animations of health probability data (such as chances of disease or side effects) that have been studied in head-to-head comparisons with either static graphics or numerical communications. MATERIALS AND METHODS Secondary analysis of a large systematic review on ways to communicate numbers in health. RESULTS We group the research to show that 4 types of animated or interactive visualizations have been studied by multiple researchers: those that simulate experience of probabilistic events; those that demonstrate the randomness of those events; those that reduce information overload by directing attention sequentially to different items of information; and those that promote elaborative thinking. Overall, these 4 types of visualizations do not show strong evidence of improving comprehension, risk perception, or health behaviors over static graphics. DISCUSSION Evidence is not yet strong that interactivity or animation is more effective than static graphics for communicating probabilities in health. We discuss 2 possibilities: that the most effective visualizations haven't been studied, and that the visualizations aren't effective. CONCLUSION Future studies should rigorously compare participant performance with novel interactive or animated visualizations against their performance with static visualizations. Such evidence would help determine whether health communicators should emphasize novel interactive visualizations or rely on older forms of visual communication, which may be accessible to broader audiences, including those with limited digital access.
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Affiliation(s)
- Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37209, United States
| | - Natalie C Benda
- Columbia School of Nursing, New York, NY 10032, United States
| | - Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, Department of Internal Medicine, and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI 48109, United States
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2
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Reading Turchioe M, Mangal S. Health literacy, numeracy, graph literacy, and digital literacy: an overview of definitions, evaluation methods, and best practices. Eur J Cardiovasc Nurs 2024; 23:423-428. [PMID: 37590968 PMCID: PMC11129894 DOI: 10.1093/eurjcn/zvad085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 08/19/2023]
Abstract
Health literacy is an important skill for people receiving care. Those with limited literacy face disparities in their care and health outcomes when strategies for addressing literacy are not used when delivering health information. In this article, we introduce the importance of considering health literacy, defining it and related concepts including numeracy, graph literacy, and digital literacy, and discuss open questions about measuring health literacy in clinical care. Finally, we present best practices, including assuming 'universal precautions', carefully considering wording, leveraging visualizations, recognizing cultural differences in interpretation, providing guidance on pilot testing, and considering digital literacy when developing electronic materials.
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Affiliation(s)
| | - Sabrina Mangal
- University of Washington School of Nursing, Seattle, WA, USA
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Naser-Tavakolian A, Gale R, Luu M, Masterson JM, Venkataramana A, Khodyakov D, Anger JT, Posadas E, Sandler H, Freedland SJ, Spiegel B, Daskivich TJ. Use of Persuasive Language in Communication of Risk during Prostate Cancer Treatment Consultations. Med Decis Making 2024; 44:320-334. [PMID: 38347686 PMCID: PMC11102816 DOI: 10.1177/0272989x241228612] [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] [Indexed: 04/04/2024]
Abstract
BACKGROUND Physician treatment preference may influence how risks are communicated in prostate cancer consultations. We identified persuasive language used when describing cancer prognosis, life expectancy, and side effects in relation to a physician's recommendation for aggressive (surgery/radiation) or nonaggressive (active surveillance/watchful waiting) treatment. METHODS A qualitative analysis was performed on transcribed treatment consultations of 40 men with low- and intermediate-risk prostate cancer across 10 multidisciplinary providers. Quotes pertaining to cancer prognosis, life expectancy, and side effects were randomized. Coders predicted physician treatment recommendations from isolated blinded quotes. Testing characteristics of consensus predictions against the physician's treatment recommendation were reported. Coders then identified persuasive strategies favoring aggressive/nonaggressive treatment for each quote. Frequencies of persuasive strategies favoring aggressive/nonaggressive treatment were reported. Logistic regression quantified associations between persuasive strategies and physician treatment recommendations. RESULTS A total of 496 quotes about cancer prognosis (n = 127), life expectancy (n = 51), and side effects (n = 318) were identified. The accuracy of predicting treatment recommendation based on individual quotes containing persuasive language (n = 256/496, 52%) was 91%. When favoring aggressive treatment, persuasive language downplayed side effect risks and amplified cancer risk (recurrence, progression, or mortality). Significant predictors (P < 0.05) of aggressive treatment recommendation included favorable side effect interpretation, downplaying side effects, and long time horizon for cancer risk due to longevity. When favoring nonaggressive treatment, persuasive language amplified side effect risks and downplayed cancer risk. Significant predictors of nonaggressive treatment recommendation included unfavorable side effect interpretation, favorable interpretation of cancer risk, and short time horizon for cancer risk due to longevity. CONCLUSIONS Physicians use persuasive language favoring their preferred treatment, regardless of whether their recommendation is appropriate. IMPLICATIONS Clinicians should quantify risk so patients can judge potential harm without solely relying on persuasive language. HIGHLIGHTS Physicians use persuasive language favoring their treatment recommendation when communicating risks of prostate cancer treatment, which may influence a patient's treatment choice.Coders predicted physician treatment recommendations based on isolated, randomized quotes about cancer prognosis, life expectancy, and side effects with 91% accuracy.Qualitative analysis revealed that when favoring nonaggressive treatment, physicians used persuasive language that amplified side effect risks and downplayed cancer risk. When favoring aggressive treatment, physicians did the opposite.Providers should be cognizant of using persuasive strategies and aim to provide quantified assessments of risk that are jointly interpreted with the patient so that patients can make evidence-based conclusions regarding risks without solely relying on persuasive language.
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Affiliation(s)
| | - Rebecca Gale
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Cedars-Sinai Medical Center, Los Angeles, CA
| | - Michael Luu
- Department of Biostatistics, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | | | | | - Jennifer T. Anger
- Department of Urology, University of California, San Diego, San Diego, CA
| | - Edwin Posadas
- Department of Medicine, Division of Medical Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Howard Sandler
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Stephen J. Freedland
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
- Section of Urology, Durham VA Medical Center, Durham, NC
| | - Brennan Spiegel
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Cedars-Sinai Medical Center, Los Angeles, CA
- Department of Medicine, Divisions of Gastroenterology and Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Timothy J. Daskivich
- Department of Urology, Cedars-Sinai Medical Center, Los Angeles, CA
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Cedars-Sinai Medical Center, Los Angeles, CA
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Slavik CE, Chapman DA, Cohen AS, Bendefaa N, Peters E. Clearing the air: evaluating institutions' social media health messaging on wildfire and smoke risks in the US Pacific Northwest. BMC Public Health 2024; 24:379. [PMID: 38317121 PMCID: PMC10840270 DOI: 10.1186/s12889-024-17907-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/27/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Wildfire smoke contributes substantially to the global disease burden and is a major cause of air pollution in the US states of Oregon and Washington. Climate change is expected to bring more wildfires to this region. Social media is a popular platform for health promotion and a need exists for effective communication about smoke risks and mitigation measures to educate citizens and safeguard public health. METHODS Using a sample of 1,287 Tweets from 2022, we aimed to analyze temporal Tweeting patterns in relation to potential smoke exposure and evaluate and compare institutions' use of social media communication best practices which include (i) encouraging adoption of smoke-protective actions; (ii) leveraging numeric, verbal, and Air Quality Index risk information; and (iii) promoting community-building. Tweets were characterized using keyword searches and the Linguistic Inquiry and Word Count (LIWC) software. Descriptive and inferential statistics were carried out. RESULTS 44% of Tweets in our sample were authored between January-August 2022, prior to peak wildfire smoke levels, whereas 54% of Tweets were authored during the two-month peak in smoke (September-October). Institutional accounts used Twitter (or X) to encourage the adoption of smoke-related protective actions (82% of Tweets), more than they used it to disseminate wildfire smoke risk information (25%) or promote community-building (47%). Only 10% of Tweets discussed populations vulnerable to wildfire smoke health effects, and 14% mentioned smoke mitigation measures. Tweets from Washington-based accounts used significantly more verbal and numeric risk information to discuss wildfire smoke than Oregon-based accounts (p = 0.042 and p = 0.003, respectively); however, Tweets from Oregon-based accounts on average contained a higher percentage of words associated with community-building language (p < 0.001). CONCLUSIONS This research provides practical recommendations for public health practitioners and researchers communicating wildfire smoke risks on social media. As exposures to wildfire smoke rise due to climate change, reducing the environmental disease burden requires health officials to leverage popular communication platforms, distribute necessary health-related messaging rapidly, and get the message right. Timely, evidence-based, and theory-driven messaging is critical for educating and empowering individuals to make informed decisions about protecting themselves from harmful exposures. Thus, proactive and sustained communications about wildfire smoke should be prioritized even during wildfire "off-seasons."
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Affiliation(s)
- Catherine E Slavik
- School of Journalism and Communication, University of Oregon, 1715 Franklin Boulevard, Eugene, OR, 97403, USA.
- Center for Science Communication Research, University of Oregon, Eugene, OR, USA.
| | - Daniel A Chapman
- School of Journalism and Communication, University of Oregon, 1715 Franklin Boulevard, Eugene, OR, 97403, USA
- Center for Science Communication Research, University of Oregon, Eugene, OR, USA
| | - Alex Segrè Cohen
- School of Journalism and Communication, University of Oregon, 1715 Franklin Boulevard, Eugene, OR, 97403, USA
- Center for Science Communication Research, University of Oregon, Eugene, OR, USA
| | - Nahla Bendefaa
- School of Journalism and Communication, University of Oregon, 1715 Franklin Boulevard, Eugene, OR, 97403, USA
| | - Ellen Peters
- School of Journalism and Communication, University of Oregon, 1715 Franklin Boulevard, Eugene, OR, 97403, USA
- Center for Science Communication Research, University of Oregon, Eugene, OR, USA
- Department of Psychology, University of Oregon, Eugene, OR, USA
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Desai PM, Harkins S, Rahman S, Kumar S, Hermann A, Joly R, Zhang Y, Pathak J, Kim J, D’Angelo D, Benda NC, Reading Turchioe M. Visualizing machine learning-based predictions of postpartum depression risk for lay audiences. J Am Med Inform Assoc 2024; 31:289-297. [PMID: 37847667 PMCID: PMC10797282 DOI: 10.1093/jamia/ocad198] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 08/15/2023] [Accepted: 09/28/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVES To determine if different formats for conveying machine learning (ML)-derived postpartum depression risks impact patient classification of recommended actions (primary outcome) and intention to seek care, perceived risk, trust, and preferences (secondary outcomes). MATERIALS AND METHODS We recruited English-speaking females of childbearing age (18-45 years) using an online survey platform. We created 2 exposure variables (presentation format and risk severity), each with 4 levels, manipulated within-subject. Presentation formats consisted of text only, numeric only, gradient number line, and segmented number line. For each format viewed, participants answered questions regarding each outcome. RESULTS Five hundred four participants (mean age 31 years) completed the survey. For the risk classification question, performance was high (93%) with no significant differences between presentation formats. There were main effects of risk level (all P < .001) such that participants perceived higher risk, were more likely to agree to treatment, and more trusting in their obstetrics team as the risk level increased, but we found inconsistencies in which presentation format corresponded to the highest perceived risk, trust, or behavioral intention. The gradient number line was the most preferred format (43%). DISCUSSION AND CONCLUSION All formats resulted high accuracy related to the classification outcome (primary), but there were nuanced differences in risk perceptions, behavioral intentions, and trust. Investigators should choose health data visualizations based on the primary goal they want lay audiences to accomplish with the ML risk score.
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Affiliation(s)
- Pooja M Desai
- Department of Biomedical Informatics, Columbia University, New York, NY 10032, United States
| | - Sarah Harkins
- Columbia University School of Nursing, New York, NY 10032, United States
| | - Saanjaana Rahman
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY 10065, United States
| | - Shiveen Kumar
- College of Agriculture and Life Science University, Cornell University, Ithaca, NY 14850, United States
| | - Alison Hermann
- Department of Psychiatry, Weill Cornell Medical College, New York, NY 10065, United States
| | - Rochelle Joly
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY 10065, United States
| | - Yiye Zhang
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY 10065, United States
| | - Jyotishman Pathak
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY 10065, United States
| | - Jessica Kim
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY 10065, United States
| | - Deborah D’Angelo
- Department of Population Health Sciences, Weill Cornell Medical College, New York, NY 10065, United States
| | - Natalie C Benda
- Columbia University School of Nursing, New York, NY 10032, United States
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Matsumura A, Garg R, Hussain M, Matsumura ME. Political orientation of online media sources and reporting of Covid-19 vaccine myocarditis. PLoS One 2024; 19:e0296295. [PMID: 38166122 PMCID: PMC10760870 DOI: 10.1371/journal.pone.0296295] [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: 07/07/2023] [Accepted: 11/28/2023] [Indexed: 01/04/2024] Open
Abstract
BACKGROUND Political orientation may play a formative role in perceptions of risk associated with COVID-19 vaccination including vaccine myocarditis (CVM). Whether political alignment of news sources plays a role in perception of this risk is unknown. OBJECTIVE We examined the relationship between political orientation of online media sites and aspects of reporting of CVM. METHODS Media sites were classified as "left" or "right" biased using the Allsides media bias rating report. For each site "COVID vaccine myocarditis" was searched in articles posted May 2021 to December 2022. Each search return was reviewed for the following: 1) Did it contain numerical data regarding CVM risk? 2) Did it report benefits of covid vaccination? 3) Did it mention covid infection-related myocarditis? Monthly reports of vaccine-related adverse events were obtained from the Vaccine Adverse Events Reporting System (VAERS). RESULTS A total of 487 online reports regarding CVM were reviewed. Comparison of monthly report volumes from left vs. right biased media sources demonstrated significant correlation (r = 0.546, p = 0.013). Additionally monthly reporting of CVM was temporally related to monthly volume of VAERS reporting (r = 0.519, p = 0.023). These data suggest that monthly reporting volumes were driven by availability of information regarding CVM rather than media political alignment. Left biased media sources were significantly more likely to include numerical CVM data vs. right biased sources (76.6% vs. 24.3%, p<0.001) and likewise were more likely to include data supporting benefits of covid vaccination (85.1% vs. 21.7%. p<0.001). In contrast, there was no difference regarding mention of COVID-19 infection-related myocarditis (24.5% vs. 24.3%, p = 0.957). CONCLUSION Political orientation of online news sites was not associated with frequency of CVM reports but was related to report content, most notably whether reports included numerical data regarding CVM risk. These differential reporting characteristics may contribute to the relationship between political orientation and patient conceptualization of risk of CVM.
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Affiliation(s)
- Addison Matsumura
- Department of Biological Sciences, Oberlin College, Oberlin, OH, United States of America
| | - Ria Garg
- Internal Medicine Residency Program, Geisinger Health System, Wilkes-Barre, PA, United States of America
| | - Muzna Hussain
- Internal Medicine Residency Program, Geisinger Health System, Wilkes-Barre, PA, United States of America
| | - Martin E. Matsumura
- The Pearsall Heart Hospital, Geisinger Health System, Wilkes-Barre, PA, United States of America
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7
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Schweinsberg M, Thau S, Pillutla M. Research-Problem Validity in Primary Research: Precision and Transparency in Characterizing Past Knowledge. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2023; 18:1230-1243. [PMID: 36745743 PMCID: PMC10475212 DOI: 10.1177/17456916221144990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Four validity types evaluate the approximate truth of inferences communicated by primary research. However, current validity frameworks ignore the truthfulness of empirical inferences that are central to research-problem statements. Problem statements contrast a review of past research with other knowledge that extends, contradicts, or calls into question specific features of past research. Authors communicate empirical inferences, or quantitative judgments, about the frequency (e.g., "few," "most") and variability (e.g., "on the one hand," "on the other hand") in their reviews of existing theories, measures, samples, or results. We code a random sample of primary research articles and show that 83% of quantitative judgments in our sample are vague and do not have a transparent origin, making it difficult to assess their validity. We review validity threats of current practices. We propose that documenting the literature search, reporting how the search was coded, and quantifying the search results facilitates more precise judgments and makes their origin transparent. This practice enables research questions that are more closely tied to the existing body of knowledge and allows for more informed evaluations of the contribution of primary research articles, their design choices, and how they advance knowledge. We discuss potential limitations of our proposed framework.
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8
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Bagautdinova D, Wang S, Brito JP, Bylund CL, Edwards C, Silver N, Danan D, Treise D, Maraka S, Hargraves I, Singh Ospina N. Thyroid Cancer Risk Communication in Patients with Thyroid Nodules. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1234-1240. [PMID: 36602695 PMCID: PMC10319912 DOI: 10.1007/s13187-022-02253-w] [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] [Accepted: 12/11/2022] [Indexed: 05/05/2023]
Abstract
The objective of this study is to evaluate thyroid cancer risk clinician-patient communication among patients receiving usual counseling and counseling enhanced by a conversation aid. A secondary analysis of clinical visit recordings and post-visit surveys obtained during a trial assessing the impact of a conversation aid for patients with thyroid nodules was conducted. We assessed how thyroid cancer risk was communicated, different risk communication strategies between groups, and predictors of accurate cancer risk perception. Fifty-nine patients were analyzed. Most were women (90%) and middle-aged (median 57 years). A verbal description of thyroid cancer risk was present most frequently (83%) and was more frequent in the conversation aid than the usual care group (100% vs. 63%, p < 0.001). A numerical description using percentages was present in 41% of visits and was more frequent in the conversation aid group (59% vs. 19%, p = 0.012). Natural frequencies (7%) and positive/negative framing (10%) were utilized less commonly. Uncertainty about risks was not discussed. No predictors of accurate risk perception were identified. Clinicians most commonly present a verbal description of thyroid cancer risk. Less commonly, natural frequencies, negative/positive framing, or uncertainty is discussed. Clinicians caring for patients with thyroid nodules should be aware of different strategies for communicating thyroid cancer risk.
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Affiliation(s)
- Diliara Bagautdinova
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Shu Wang
- Center & Department of Biostatistics, University of Florida Health Cancer Center, University of Florida, Gainesville, FL, USA
| | - Juan P Brito
- Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA
| | - Carma L Bylund
- Health Outcomes & Biomedical Informatics, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Catherine Edwards
- Division of Endocrinology and Metabolism, Department of Medicine, University of Florida, 1600 SW Archer Road, Room H2, Gainesville, FL, 32606, USA
| | - Natalie Silver
- Center for Immunotherapy & Precision Immuno-Oncology, Head & Neck Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Deepa Danan
- Ear, Nose & Throat, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Debbie Treise
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Spyridoula Maraka
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN, USA
- Division of Endocrinology and Metabolism, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Endocrine Section, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA
| | - Ian Hargraves
- Knowledge and Evaluation Research Unit in Endocrinology (KER_Endo), Mayo Clinic, Rochester, MN, USA
| | - Naykky Singh Ospina
- Division of Endocrinology and Metabolism, Department of Medicine, University of Florida, 1600 SW Archer Road, Room H2, Gainesville, FL, 32606, USA.
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Dahm MR, Cattanach W, Williams M, Basseal JM, Gleason K, Crock C. Communication of Diagnostic Uncertainty in Primary Care and Its Impact on Patient Experience: an Integrative Systematic Review. J Gen Intern Med 2023; 38:738-754. [PMID: 36127538 PMCID: PMC9971421 DOI: 10.1007/s11606-022-07768-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 08/10/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Diagnostic uncertainty is a pervasive issue in primary care where patients often present with non-specific symptoms early in the disease process. Knowledge about how clinicians communicate diagnostic uncertainty to patients is crucial to prevent associated diagnostic errors. Yet, in-depth research on the interpersonal communication of diagnostic uncertainty has been limited. We conducted an integrative systematic literature review (PROSPERO CRD42020197624, unfunded) to investigate how primary care doctors communicate diagnostic uncertainty in interactions with patients and how patients experience their care in the face of uncertainty. METHODS We searched MEDLINE, PsycINFO, and Linguistics and Language Behaviour Abstracts (LLBA) from inception to December 2021 for MeSH and keywords related to 'communication', 'diagnosis', 'uncertainty' and 'primary care' environments and stakeholders (patients and doctors), and conducted additional handsearching. We included empirical primary care studies published in English on spoken communication of diagnostic uncertainty by doctors to patients. We assessed risk of bias with the QATSDD quality assessment tool and conducted thematic and content analysis to synthesise the results. RESULTS Inclusion criteria were met for 19 out of 1281 studies. Doctors used two main communication strategies to manage diagnostic uncertainty: (1) patient-centred communication strategies (e.g. use of empathy), and (2) diagnostic reasoning strategies (e.g. excluding serious diagnoses). Linguistically, diagnostic uncertainty was either disclosed explicitly or implicitly through diverse lexical and syntactical constructions, or not communicated (omission). Patients' experiences of care in response to the diverse communicative and linguistic strategies were mixed. Patient-centred approaches were generally regarded positively by patients. DISCUSSION Despite a small number of included studies, this is the first review to systematically catalogue the diverse communication and linguistic strategies to express diagnostic uncertainty in primary care. Health professionals should be aware of the diverse strategies used to express diagnostic uncertainty in practice and the value of combining patient-centred approaches with diagnostic reasoning strategies.
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Affiliation(s)
- Maria R Dahm
- Institute for Communication in Health Care (ICH), ANU College of Arts and Social Sciences, The Australian National University, Baldessin Precinct Building, 110 Ellery Crescent, Canberra, ACT 2600, Australia.
| | - William Cattanach
- ANU Medical School, ANU College of Health and Medicine, The Australian National University, Canberra, Australia
| | | | - Jocelyne M Basseal
- Discipline of Infectious Diseases & Immunology, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kelly Gleason
- Johns Hopkins School of Nursing, Baltimore City, MD, USA
| | - Carmel Crock
- Royal Victorian Eye and Ear Hospital, Melbourne, Australia
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10
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Rosen JE, Chang SSE, Williams S, Lee JS, Han D, Agrawal N, Joo JH, Hsieh G, Reinecke K, Liao JM. Association between Risk Communication Format and Perceived Risk of Adverse Events after COVID-19 Vaccination among US Adults. Healthcare (Basel) 2023; 11:healthcare11030380. [PMID: 36766956 PMCID: PMC9914684 DOI: 10.3390/healthcare11030380] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
The format used to communicate probability-verbal versus numerical descriptors-can impact risk perceptions and behaviors. This issue is salient for the Coronavirus disease 2019 (COVID-19), where concerns about vaccine-related risks may reduce uptake and verbal descriptors have been widely used by public health, news organizations and on social media, to convey risk. Because the effect of risk-communication format on perceived COVID-19 vaccine-related risks remains unknown, we conducted an online randomized survey among 939 US adults. Participants were given risk information, using verbal or numerical descriptors and were asked to report their perceived risk of experiencing headache, fever, fatigue or myocarditis from COVID-19 vaccine. Associations between risk communication format and perceived risk were assessed using multivariable regression. Compared to numerical estimates, verbal descriptors were associated with higher perceived risk of headache (β = 5.0 percentage points, 95% CI = 2.0-8.1), fever (β = 27 percentage points, 95% CI = 23-30), fatigue (β = 4.9 percentage points, 95% = CI 1.8-8.0) and myocarditis (β = 4.6 percentage points, 95% CI = 2.1-7.2), as well as greater variability in risk perceptions. Social media influence was associated with differences in risk perceptions for myocarditis, but not side effects. Verbal descriptors may lead to greater, more inaccurate and variable vaccine-related risk perceptions compared to numerical descriptors.
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Affiliation(s)
- Joshua E. Rosen
- Surgical Outcomes Research Center, Department of Surgery, University of Washington, Seattle, WA 98195, USA
- Correspondence: ; Tel.: +1-206-598-3300
| | | | - Spencer Williams
- Department of Human Centered Design & Engineering, University of Washington, Seattle, WA 98195, USA
| | - Joy S. Lee
- Department of Medicine, University of Washington, Seattle, WA 98195, USA
- Value and Systems Science Lab, Seattle, WA 98195, USA
| | - DaHee Han
- Desautels Faculty of Management, McGill University, Montreal, QC H3A 1G5, Canada
| | - Nidhi Agrawal
- Foster School of Business, University of Washington, Seattle, WA 98195, USA
| | - Joseph H. Joo
- Department of Medicine, University of Washington, Seattle, WA 98195, USA
- Value and Systems Science Lab, Seattle, WA 98195, USA
| | - Gary Hsieh
- Department of Human Centered Design & Engineering, University of Washington, Seattle, WA 98195, USA
| | - Katharina Reinecke
- Paul G. Allen School of Computer Science & Engineering, University of Washington, Seattle, WA 98195, USA
| | - Joshua M. Liao
- Department of Medicine, University of Washington, Seattle, WA 98195, USA
- Value and Systems Science Lab, Seattle, WA 98195, USA
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Sharko M, Sharma MM, Benda NC, Chan M, Wilsterman E, Liu LG, Demetres M, Delgado D, Ancker JS. Strategies to optimize comprehension of numerical medication instructions: A systematic review and concept map. PATIENT EDUCATION AND COUNSELING 2022; 105:1888-1903. [PMID: 35123834 PMCID: PMC9203902 DOI: 10.1016/j.pec.2022.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 12/13/2021] [Accepted: 01/25/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To develop evidence-based recommendations for improving comprehension of quantitative medication instructions. METHODS This review included a literature search from inception to November 2021. Studies were included for the following: 1) original research; 2) compared multiple formats for presenting quantitative medication information on dose, frequency, and/or time; 3) included patients/lay-people; 4) assessed comprehension-related outcomes quantitatively. To classify the studies, we developed a concept map. We weighed 3 factors (risk of bias in individual studies, consistency of findings among studies, and homogeneity of the interventions tested) to generate 3 levels of recommendations. RESULTS Twenty-one studies were included. Level 1 recommendations are: 1) use visualizations of medication doses for liquid medications, and 2) express instructions in time-periods rather than times per day. Level 2 recommendations include: validate icons, use panels or tables with explanatory text, use visualizations for non-English speaking populations and for those with low health literacy and limited English proficiency. CONCLUSIONS Visualized liquid medication doses and time period-based administration instructions improve comprehension of numerical medication instructions. Use of visualizations for those with limited health literacy and English proficiency could result in improved outcomes. PRACTICE IMPLICATIONS Practitioners should use visualizations for liquid medication instructions and time period-based instructions to improve outcomes.
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Affiliation(s)
- Marianne Sharko
- Dept. of Population Health Sciences, Division of Health Informatics, Weill Cornell Medical College, New York, NY, USA; Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA.
| | - Mohit M Sharma
- Dept. of Population Health Sciences, Division of Health Informatics, Weill Cornell Medical College, New York, NY, USA
| | - Natalie C Benda
- Dept. of Population Health Sciences, Division of Health Informatics, Weill Cornell Medical College, New York, NY, USA
| | - Melissa Chan
- Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
| | - Eric Wilsterman
- Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
| | - Lisa Grossman Liu
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | | | - Diana Delgado
- Weill Cornell Medicine Samuel J Wood Library, New York, NY, USA
| | - Jessica S Ancker
- Dept. of Population Health Sciences, Division of Health Informatics, Weill Cornell Medical College, New York, NY, USA; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
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What is a “likely” amount? Representative (modal) values are considered likely even when their probabilities are low. ORGANIZATIONAL BEHAVIOR AND HUMAN DECISION PROCESSES 2022. [DOI: 10.1016/j.obhdp.2022.104166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Liver drains after surgery: what is the real practice? An international snapshot from the Li.DR.A.S. survey. Updates Surg 2022; 74:1317-1326. [PMID: 35657558 DOI: 10.1007/s13304-022-01301-w] [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: 02/24/2022] [Accepted: 05/16/2022] [Indexed: 10/18/2022]
Abstract
Despite current evidence, the use of drains in liver surgery is still controversial. We conducted an international survey to investigate the clinical use of drains in the E-AHPBA, A-HPBA and A-PHPBA communities. An open survey of 30 questions was prepared on Google-Form and distributed by email to all members. One hundred and ninety-one HPB surgeons responded to the survey. One hundred and twelve surgeons (58.6%) reported routine use of abdominal drains after liver resections. Eighty-eight (46.1%) responded that removal was driven by low volume and low bilirubin levels in the drains. For minor liver resection, 97 (50.8%) surgeons reported using drains selectively; in contrast, 134 (70.2%) surgeons prefer to use a drain always after major procedures. Among patients with cirrhosis, 87 (45.5%) surgeons reported routine drains placement, while 84 (44.0%) considered drains selectively. A no-drain policy was most prevalent among surgeons from North America (80%) versus Asian-Pacific (70.0%), European and African (60.8%), and South American (61.5%) surgeons. Among minimally invasive surgeons, 74.2% reported drain use only in selected cases versus 35.0% among surgeons who performed open surgery. The practice of draining after liver surgery is still highly variable among centers and surgeons around the world, with a high variability according to the underlying liver condition and planned surgical approach.
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Dhami MK, Mandel DR. Communicating uncertainty using words and numbers. Trends Cogn Sci 2022; 26:514-526. [DOI: 10.1016/j.tics.2022.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/27/2022] [Accepted: 03/08/2022] [Indexed: 11/24/2022]
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