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Genie MG, Poudel N, Paolucci F, Ngorsuraches S. Choice Consistency in Discrete Choice Experiments: Does Numeracy Skill Matter? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024:S1098-3015(24)02782-7. [PMID: 39094694 DOI: 10.1016/j.jval.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/05/2024] [Accepted: 07/17/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVES This study investigated the relationship between numeracy skills (NS) and choice consistency in discrete choice experiments (DCEs). METHODS A DCE was conducted to explore patients' preferences for kidney transplantation in Italy. Patients completed the DCE and answered 3-item numeracy questions. A heteroskedastic multinomial logit model was used to investigate the effect of numeracy on choice consistency. RESULTS Higher NS were associated with greater choice consistency, increasing the scale to 1.63 (P < .001), 1.39 (P < .001), and 1.18 (P < .001) for patients answering 3 of 3, 2 of 3, and 1 of 3 questions correctly, respectively, compared with those with no correct answers. This corresponded to 63%, 39%, and 18% more consistent choices, respectively. Accounting for choice consistency resulted in varying willingness-to-wait (WTW) estimates for kidney transplant attributes. Patients with the lowest numeracy (0/3) were willing to wait approximately 42 months [95% CI: 29.37, 54.68] for standard infectious risk, compared with 33 months [95% CI: 28.48, 38.09] for 1 of 3, 28 months [95% CI: 25.13, 30.32] for 2 of 3, and 24 months [95% CI: 20.51, 27.25] for 3 of 3 correct answers. However, WTW differences for an additional year of graft survival and neoplastic risk were not statistically significant across numeracy levels. Supplementary analyses of 2 additional DCEs on COVID-19 vaccinations and rheumatoid arthritis, conducted online, supported these findings: higher NS were associated with more consistent choices across different disease contexts and survey formats. CONCLUSIONS The findings suggested that combining patients with varying NS could bias WTW estimates, highlighting the need to consider numeracy in DCE data analysis and interpretation.
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Affiliation(s)
- Mesfin G Genie
- Newcastle Business School, College of Human and Social Futures, The University of Newcastle, Australia; Department of Population Health Sciences, Duke University, Durham, NC, USA; Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK.
| | - Nabin Poudel
- Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL, USA; Department of Practice, Sciences, and Health Outcomes Research, University of Maryland, School of Pharmacy, Baltimore, MD, USA
| | - Francesco Paolucci
- Newcastle Business School, College of Human and Social Futures, The University of Newcastle, Australia
| | - Surachat Ngorsuraches
- Department of Health Outcomes Research and Policy, Auburn University, Auburn, AL, USA
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2
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Ben-Moshe N, Levinstein BA, Livengood J. Probability and informed consent. THEORETICAL MEDICINE AND BIOETHICS 2023; 44:545-566. [PMID: 37552358 DOI: 10.1007/s11017-023-09636-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 08/09/2023]
Abstract
In this paper, we illustrate some serious difficulties involved in conveying information about uncertain risks and securing informed consent for risky interventions in a clinical setting. We argue that in order to secure informed consent for a medical intervention, physicians often need to do more than report a bare, numerical probability value. When probabilities are given, securing informed consent generally requires communicating how probability expressions are to be interpreted and communicating something about the quality and quantity of the evidence for the probabilities reported. Patients may also require guidance on how probability claims may or may not be relevant to their decisions, and physicians should be ready to help patients understand these issues.
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Affiliation(s)
- Nir Ben-Moshe
- Department of Philosophy, University of Illinois at Urbana-Champaign, 200 Gregory Hall, 810 South Wright Street, Urbana, IL, 61801, USA.
| | - Benjamin A Levinstein
- Department of Philosophy, University of Illinois at Urbana-Champaign, 200 Gregory Hall, 810 South Wright Street, Urbana, IL, 61801, USA
| | - Jonathan Livengood
- Department of Philosophy, University of Illinois at Urbana-Champaign, 200 Gregory Hall, 810 South Wright Street, Urbana, IL, 61801, USA
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3
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Benn Y, Jayes M, Casassus M, Williams M, Jenkinson C, McGowan E, Conroy P. A qualitative study into the experience of living with acalculia after stroke and other forms of acquired brain injury. Neuropsychol Rehabil 2023; 33:1512-1536. [PMID: 35959752 DOI: 10.1080/09602011.2022.2108065] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/26/2022] [Indexed: 10/15/2022]
Abstract
Acalculia, an acquired disability following a brain injury, involves difficulty processing numerical information and/or calculations. Acalculia is not routinely screened for, and as a result there is a lack of understanding about the nature and prevalence and the impact of the condition. This qualitative study was initiated by stroke survivors with a strong interest in acalculia. Sixteen stroke/brain injury survivors with acalculia and seven carers were interviewed using semi-structured online interviews. Participants ranged in age, gender, time post-onset, country of residence and numeracy level prior to brain injury. Data were analysed using thematic analysis. Three main themes were identified: Awareness and Diagnosis; Emotional and Practical Impact (independence); Support, Coping Strategies and Self-training. Participants and carers repeatedly referred to the lack of awareness and treatment for acalculia and the impact acalculia has had on their lives and independence. Practical impacts included managing money, making appointments, using timetables, organizing social activities and employment, and managing medication. Our results highlight the urgent need to develop suitable assessments and interventions for acalculia and the scope for this to be Patient, Carer and Public involvement (PCPI)-led. The data also reveal useful strategies and suggestions regarding effective timing, targets and approaches for intervention.
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Affiliation(s)
- Yael Benn
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Mark Jayes
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
- Honorary Research Fellow, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Martin Casassus
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
- Universidad Autónoma de Chile, Providencia, Región Metropolitana, Chile
| | | | | | - Ellen McGowan
- Pennine Care NHS Foundation Trust, Greater Manchester and Derbyshire, UK
| | - Paul Conroy
- School of Health Sciences, University of Manchester, Manchester, UK
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Abstract
PURPOSE OF REVIEW Health literacy influences how children and families participate in their medical care, use health services, and overall health outcomes. Health literacy is underexplored in pediatric dermatology. In this scoping review, we provide examples of how limited health literacy can be a barrier to patient care in pediatric dermatology and how to mitigate its effects. RECENT FINDINGS Limited health literacy is associated with worse health outcomes, decreased medication adherence, and decreased use of the healthcare system versus those with adequate health literacy. Materials created to help patients understand their medical conditions and treatment options often are written at a reading level far above that of the average patient and caregiver. Given the reading level of patient-facing materials, those with limited health literacy are more susceptible to medication administration errors, with omissions or incorrect dosing being most frequent to occur. There is limited research about how skills related to health literacy, including numeracy and electronic health literacy, can be addressed in pediatric dermatology. SUMMARY Health literacy impacts patient care, treatment, and adherence in pediatric dermatology. This article gives examples of how to address common challenges in the pediatric dermatology clinic and presents areas for further research and improvement.
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Affiliation(s)
| | | | - Carrie C Coughlin
- Division of Dermatology, Departments of Medicine and Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
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Goldstein C, Woods N, MacKinnon R, Fazelzad R, Gill B, Giuliani ME, Papadakos T, Wei Q, Papadakos J. Numeracy Education for Health Care Providers: A Scoping Review. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 44:35-43. [PMID: 37341576 DOI: 10.1097/ceh.0000000000000504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
INTRODUCTION Health numeracy (numerical literacy) refers to an individual's ability to use numerical information to make effective health decisions. Numeracy is fundamental in the role of a health care provider, forming the basis of evidence-based medicine and effective patient-provider communication. Despite a high level of education, many health care providers struggle with numeracy. Numeracy is often integrated into training curricula; however, teaching modality, competencies covered, learner satisfaction, and effectiveness of these educational interventions varies. METHOD A scoping review was conducted to explore and summarize what is known about numeracy skills education programs for health care providers. A comprehensive literature search was conducted from January 2010 to April 2021 in 10 databases. Controlled vocabulary terms and text words were used. The search was restricted to human studies, adults, and the English language. Articles were included if they were related to numeracy education for health care providers or trainees and provided details regarding methods, evaluation, and results. RESULTS The literature search retrieved 31,611 results and 71 met the inclusion criteria. Most interventions were conducted in a university setting, and targeted nursing students, medical students, resident physicians, and pharmacy students. Common numeracy concepts included statistics/biostatistics, medication calculations, evidence-based medicine, research methodology, and epidemiology. A variety of teaching modalities were used, which most often combined active approaches (eg, workshops, laboratories, small-group exercises, and discussion boards) with passive approaches (eg, traditional lectures and didactic teaching). Measured outcomes included knowledge and skills, self-efficacy, attitudes, and engagement. DISCUSSION Although efforts have been made to incorporate numeracy into training curricula, greater emphasis should be placed on developing strong numeracy skills in health care providers, particularly given the role numerical information plays in clinical decision making, evidence-based practices, and patient-provider communication.
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Affiliation(s)
- Casey Goldstein
- Ms. Goldstein: Beginning a residency in Family Medicine at the University of Toronto, Ontario, Canada. Dr. Woods: Associate Professor, Temerty Faculty of Medicine, University of Toronto and Director, The Institute for Education Research, University Health Network, Toronto, Ontario, Canada. Ms. MacKinnon: Master of Public Health student at the University of Guelph, Guelph, Ontario, Canada. Ms. Fazelzad: Information Specialist at Library and Information Services University Health Network (UHN)-Princess Margaret Cancer Centre, Toronto, Ontario, Canada. Ms. Gill: A recent Master of Public Health graduate from Western University, London, Ontario. Dr. Giuliani: Director of Education at Princess Margaret Cancer Centre and an Associate Professor in the Department of Radiation Oncology, Toronto, Ontario, Canada. Ms. Papadakos: Co-Director, Cancer Self-Management Research Centre and Senior Manager Educational Design & Knowledge Translation, Cancer Education at the Princess Margaret Cancer Centre, Toronto, Ontario, Canada. Ms. Wei: Recent Master of Public Health graduate from Western University, London, Ontario, Canada. Dr. Papadakos: Co-Director, Cancer Health Literacy Research Centre, Princess Margaret Cancer Centre; Scientist, The Institute for Education Research, University Health Network; Assistant Professor, Dalla Lana School of Public Health, University of Toronto; and Provincial Head, Patient Education at Ontario Health, Toronto, Ontario, Canada
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Numeracy levels influence shared decision-making and surgical outcomes: A scoping review of the literature. Am J Surg 2023; 225:967-974. [PMID: 36623965 DOI: 10.1016/j.amjsurg.2023.01.002] [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: 10/17/2022] [Revised: 12/18/2022] [Accepted: 01/03/2023] [Indexed: 01/06/2023]
Abstract
BACKGROUND Health literacy has been widely studied with regard to medical decision-making and health care access, however research regarding numeracy - the ability to comprehend and attach meaning to numbers - is more limited. METHODS A scoping review following PRISMA guidelines was conducted. We screened 132 abstracts and 12 studies were included in the analysis. RESULTS Surgical population numeracy ranged from 47 to 86.1%. We found heterogeneity in the scales used to measure numeracy and the cutoff values used to define adequate numeracy. Low numeracy was shown to influence the accuracy of patients' responses to quality of life measures used to determine surgical outcomes and was associated with patient overestimation of pre-operative risk. Adequate numeracy was correlated with improved outcomes 2-4 years after bariatric surgery. CONCLUSIONS Patient numeracy is generally poor and has important implications for pre-operative risk understanding, accuracy of health measurement tools and long-term surgical outcomes.
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Thompson CA, Mielicki MK, Rivera F, Fitzsimmons CJ, Scheibe DA, Sidney PG, Schiller LK, Taber JM, Waters EA. Leveraging Math Cognition to Combat Health Innumeracy. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2023; 18:152-177. [PMID: 35943825 DOI: 10.1177/17456916221083277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Rational numbers (i.e., fractions, percentages, decimals, and whole-number frequencies) are notoriously difficult mathematical constructs. Yet correctly interpreting rational numbers is imperative for understanding health statistics, such as gauging the likelihood of side effects from a medication. Several pernicious biases affect health decision-making involving rational numbers. In our novel developmental framework, the natural-number bias-a tendency to misapply knowledge about natural numbers to all numbers-is the mechanism underlying other biases that shape health decision-making. Natural-number bias occurs when people automatically process natural-number magnitudes and disregard ratio magnitudes. Math-cognition researchers have identified individual differences and environmental factors underlying natural-number bias and devised ways to teach people how to avoid these biases. Although effective interventions from other areas of research can help adults evaluate numerical health information, they circumvent the core issue: people's penchant to automatically process natural-number magnitudes and disregard ratio magnitudes. We describe the origins of natural-number bias and how researchers may harness the bias to improve rational-number understanding and ameliorate innumeracy in real-world contexts, including health. We recommend modifications to formal math education to help children learn the connections among natural and rational numbers. We also call on researchers to consider individual differences people bring to health decision-making contexts and how measures from math cognition might identify those who would benefit most from support when interpreting health statistics. Investigating innumeracy with an interdisciplinary lens could advance understanding of innumeracy in theoretically meaningful and practical ways.
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Affiliation(s)
| | | | - Ferdinand Rivera
- Department of Mathematics and Statistics, San Jose State University
| | | | | | | | - Lauren K Schiller
- Department of Human Development, Teachers College, Columbia University
| | | | - Erika A Waters
- Department of Surgery, Washington University School of Medicine in St. Louis
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Khajeei D, Neufeld H, Donelle L, Meyer SB, Neiterman E, Ike NA, Li JZ. Maternal health literacy and health numeracy conceptualizations in public health: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3534-e3546. [PMID: 36039472 DOI: 10.1111/hsc.13981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/09/2022] [Accepted: 08/13/2022] [Indexed: 06/15/2023]
Abstract
Despite unprecedented advancement in educational opportunities and access to information, maternal health literacy (MHL) and health numeracy (HN) skills remain low in North America. By enhancing MHL, the educated civic public-those who have the capacity, skills, and knowledge to apply prose and numerical health information-engages more proactively in public health practice. The purpose of this scoping review was to map the existing empirical evidence on MHL to work toward a better understanding of the practical implications for public health. We explored MHL and HN through the following research question: "How are maternal health literacy and health numeracy conceptualised in public health planning, implementation, and evaluation?" First, we employed a five-stage methodological framework for scoping reviews and used PRISMA-P to systematically identify eligible articles. Then, we used thematic analysis and an inductive approach guided by the research aims to identify themes related to how MHL and HN are conceptualised in empirical studies and developed an evidence table. Finally, two different reviewers coded articles using an inductive approach into six themes. We identified 1733 articles through a systematic search of five databases. After screening all the articles, 52 articles were included for thematic analysis. The final themes were: (i) sociocultural demographics; (ii) self-efficacy; (iii) communication; (iv) information seeking and operationalisation; (v) health status; and (vi) reasoning. The research evidence demonstrated limitations concerning the impact of sociocultural background on a mother's recognition of health problems and the extent of which patient-centred care is culturally and linguistically appropriate. The research evidence revealed an opportunity to address the sociocultural linguistic experience of mothers within public health practice. Our research team supports moving away from the biomedical model of evidence-based medicine and adopting evidence-based practice ensures healthcare providers develop a holistic understanding of the maternal health needs of socioculturally diverse mothers.
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Affiliation(s)
- Dahlia Khajeei
- Faculty of Health, School of Public Health Sciences (SPHS), University of Waterloo, Waterloo, Ontario, Canada
| | - Hannah Neufeld
- Faculty of Health, School of Public Health Sciences (SPHS), University of Waterloo, Waterloo, Ontario, Canada
| | - Lorie Donelle
- Faculty of Health, School of Public Health Sciences (SPHS), University of Waterloo, Waterloo, Ontario, Canada
| | - Samantha B Meyer
- Faculty of Health, School of Public Health Sciences (SPHS), University of Waterloo, Waterloo, Ontario, Canada
| | - Elena Neiterman
- Faculty of Health, School of Public Health Sciences (SPHS), University of Waterloo, Waterloo, Ontario, Canada
| | - Nnenna A Ike
- Faculty of Health, School of Public Health Sciences (SPHS), University of Waterloo, Waterloo, Ontario, Canada
| | - Janet Z Li
- Faculty of Health, School of Public Health Sciences (SPHS), University of Waterloo, Waterloo, Ontario, Canada
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Sunderaraman P, Barker M, Chapman S, Cosentino S. Assessing numerical reasoning provides insight into financial literacy. APPLIED NEUROPSYCHOLOGY. ADULT 2022; 29:710-717. [PMID: 32795202 PMCID: PMC8720496 DOI: 10.1080/23279095.2020.1805745] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Financial literacy is linked to financial well-being and decision making. While financial literacy and numeracy skills are strongly related, the relevance of different aspects of numeracy (mental arithmetic, math achievement, and numerical reasoning) for financial literacy has not yet been examined. Data were collected from 88 cognitively healthy adults, mean age = 50 years (SD = 15); mean education = 15 years (SD = 2); 61% females; with 56% Caucasian, 36% Black, and 90% non-Hispanic. Financial literacy was measured with the widely used Big Three scale, and numeracy was measured with the Wechsler Adult Intelligence Scale-III, Arithmetic subtest; the Wide Range Achievement Test-IV, Math Computation subtest; and the Weller's Abbreviated Numeracy Scale (WANS). Regressions analyses were conducted with financial literacy as the outcome variable and each numeracy measure along with demographics (age, sex, and education) as the predictors. In all the models, only the numeracy measures were significant as individual predictors, with numerical reasoning holding the strongest association with financial literacy, followed by mental arithmetic and math achievement. The current study supports the existing literature that numeracy is important for financial literacy, and provides empirical evidence for the specific contributions of individual numeracy measures that clinicians may use to garner impressions about financial skills.
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Affiliation(s)
| | - Megan Barker
- Columbia University Medical Center, New York, NY, USA
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10
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Curtius K, Kabir M, Al Bakir I, Choi CHR, Hartono JL, Johnson M, East JE, Lindsay JO, Vega R, Thomas-Gibson S, Warusavitarne J, Wilson A, Graham TA, Hart A. Multicentre derivation and validation of a colitis-associated colorectal cancer risk prediction web tool. Gut 2022; 71:705-715. [PMID: 33990383 PMCID: PMC8921573 DOI: 10.1136/gutjnl-2020-323546] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/24/2021] [Accepted: 04/18/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Patients with ulcerative colitis (UC) diagnosed with low-grade dysplasia (LGD) have increased risk of developing advanced neoplasia (AN: high-grade dysplasia or colorectal cancer). We aimed to develop and validate a predictor of AN risk in patients with UC with LGD and create a visual web tool to effectively communicate the risk. DESIGN In our retrospective multicentre validated cohort study, adult patients with UC with an index diagnosis of LGD, identified from four UK centres between 2001 and 2019, were followed until progression to AN. In the discovery cohort (n=246), a multivariate risk prediction model was derived from clinicopathological features using Cox regression. Validation used data from three external centres (n=198). The validated model was embedded in a web tool to calculate patient-specific risk. RESULTS Four clinicopathological variables were significantly associated with AN progression in the discovery cohort: endoscopically visible LGD >1 cm (HR 2.7; 95% CI 1.2 to 5.9), unresectable or incomplete endoscopic resection (HR 3.4; 95% CI 1.6 to 7.4), moderate/severe histological inflammation within 5 years of LGD diagnosis (HR 3.1; 95% CI 1.5 to 6.7) and multifocality (HR 2.9; 95% CI 1.3 to 6.2). In the validation cohort, this four-variable model accurately predicted future AN cases with overall calibration Observed/Expected=1.01 (95% CI 0.64 to 1.52), and achieved 100% specificity for the lowest risk group over 13 years of available follow-up. CONCLUSION Multicohort validation confirms that patients with large, unresected, multifocal LGD and recent moderate/severe inflammation are at highest risk of developing AN. Personalised risk prediction provided via the Ulcerative Colitis-Cancer Risk Estimator ( www.UC-CaRE.uk ) can support treatment decision-making.
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Affiliation(s)
- Kit Curtius
- Centre for Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University of London, London, UK
- Division of Biomedical Informatics, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Misha Kabir
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Gastroenterology, St Mark's Hospital and Academic Institute, London, UK
| | - Ibrahim Al Bakir
- Centre for Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University of London, London, UK
- Department of Gastroenterology, St Mark's Hospital and Academic Institute, London, UK
| | - Chang Ho Ryan Choi
- Department of Gastroenterology & Hepatology, St George Hospital, Sydney, New South Wales, Australia
| | - Juanda L Hartono
- Division of Gastroenterology, National University Hospital, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Michael Johnson
- Translational Gastroenterology Unit, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, UK
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - James E East
- Translational Gastroenterology Unit, Nuffield Department of Medicine, John Radcliffe Hospital, Oxford, UK
- Oxford NIHR Biomedical Research Centre, University of Oxford, Oxford, UK
| | - James O Lindsay
- Blizard Institute, Barts and The London School of Medicine and Dentistry, London, UK
- Department of Gastroenterology, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Roser Vega
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Siwan Thomas-Gibson
- Department of Gastroenterology, St Mark's Hospital and Academic Institute, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Janindra Warusavitarne
- Department of Surgery and Cancer, Imperial College London, London, UK
- Colorectal Surgery and Lennard-Jones Intestinal Failure Unit, St Mark's Hospital and Academic Institute, London, UK
| | - Ana Wilson
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Gastroenterology, St Mark's Hospital and Academic Institute, London, UK
| | - Trevor A Graham
- Centre for Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Ailsa Hart
- Department of Gastroenterology, St Mark's Hospital and Academic Institute, London, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
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Olchowska-Kotala A, Uchmanowicz I, Szczepanowski R. Verbal Descriptors of the Frequency of Side Effects: Implementation of EMA Recommendations in Patient Information Leaflets in Poland. Int J Qual Health Care 2022; 34:6547612. [DOI: 10.1093/intqhc/mzac013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/20/2021] [Accepted: 03/11/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The European Medicines Agency (EMA) recommends a description of drug side effects based on the frequency format and the associated verbal description. Although the recommendations refer to English-speaking countries, in several non-English speaking states, official authorities have accepted the proposed recommendations on how the patient information leaflets should be designed for descriptions of side effect frequencies. The aim of the study was to examine how manufacturers of authorized medicines in Poland implement the EMA recommendations regarding the verbal descriptors of the frequency of side effects.
Methods
A qualitative study. As a first step, we identified which of the 150 pharmaceutical companies operating in Poland had the largest market share. Then, five manufacturers were selected at random from the list of the top fifteen drug manufacturers in Poland by market share of the pharmaceutical sector. Lists of medicinal products authorized for marketing in Poland were downloaded from manufacturers’ websites, and then five products from each manufacturer were selected based on random sampling. The study included only prescription medicines and excluded over-the-counter medicines and dietary supplements from the sample. Subsequently, for each of the 25 drugs relevant patient information leaflets were obtained from the manufacturers’ websites. We evaluated how information on the frequency of side effects was provided in each leaflet, including the use of EU-recommended terms (verbal descriptors such as "very common," "common," "uncommon," "rare," "very rare") and additional notes explaining their meanings.
Results
For all manufacturers, word labels of the frequencies of side effects selected for the study were the same but the additional notes explaining their meanings were different. There were various explanations of how to understand verbal descriptors of the frequency of side effects not only across different manufacturers but also across different medicines from one manufacturer.
Conclusions
There is no single standard in the Polish pharmaceutical industry for implementing the EMA recommendations into the written information about the frequency of side effects. The observed differences for an explanation of how to understand a given verbal term do not favor a uniform interpretation of the verbal frequency labels meaning by patients.
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Affiliation(s)
- Agnieszka Olchowska-Kotala
- Department of Humanities and Social Science, Wroclaw Medical University, ul Mikulicza-Radeckiego 7, 50-368 Wroclaw, Poland
| | - Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Wroclaw Medical University, ul. K. Bartla 5, 51-618 Wroclaw, Poland
| | - Remigiusz Szczepanowski
- Department of Humanities and Social Science, Wroclaw Medical University, ul. K. Bartla 5, 51-618 Wroclaw, Poland
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Levy S, Goldfarb L. The perception of subset quantity and items in an environment with distractors in a population with mathematical learning difficulties. Trends Neurosci Educ 2021; 25:100166. [PMID: 34844698 DOI: 10.1016/j.tine.2021.100166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE People often perceive a quantity of specific objects that appear as part of an overall group of items (a subset). This study investigates this type of perception among a population with mathematical leaning difficulties (MLD). METHOD Sixty-two participants (mean age: 26.82) reported the general and subset quantity of items using a subset quantity detection task or a conjunction visual search task. RESULTS MLD had difficulties perceiving both the general quantity presented and the subset quantity of items. They also had difficulties preforming a conjunction visual search task, even when the task did not involve numerical processing. CONCLUSIONS MLD has spatial difficulties in the form of visual search and subset quantity detection. The current study suggests that MLD might experience greater difficulties in daily tasks, which might be related to those tasks (e.g., detecting the amount of forks among other items of silverware on the table).
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Affiliation(s)
- Sharon Levy
- Edmond J. Safra Brain Research Center for the Study of Learning Disabilities, University of Haifa, Israel
| | - Liat Goldfarb
- Edmond J. Safra Brain Research Center for the Study of Learning Disabilities, University of Haifa, Israel.
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Prokhorov AV, Calabro KS, Arya A, Russell S, Czerniak KW, Botello GC, Chen M, Yuan Y, Perez A, Vidrine DJ, Perry CL, Khalil GE. Mobile Text Messaging for Tobacco Risk Communication Among Young Adult Community College Students: Randomized Trial of Project Debunk. JMIR Mhealth Uhealth 2021; 9:e25618. [PMID: 34822339 PMCID: PMC8663493 DOI: 10.2196/25618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/19/2021] [Accepted: 10/08/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The use of new and emerging tobacco products (NETPs) and conventional tobacco products (CTPs) has been linked to several alarming medical conditions among young adults (YAs). Considering that 96% of YAs own mobile phones, SMS text messaging may be an effective strategy for tobacco risk communication. OBJECTIVE Project Debunk is a community-based randomized trial aiming to identify specific types of messages that effectively improve perceived NETP and CTP risk among YAs in community colleges. METHODS With YAs recruited offline from 3 campuses at the Houston Community College (September 2016 to July 2017), we conducted a 6-month randomized trial with 8 arms based on the combination of 3 message categories: framing (gain-framed vs loss-framed), depth (simple vs complex), and appeal (emotional vs rational). Participants received fully automated web-based SMS text messages in two 30-day campaigns (2 messages per day). We conducted repeated-measures mixed-effect models stratified by message type received, predicting perceived CTP and NETP risks. Owing to multiple testing with 7 models, an association was deemed significant for P<.007 (.05 divided by 7). RESULTS A total of 636 participants completed the baseline survey, were randomized to 1 of 8 conditions (between 73 and 86 participants per condition), and received messages from both campaigns. By the 2-month post campaign 2 assessment point, 70.1% (446/636) completed all outcome measures. By the end of both campaigns, participants had a significant increase in perceived NETP risk over time (P<.001); however, participants had a marginal increase in perceived CTP risk (P=.008). Separately for each group, there was a significant increase in perceived NETP risk among participants who received rational messages (P=.005), those who received emotional messages (P=.006), those who received simple messages (P=.003), and those who received gain-framed messages (P=.003). CONCLUSIONS In this trial, YAs had an increase in perceived NETP risk. However, with stratification, we observed a significant increase in perceived NETP risk upon exposure to rational, emotional, simple, and gain-framed messages. In addition, YAs generally had an increase in perceived CTP risk and presented nonsignificant but observable improvement upon exposure to emotional, complex, and loss-framed messages. With the results of this study, researchers and practitioners implementing mobile health programs may take advantage of our tailored messages through larger technology-based programs such as smartphone apps and social media campaigns. TRIAL REGISTRATION ClinicalTrials.gov NCT03457480; https://clinicaltrials.gov/ct2/show/NCT03457480. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/10977.
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Affiliation(s)
- Alexander V Prokhorov
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Karen Sue Calabro
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Ashish Arya
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Sophia Russell
- Department of Health Disparities, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Katarzyna W Czerniak
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Gabrielle C Botello
- Department of Health Services Research, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Minxing Chen
- Department of Biostatistics, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Ying Yuan
- Department of Biostatistics, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Adriana Perez
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center, Austin, TX, United States
| | - Damon J Vidrine
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, United States
| | - Cheryl L Perry
- School of Public Health, Health Science Center, University of Texas, Austin, TX, United States
| | - Georges Elias Khalil
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, United States
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Hoffmann TC, Del Mar C, Santhirapala R, Freeman A. Teaching clinicians shared decision making and risk communication online: an evaluation study. BMJ Evid Based Med 2021; 26:253. [PMID: 32962972 PMCID: PMC8479734 DOI: 10.1136/bmjebm-2020-111521] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To describe the development and initial evaluation of a brief e-learning course as a means of teaching shared decision making and risk communication skills to clinicians of all specialties. DESIGN Comparison pre-course and post-course of scores in subjective confidence and objective knowledge about shared decision making and risk communication. SETTING Online and open to all specialties and levels of clinical experience, including students. PARTICIPANTS The course is freely available online and all who started the course from September 2018 to May 2020 were invited to participate in the evaluation study. INTERVENTION The self-guided e-learning course is made up of four modules and takes approximately 2 hours to complete. It is hosted on the website of the Winton Centre for Risk Communication and the UK's National Health Service e-learning platform. MAIN OUTCOME MEASURES Pre-course and post-course confidence in performing shared decision making (as measured by a 10-item scale adapted from the OPTION tool; total score range 10-50), and objective knowledge about basic principles of shared decision making and risk communication, as measured by performance on four knowledge questions and three calculations. At course commencement, a single item from the Berlin Numeracy Test, and the eight-item Subjective Numeracy Test were also asked. RESULTS Of 366 unique participants who consented and commenced the course, 210 completed all modules and the final post-course test. Participants' mean age was 38.1 years, 69% were in current clinical practice and had a mean of 10.5 years of clinical practice. Numeracy was relatively low, with 50.7% correctly answering the Berlin Numeracy Test item pre-course. Participants who completed the course showed a significant improvement in their confidence by a mean summed score of 3.7 units (95% CI 2.9 to 4.6, p<0.0001) from a mean pre-course of 37.4 (SD 6.1) to post-course of 41.1 (SD 6.9). There was an increase in the proportion of correct answers for most knowledge questions (p<0.0001, p=0.013 for two directly compared), although no improvement in most skill questions that involved numbers (eg, calculating relative risks). Participants with higher numeracy appeared to show higher skill and confidence on most questions. CONCLUSIONS This online, free e-learning course was successful in increasing participants' confidence in, and some aspects of knowledge about, shared decision making and risk communication. It also highlighted the need for improvements in clinicians' numerical skills as a vital part of training. We suggest that the course is used in combination with practical face-to-face experience and more intensive numerical skills training.
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Affiliation(s)
- Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Chris Del Mar
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Ramai Santhirapala
- Department of Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Alexandra Freeman
- Winton Centre for Risk & Evidence Communication, University of Cambridge, Cambridge, UK
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15
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Murray G, Willer CJ, Arner T, Roche JM, Morris BJ. Contextualized Knowledge Reduces Misconceived COVID-19 Health Decisions. JOURNAL OF APPLIED RESEARCH IN MEMORY AND COGNITION 2021; 10:381-391. [PMID: 34729297 PMCID: PMC8553299 DOI: 10.1016/j.jarmac.2021.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 12/30/2022]
Abstract
How do we resolve conflicting ideas about how to protect our health during a pandemic? Prior knowledge influences our decisions, potentially creating implicit cognitive conflict with new, correct information. COVID-19 provides a natural condition for investigating how an individual's health-specific knowledge (e.g., understanding mask efficacy) and their personal context (e.g., outbreak proximity) influence their protective health behavior endorsement, as information about the virus, its spread, and lethality has changed over time. Using a dual-process-model framework, we investigated the role cognitive conflict has on health decision-making. We used a computer mouse-tracking paradigm alongside geographical information systems (GIS) as a proxy for context. The results support a contextualized-deficit-model framework in which relevant knowledge and context-based factors help individuals override cognitive conflict to make more preventative health decisions. Findings from this study may provide evidence for a more effective way for experts to combat non-adherence due to conflicting health information.
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Affiliation(s)
- Grace Murray
- Correspondence concerning this article should be addressed to Grace Murray, School of Lifespan Development and Educational Science, Kent State University, Kent, OH, United States
| | | | - Tracy Arner
- Department of Psychology, Arizona State University, USA
| | - Jennifer M Roche
- School of Lifespan Development & Educational Science, Kent State University, USA.,Department of Speech Pathology & Audiology, Kent State University, USA
| | - Bradley J Morris
- School of Lifespan Development & Educational Science, Kent State University, USA
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16
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Raittio E, Raittio L. Statements considering intervention effects in Finnish clinical practice guidelines: Recommending interventions with non-numeric effect-sizes or unspecified outcomes. J Eval Clin Pract 2021; 27:751-758. [PMID: 32735367 DOI: 10.1111/jep.13455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Representation of benefits and harms associated with specific interventions in an understandable and comparable way is crucial for informed decision making that clinical practice guidelines (CPGs) aim to enhance. Therefore, we investigated how statements concerning the effects of interventions considered and described benefits and harms, magnitude of effect and its uncertainty, numeric and non-numeric information, and outcomes in Finnish CPGs. METHODS We selected 10 CPGs on common diseases and risk factors published by The Finnish Medical Society, Duodecim. All the statements which were graded with the level of evidence from high to very low (levels A-D) were included in analyses. From these statements, assessments were made regarding whether the statement considered benefits or harms, whether relative or absolute numeric measures were shown, whether the statement supported or was against the intervention considered, and what outcome was reported. RESULTS Of the 10 CPGs, 448 statements were assessed. Most of the statements of effects considered intervention benefits (87%) rather than harms. Half of the statements considering harms were represented in a way that supported the intervention. Most of the statements (94%) did not include numeric estimates of magnitude of the effect. When numeric estimates of magnitude of the effect were present, they were most frequently relative measures and were typically placed in a statement considering (a) intervention benefits with a primary outcome, (b) given the grade of A for level of evidence, and (c) that supported the use of intervention. CONCLUSIONS In the Finnish CPGs, the statements were rarely framed with both absolute and relative numeric measures of an intervention's effect. Harms were rarely reported with a grade indicating the level of evidence. The users of CPGs would benefit from more consistent and understandable framing of statements considering both benefits and harms of interventions.
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Affiliation(s)
- Eero Raittio
- The University of Eastern Finland, Institute of Dentistry, Kuopio, Finland.,City of Tampere, Oral Health Care, Tampere, Finland
| | - Lauri Raittio
- Tampere University, The Faculty of Medicine and Health Technology, Tampere, Finland
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17
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Raittio E, Raittio L. Verbal communication of effect-sizes, possible comparators, and uncertainty of evidence in the Finnish clinical practice guidelines: Omitting effect-sizes and comparators without expressing much uncertainty. J Eval Clin Pract 2021; 27:759-766. [PMID: 33084201 DOI: 10.1111/jep.13499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 11/27/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Our aim was to investigate verbal representations of intervention effect-size, uncertainty of evidence, and possible intervention comparators in statements concerning effects of interventions in Finnish clinical practice guidelines. METHOD We selected 10 clinical practice guidelines on common diseases and risk factors published by The Finnish Medical Society Duodecim. All the statements that considered beneficial effects of interventions and that were graded with a level of evidence (levels A, high, to D, very low) were included in analyses. We assessed whether the statements verbally represented intervention effect-size, uncertainty of evidence or a possible comparator, and the reported outcome. RESULTS Of 385 statements, verbal representation of beneficial effect-sizes occurred in 25 (6%) statements. Most (72%) statements indicated that intervention had a beneficial effect, but did not specify effect-size. Less than half (42%) of the statements represented uncertainty verbally. Comparisons to placebo or no-treatment were rare (3%) and 18% of the statements compared interventions to other treatments. Against instructions, a considerable part (35%) of statements with B-level evidence did not represent uncertainty. CONCLUSION Communicating beneficial intervention effects, effect-sizes, possible comparators, and uncertainty of evidence require much broader attention in the clinical practice guideline context.
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Affiliation(s)
- Eero Raittio
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.,Oral Health Care, City of Tampere, Tampere, Finland
| | - Lauri Raittio
- The Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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18
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Schwartz PH, O’Doherty KC, Bentley C, Schmidt KK, Burgess MM. Layperson Views about the Design and Evaluation of Decision Aids: A Public Deliberation. Med Decis Making 2021; 41:527-539. [PMID: 33813928 PMCID: PMC8191156 DOI: 10.1177/0272989x21998980] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 01/28/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE We carried out the first public deliberation to elicit lay input regarding guidelines for the design and evaluation of decision aids, focusing on the example of colorectal ("colon") cancer screening. METHODS A random, demographically stratified sample of 28 laypeople convened for 4 days, during which they were informed about key issues regarding colon cancer, screening tests, risk communication, and decision aids. Participants then deliberated in small and large group sessions about the following: 1) What information should be included in all decision aids for colon screening? 2) What risk information should be in a decision aid and how should risk information be presented? 3) What makes a screening decision a good one (reasonable or legitimate)? 4) What makes a decision aid and the advice it provides trustworthy? With the help of a trained facilitator, the deliberants formulated recommendations, and a vote was held on each to identify support and alternative views. RESULTS Twenty-one recommendations ("deliberative conclusions") were strongly supported. Some conclusions matched current recommendations, such as that decision aids should be available for use with and without providers present (conclusions 1-4) and should support informed choice (conclusion 9). Some conclusions differed from current recommendations, at least in emphasis-for example, that decision aids should disclose cost of screening (conclusion 11) and should be kept simple and understandable (conclusion 14). Deliberants recommended that decision aids should disclose the baseline risk of getting colon cancer (conclusions 15, 17). LIMITATIONS Single location and medical decision. CONCLUSIONS Guidelines for design of decision aids should consider putting a greater focus on disclosing cost and keeping decision aids simple, and they possibly should recommend disclosing less extensive amounts of quantitative information than currently recommended.
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Affiliation(s)
- Peter H. Schwartz
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Center for Bioethics, Indianapolis, IN, USA
- Philosophy Department, Indiana University School of Liberal Arts, Indianapolis, IN, USA
- Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | | | - Colene Bentley
- British Columbia Cancer Research Institute, Vancouver, BC, Canada
| | - Karen K. Schmidt
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Center for Bioethics, Indianapolis, IN, USA
| | - Michael M. Burgess
- W. Maurice Young Centre for Applied Ethics, School of Population and Public Health, Medical Genetics, University of British Columbia, Vancouver, BC, Canada
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19
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Schmidt FM, Zottmann JM, Sailer M, Fischer MR, Berndt M. Statistical literacy and scientific reasoning & argumentation in physicians. GMS JOURNAL FOR MEDICAL EDUCATION 2021; 38:Doc77. [PMID: 34056066 PMCID: PMC8136351 DOI: 10.3205/zma001473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 12/05/2020] [Accepted: 01/25/2021] [Indexed: 06/12/2023]
Abstract
Objective: Statistical literacy (SL) of physicians, i.e. the ability to use and interpret statistical numbers in the context of science, is an essential prerequisite for risk estimation and communication. Together with scientific reasoning and argumentation (SRA) skills, SL provides the basis for evidence-based practice. Several studies suggest that in medical students both skills are underdeveloped. The aim of the present study was to investigate these skills in practicing physicians and how these skills were acquired. Methods: Data collection in N=71 physicians was conducted online and as paper pencil. SL was assessed with multiple-choice items. SRA skills evidence evaluation and drawing conclusions were measured with a decision scenario. Results: Study results indicated that physicians have medium levels of SL (M=17.58, SD=6.92, max 30 pts.) and SRA (evidence evaluation: M=7.75, SD=1.85, max 10 pts.; drawing conclusions: M=37.20, SD=5.35, max 60 pts.). Skills development via autodidactic learning activities (M=4.78, SD=1.13, range 1-6) was reported significantly more often than development during formal medical education (M=2.31, SD=1.46), t(71)=-9.915, p<.001, or in extracurricular activities (M=3.34, SD=1.87), t(71)=4.673, p<.001. The active involvement in research seemed decisive: The number of publications and time spent in research significantly correlated with SL, r(71)=.355, p=.002; respectively r(71)=.280, p=.018. SRA skills were predicted by the type of MD-thesis, β=-.380, p=.016, and working in research, β=3.355, p=.008. Conclusion: Active involvement in research activities seems to be a very important factor for the development of both SL and SRA skills. The implementation of systematic fostering of these skills during formal medical education seems warranted.
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Affiliation(s)
- Felicitas M. Schmidt
- University Hospital, LMU Munich, Institute of Medical Education, Munich, Germany
| | - Jan M. Zottmann
- University Hospital, LMU Munich, Institute of Medical Education, Munich, Germany
| | | | - Martin R. Fischer
- University Hospital, LMU Munich, Institute of Medical Education, Munich, Germany
| | - Markus Berndt
- University Hospital, LMU Munich, Institute of Medical Education, Munich, Germany
- Walden University, Richard W. Riley College of Education and Leadership, Minneapolis, USA
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20
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Kaimal A, Norton ME. Society for Maternal-Fetal Medicine Consult Series #55: Counseling women at increased risk of maternal morbidity and mortality. Am J Obstet Gynecol 2021; 224:B16-B23. [PMID: 33309561 DOI: 10.1016/j.ajog.2020.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Women should be provided with evidence-based information when considering options for contraception and pregnancy management. When counseling about health conditions and available treatments, healthcare practitioners should employ strategies that encourage the incorporation of informed patient preferences into a shared decision-making process with the patient. To optimize the health of women at risk of experiencing adverse health outcomes during or after pregnancy, counseling should be a continuous process throughout the reproductive life course. The purpose of this Consult is to provide guidance for all healthcare practitioners about counseling reproductive-aged women who may be at high risk of experiencing maternal morbidity or mortality.
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Affiliation(s)
- Anjali Kaimal
- Society for Maternal-Fetal Medicine, 409 12 St. SW, Washington, DC 20024, USA.
| | - Mary E Norton
- Society for Maternal-Fetal Medicine, 409 12 St. SW, Washington, DC 20024, USA.
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21
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Drelles K, Pilarski R, Manickam K, Shoben AB, Toland AE. Impact of Previous Genetic Counseling and Objective Numeracy on Accurate Interpretation of a Pharmacogenetics Test Report. Public Health Genomics 2021; 24:26-32. [PMID: 33445171 DOI: 10.1159/000512476] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/20/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Pharmacogenetic (PGx) testing can be useful for providing information about a patient's drug response by increasing drug efficacy and decreasing the incidence of adverse drug events. While PGx tests were previously only offered to patients under healthcare provider supervision, they are now available as direct to consumer (DTC) tests. This study aimed to assess how accurately individuals from the general population were able to interpret a sample PGx test report and if accuracy differed based on individuals' numeracy or prior genetic counseling (GC). METHODS We surveyed 293 individuals from the general population, ascertained through ResearchMatch. The survey included questions about PGx test interpretation, numeracy, and genetic literacy. RESULTS In our cohort, numeracy level impacted PGx result interpretation, with those of high numeracy performing statistically significantly better on both the table format and graphical format (p value = 0.002 and p value <0.001, respectively) and genetic knowledge questions (p value <0.001) than those with low/average numeracy. In addition, previous GC did not impact test interpretation or genetic knowledge, but the number of individuals with prior GC was small (n = 26). DISCUSSION/CONCLUSION We found that numeracy had a significant impact on correct interpretation of PGx test reports. Because many individuals in the USA have low numeracy levels, it is extremely important that patients do not make their own medication management decision based on the test results and that they consult with their physicians about their PGx testing. The importance of consultation and discussion with providers about results should be emphasized on the test report.
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Affiliation(s)
- Kelly Drelles
- Division of Human Genetics, Department of Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Robert Pilarski
- Division of Human Genetics, Department of Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Kandamurugu Manickam
- Division of Genetic and Genomic Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Abigail B Shoben
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Amanda Ewart Toland
- Division of Human Genetics, Department of Internal Medicine, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA, .,Department of Cancer Biology and Genetics, Compehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA,
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22
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Lawrence NJ, Martin A, Davis ID, Troon S, Sengupta S, Hovey E, Coskinas X, Kaplan R, Smith B, Ritchie AWS, Meade A, Goh J, Gurney H, Harrison M, Fife K, Eisen T, Blinman P, Stockler MR. Individualised Predictions of the Survival Benefit Due to Adjuvant Therapy in a Randomised Trial of Sorafenib after Nephrectomy for Localised Renal Cell Carcinoma. KIDNEY CANCER 2020. [DOI: 10.3233/kca-200104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Little has been published regarding how doctors think and talk about prognosis and the potential benefits of adjuvant therapy. OBJECTIVE: We sought predictions of survival rates and survival times, for patients with and without adjuvant therapy, from the clinicians of patients participating in a randomised trial of adjuvant sorafenib after nephrectomy for renal cell carcinoma. METHODS: A subset of medical oncologists and urologists in the SORCE trial completed questionnaires eliciting their predictions of survival rates and survival times, with and without adjuvant sorafenib, for each of their participating patients. To compare predictions elicited as survival times versus survival rates, we transformed survival times to survival rates. To compare predicted benefits elicited as absolute improvements in rates and times, we transformed them into hazard ratios (HR), a measure of relative benefit.We postulated that a plausible benefit in overall survival (OS) should be smaller than that hypothesized for disease–free survival (DFS) in the trials original sample size justification (i.e. HR for OS should be ≥ 0.75). RESULTS: Sixty–one medical oncologists and 17 urologists completed questionnaires on 216 patients between 2007 and 2013. Predictions of survival without adjuvant sorafenib were similar whether elicited as survival rates or survival times (median 5–year survival rate of 61% vs 60%, p = 0.6). Predicted benefits of sorafenib were larger when elicited as improvements in survival rates than survival times (median HR 0.76 vs 0.83, p < 0.0001). The proportion of HR for predicted OS with sorafenib that reflected a plausible benefit (smaller effect of sorafenib on OS than hypothesized on DFS, i.e. HR ≥ 0.75) was 51% for survival rates, and 65% for survival times. CONCLUSIONS: The predicted benefits of adjuvant sorafenib were larger when elicited as improvements in survival rates than as survival times, and were often larger than the sample size justification for the trial. These potential biases should be considered when thinking and talking about individual patients in clinical practice, and when designing clinical trials.
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Affiliation(s)
- Nicola J. Lawrence
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, NSW, Australia
- Cancer Trials New Zealand, The University of Auckland, Auckland, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - Andrew Martin
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, NSW, Australia
| | - Ian D. Davis
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, NSW, Australia
- Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Oncology, Eastern Health, Box Hill, VIC, Australia
| | - Simon Troon
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, NSW, Australia
- Fiona Stanley Hospital, Perth, WA, Australia
| | - Shomik Sengupta
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, NSW, Australia
- Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
- Urology Unit, Austin Health, Heidelberg, VIC, Australia
| | - Elizabeth Hovey
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, NSW, Australia
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia
| | - Xanthi Coskinas
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, NSW, Australia
| | - Richard Kaplan
- MRC Clinical Trials Unit, University College London, London, United Kingdom
| | - Benjamin Smith
- MRC Clinical Trials Unit, University College London, London, United Kingdom
| | | | - Angela Meade
- MRC Clinical Trials Unit, University College London, London, United Kingdom
| | - Jeffrey Goh
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, NSW, Australia
- Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
- University of Queensland, St Lucia, QLD, Australia
| | - Howard Gurney
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, NSW, Australia
- Macquarie University and Westmead Hospital, Sydney, NSW, Australia
| | - Michelle Harrison
- Chris O’Brien Lifehouse, Sydney, NSW, Australia
- Liverpool Hospital, Sydney, NSW, Australia
| | - Kate Fife
- Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Tim Eisen
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, NSW, Australia
- Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - Prunella Blinman
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, NSW, Australia
- Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Martin R. Stockler
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, NSW, Australia
- Chris O’Brien Lifehouse, Sydney, NSW, Australia
- Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, NSW, Australia
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23
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Durand MA, Yen RW, O’Malley J, Elwyn G, Mancini J. Graph literacy matters: Examining the association between graph literacy, health literacy, and numeracy in a Medicaid eligible population. PLoS One 2020; 15:e0241844. [PMID: 33175891 PMCID: PMC7657552 DOI: 10.1371/journal.pone.0241844] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/21/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Graphic display formats are often used to enhance health information. Yet limited attention has been paid to graph literacy in people of lower education and lower socioeconomic status (SES). This study aimed to: 1) examine the relationship between graph literacy, numeracy, health literacy and sociodemographic characteristics in a Medicaid-eligible population 2) determine the impact of graph literacy on comprehension and preference for different visual formats. METHODS We conducted a cross-sectional online survey among people in the US on Medicaid, and of presumed lower education and SES. RESULTS The mean graph literacy score among 436 participants was 1.47 (SD 1.05, range: 0 to 4). Only graph literacy was significantly associated with overall comprehension (p < .001). Mean comprehension scores were highest for the table format (1.91), closely followed by bar graph (1.85) and icon array (1.80). Information comprehension was aligned with preference scores. CONCLUSIONS Graph literacy in a Medicaid-eligible population was lower than previous estimates in the US. Tables were better understood, with icon arrays yielding the lowest score. Preferences aligned with comprehension. PRACTICE IMPLICATIONS It may be necessary to reconsider the use of graphic display formats when designing information for people with lower educational levels. Further research is needed.
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Affiliation(s)
- Marie-Anne Durand
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, United States of America
- UMR 1027, Université Toulouse III Paul Sabatier, Toulouse, France
- * E-mail:
| | - Renata W. Yen
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, United States of America
| | - James O’Malley
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, United States of America
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Dartmouth College, Lebanon, NH, United States of America
| | - Julien Mancini
- Aix-Marseille Univ, APHM, INSERM, IRD, SESSTIM, “Cancer, Biomedicine & Society” Group, Hop Timone, Marseille, France
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Peters GW, Kelly JR, Beckta JM, White M, Marks LB, Ford E, Evans SB. An Evaluation of Health Numeracy among Radiation Therapists and Dosimetrists. Adv Radiat Oncol 2020; 6:100609. [PMID: 34027232 PMCID: PMC8134660 DOI: 10.1016/j.adro.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/28/2020] [Accepted: 10/13/2020] [Indexed: 12/01/2022] Open
Abstract
Purpose Medical errors in radiation oncology sometimes involve tasks reliant on practitioners’ grasp of numeracy. Numeracy has been shown to be suboptimal across various health care professionals. Herein, we assess health numeracy among American Society of Radiologic Technologists (ASRT) members. Methods and materials The Numeracy Understanding for Medicine instrument (NUMi), an instrument to measure numeracy in the general population, was adapted to oncology for this study and distributed to ASRT members (n = 14,228) in 2017. Per NUMi scoring, health numeracy scores were categorized as low (0-7), low average (8-12), high average (13-17), or high (18-20). The impact of cGy versus Gy on numeracy performance was investigated. Spearman’s rho and a Wilcox-Mann-Whitney test were used for comparisons between the different groups. Results A total of 662 eligible participants completed the instrument and identified as radiation oncology professionals. In the cGy and Gy NUMi scores, approximately 2% of respondents scored low-average, approximately 40% scored high-average, and approximately 58% scored high, with a median score of 18.0. Although the optimum NUMi score for ASRT members is unknown, one might expect our cohort to have numeracy skills at least as high as college freshmen. Roughly one-sixth of our study group scored at or below the average score of college freshmen (NUMi = 15). In the subset analysis of NUMi questions pertaining to radiation dose unit (cGy vs Gy), respondents performed better with cGy (mean score: 2.94; range, 2-3) versus Gy (mean: 2.91; range, 0-3; P = .011). Conclusions In this study of limited sample size, overall numeracy is quite good compared with the general population. However, the range of scores is wide, and some respondents have lower scores that may be concerning, suggesting that numeracy may be an issue that requires improvement for a subset of the studied cohort. Performance was superior with the unit cGy; thus, the adoption of cGy as the standard unit is reasonable.
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Affiliation(s)
- Gabrielle W Peters
- Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Jacqueline R Kelly
- Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Jason M Beckta
- Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Marney White
- School of Public Health, Yale University School of Medicine, New Haven, Connecticut
| | - Lawrence B Marks
- Division of Health Care Engineering and Lineberger Cancer Center, Department of Radiation Oncology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Eric Ford
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Suzanne B Evans
- Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
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Abstract
The Affordable Care Act (ACA) is in many ways a success. Millions more Americans now have access to health care, and the ACA catalyzed advances in health care delivery reform. Simultaneously, it has reinforced and bolstered a problem at the heart of American health policy and regulation: a love affair with choice. The ACA's insurance reforms doubled down on the particularly American obsession with choice. This article describes three ways in which that doubling down is problematic for the future of US health policy. First, pragmatically, health policy theory predicts that choice among health plans will produce tangible benefits that it does not actually produce. Most people do not like choosing among health plan options, and many people-even if well educated and knowledgeable-do not make good choices. Second, creating the regulatory structures to support these choices built and reinforced a massive market bureaucracy. Finally, and most important, philosophically and sociologically the ACA reinforces the idea that the goal of health regulation should be to preserve choice, even when that choice is empty. This vicious cycle seems likely to persist based on the lead up to the 2020 presidential election.
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Politi MC, Goodwin CM, Kaphingst KA, Wang X, Fagerlin A, Fuzzell LN, Philpott-Streiff SE. How Do Subjective Health Literacy Measures Work in Young Adults? Specifying "Online" or "Paper-Based" Forms Impacts Results. MDM Policy Pract 2020; 5:2381468320924672. [PMID: 32529034 PMCID: PMC7263163 DOI: 10.1177/2381468320924672] [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: 01/28/2020] [Accepted: 04/09/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose. There is no gold-standard health literacy measure. The Single Item Literacy Screener (SILS) and Subjective Literacy Screener (SLS) ask people to self-report ability to understand health information. They were developed in older adults, before common use of electronic health information. This study explored whether the SILS and SLS related to objective literacy, numeracy, and comprehension among young adults, and whether specifying "online" or "paper-based" wording affected these relationships. Methods. Eligible individuals (18-35 years of age, English-speaking, US residents) from an online survey company were randomized to 1) original measures; 2) measures adding "paper-based" to describe health information/forms; or 3) measures adding "online" to describe health information/forms. We examined how each measure related to e-Health Literacy (eHEALS), subjective numeracy (SNS), objective numeracy (ONS), and comprehension of a short passage. Results. A total of 848/1342 respondents correctly answered attention-checks and were analyzed. The validated SILS related to comprehension (P = 0.003), eHEALS (P = 0.04), and ONS (P < 0.001) but not SNS (P = 0.44). When adding "paper-based," SILS related to eHEALS (P < 0.001) and ONS (P = 0.003) but did not relate to comprehension (P = 0.25) or SNS (P = 0.35). When adding "online," SILS related to comprehension (P < 0.001), eHEALS (P < 0.001), ONS (P = 0.005), and SNS (P = 0.03). The validated SLS related to comprehension (P < 0.001), eHEALS (P < 0.001), ONS (P < 0.001), and SNS (P < 0.001). When adding "paper-based," the SLS only related to eHEALS (P = <0.001) and comprehension (P = 0.03) but did not relate to ONS (P = 0.13) or SNS (P = 0.33). When adding "online," the SLS related to comprehension (P < 0.001), eHEALS (P < 0.001), and SNS (P = 0.03) but not ONS (P = 0.06). Conclusions. Young adults might interpret subjective health literacy measures differently when prompted to think about electronic or paper-based information. Researchers should consider clearer instructions or modified wording when using these measures in this population.
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Affiliation(s)
- Mary C Politi
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Courtney M Goodwin
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Kimberly A Kaphingst
- Department of Communication, University of Utah, and Huntsman Cancer Institute, Salt Lake City, Utah
| | - Xuechen Wang
- Department of Population Health Sciences, University of Utah, and Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, Utah
| | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah, and Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, Utah
| | - Lindsay N Fuzzell
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Sydney E Philpott-Streiff
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri
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Grutzmacher S, Munger A, Messina L, Downes K. Screening for Health Literacy among SNAP-eligible Adults Using the Newest Vital Sign: Implications for Nutrition Facts Label Policy and Education. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2020. [DOI: 10.1080/19320248.2019.1590277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Stephanie Grutzmacher
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Ashley Munger
- Department of Child and Family Studies, California State University, Los Angeles, CA, USA
| | - Lauren Messina
- Consortium for Health and Military Performance, Department of Military and Emergency Medicine, Uniformed Services University, Bethesda, MD, USA
| | - Katheryne Downes
- Florida Orthopaedic Institute and Foundation for Orthopaedic Research and Education, Tampa, FL, USA
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Lee EH, Lee YW, Lee KW, Hong S, Kim SH. A New Objective Health Numeracy Test for Patients with Type 2 Diabetes: Development and Evaluation of Psychometric Properties. Asian Nurs Res (Korean Soc Nurs Sci) 2020; 14:66-72. [DOI: 10.1016/j.anr.2020.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/29/2020] [Accepted: 01/31/2020] [Indexed: 10/25/2022] Open
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Yamashita T, Bardo AR, Millar RJ, Liu D. Numeracy and Preventive Health Care Service Utilization among Middle-Aged and Older Adults in the U.S. Clin Gerontol 2020; 43:221-232. [PMID: 29733753 PMCID: PMC6379140 DOI: 10.1080/07317115.2018.1468378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objectives: Determine whether a specific numeracy skill cut-point(s) reflects an empirical threshold in the context of preventive health service utilization, and identify associations between numeracy and preventive health services utilization among middle-aged and older adults in the United States.Methods: A nationally representative sample (n = 2,989) of adults 45 years and older from the International Assessment of Adult Competencies (PIAAC) was analyzed. Binary logistic regression was used to examine the utilization of dental checkup, vision screening, influenza vaccination, and osteoporosis screening, using multiple numeracy level classifications.Results: A dichotomous classification of numeracy skill levels (low vs. moderate to high proficiency) was associated with dental checkup utilization, but vision screening, influenza vaccination, and osteoporosis screening.Conclusions: Middle-aged and older adults with sufficient numeracy skills are more likely to have had a dental check up in the past 12 months. Findings suggest that numeracy may be more relevant for long-term vs. short-term risk assessment in determining preventive health care service utilization.Clinical Implications: Two-level numeracy categories are recommended in preventive health contexts. Numeracy proficiency-sensitive risk communication by health care providers and education programs may enhance awareness of preventive health care and promote the utilization of specific preventive health service utilization among older adults.
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Affiliation(s)
- Takashi Yamashita
- Department of Sociology, Anthropology, and Health Administration and Policy, University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | - Anthony R Bardo
- Department of Sociology, Duke University, Durham, North Carolina, USA
| | - Roberto J Millar
- Department of Sociology, Anthropology, and Health Administration and Policy, University of Maryland, Baltimore County, Baltimore, Maryland, USA
| | - Darren Liu
- Department of Public Health, Des Moines University, Des Moines, USA
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Stonbraker S, Porras T, Schnall R. Patient preferences for visualization of longitudinal patient-reported outcomes data. J Am Med Inform Assoc 2020; 27:212-224. [PMID: 31670816 PMCID: PMC7025335 DOI: 10.1093/jamia/ocz189] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 08/20/2019] [Accepted: 10/01/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The study sought to design symptom reports of longitudinal patient-reported outcomes data that are understandable and meaningful to end users. MATERIALS AND METHODS We completed a 2-phase iterative design and evaluation process. In phase I, we developed symptom reports and refined them according to expert input. End users then completed a survey containing demographics, a measure of health literacy, and items to assess visualization preferences and comprehension of reports. We then collected participants' perspectives on reports through semistructured interviews and modified them accordingly. In phase II, refined reports were evaluated in a survey that included demographics, validated measures of health and graph literacy, and items to assess preferences and comprehension of reports. Surveys were administered using a think-aloud protocol. RESULTS Fifty-five English- and Spanish-speaking end users, 89.1% of whom had limited health literacy, participated. In phase I, experts recommended improvements and 20 end users evaluated reports. From the feedback received, we added emojis, changed date and font formats, and simplified the y-axis scale of reports. In phase II, 35 end users evaluated refined designs, of whom 94.3% preferred reports with emojis, the favorite being a bar graph combined with emojis, which also promoted comprehension. In both phases, participants literally interpreted reports and provided suggestions for future visualizations. CONCLUSIONS A bar graph combined with emojis was participants' preferred format and the one that promoted comprehension. Target end users must be included in visualization design to identify literal interpretations of images and ensure final products are meaningful.
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Affiliation(s)
| | - Tiffany Porras
- Columbia University School of Nursing, New York, New York, USA
| | - Rebecca Schnall
- Columbia University School of Nursing, New York, New York, USA
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Piper ME, Brown DC, Hendershot TP, Swan GE. PhenX: Host: Social/Cognitive measures for tobacco regulatory research. Tob Control 2020; 29:s5-s12. [PMID: 31992658 DOI: 10.1136/tobaccocontrol-2018-054467] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/29/2018] [Accepted: 07/02/2018] [Indexed: 11/04/2022]
Abstract
A working group (WG) of experts from diverse fields related to nicotine and tobacco addiction was convened to identify elements and measures from the Host: Social/Cognitive domain to include in the Tobacco Regulatory Research Collection in the PhenX Toolkit, a catalogue of measures for biomedical research. This paper describes the methods used to identify, select, approve and include measures in the toolkit with potential relevance to users of both conventional and newer tobacco products, such as electronic cigarettes (e-cigarettes). In addition to 25 complementary measures primarily focused on cigarette use already present in the PhenX Toolkit, the WG recommended 11 additional social/cognitive measures focused on children and adult users or potential users of tobacco products. Of these, 10 were self-administered measures: frequency of communication with parents about smoking, quality of communication with parents about smoking, susceptibility to tobacco use, behaviour economics/purchase behaviour, motivation to quit (both single and multi-item measures), hedonic tone or response to pleasurable situations, multigroup ethnic identity, peer and family influence on smoking, attentional control and house rules about tobacco use. The remaining selected measure was computer based (distress tolerance). Although validated tools for use in the Host: Social/Cognitive realm are available, much remains to be done to develop, standardise and validate the tools for application to users of e-cigarettes and other non-combusted tobacco products, non-English language speakers and adolescents.
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Affiliation(s)
- Megan E Piper
- Center for Tobacco Research and Intervention, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Darigg C Brown
- RTI International, Research Triangle Park, North Carolina, USA
| | | | - Gary E Swan
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
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Olchowska-Kotala A, Bajcar B. Predictors of Undergoing Colonoscopy, Does Time Horizon Matter? J Prim Prev 2020; 41:127-137. [PMID: 31981005 PMCID: PMC7060149 DOI: 10.1007/s10935-020-00581-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
When talking to patients about undergoing diagnostic colonoscopy, their doctors can present the risk of developing colorectal cancer (CRC) in different time horizons. Studies on time horizons suggest that people have different psychological associations for the near and distant future, which potentially influence their judgments and actions. The aim of this study was to examine what factors predict patients’ intentions to undergo diagnostic colonoscopy. We particularly focused on examining the role of the time horizon in which the probability of developing malignant CRC was presented, when taking into account the following factors: the perception of risk (perceived susceptibility to and perceived severity of CRC), expected discomfort related to the procedure, a previous colonoscopy, and subjective numeracy. Using the Health Belief Model, we sought to determine whether the intention to undergo a preventive colonoscopy is affected by the time horizon. We hypothesized that the risk of developing CRC in a proximal time horizon would be more threatening to an individual than a distal one and would consequently increase an individual’s behavioral intention to undergo a colonoscopy. We examined the effects of two different time horizons: the risk of developing a disease in the next few years and total lifetime risk. A total of 144 respondents (77 women and 67 men) aged 50–59 years participated in the study. We found that risk perception and expected discomfort significantly affected participants’ intention to undergo a colonoscopy. No empirical evidence was found to confirm that presenting a person with the risk of developing malignant CRC in the coming years, as compared to their lifetime risk, increases the behavioral intention to undergo a diagnostic colonoscopy.
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Affiliation(s)
- Agnieszka Olchowska-Kotala
- Department of Medical Humanities and Social Science, Wroclaw Medical University, ul. Mikulicza-Radeckiego 7, 50-367, Wrocław, Poland.
| | - Beata Bajcar
- Psychology and Ergonomics Group, Faculty of Computer Science and Management, Wrocław University of Science and Technology, Wrocław, Poland
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Henneman L, van Asperen CJ, Oosterwijk JC, Menko FH, Claassen L, Timmermans DRM. Do Preferred Risk Formats Lead to Better Understanding? A Multicenter Controlled Trial on Communicating Familial Breast Cancer Risks Using Different Risk Formats. Patient Prefer Adherence 2020; 14:333-342. [PMID: 32109999 PMCID: PMC7036980 DOI: 10.2147/ppa.s232941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/07/2020] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Counselees' preferences are considered important for the choice of risk communication format and for improving patient-centered care. We here report on counselees' preferences for how risks are presented in familial breast cancer counseling and the impact of this preferred format on their understanding of risk. PATIENTS AND METHODS As part of a practice-based randomized controlled trial, 326 unaffected women with a family history of breast cancer received their lifetime risk in one of five presentation formats after standard genetic counseling in three Dutch familial cancer clinics: 1) in percentages, 2) in frequencies ("X out of 100"), 3) in frequencies plus graphical format (10×10 human icons), 4) in frequencies and 10-year age-related risk and 5) in frequencies and 10-year age-related risk plus graphical format. Format preferences and risk understanding (accuracy) were assessed at 2-week follow-up by a questionnaire, completed by 279/326 women. RESULTS The most preferred risk communication formats were numbers combined with verbal descriptions (37%) and numbers only (26%). Of the numerical formats, most (55%) women preferred percentages. The majority (73%) preferred to be informed about both lifetime and 10-year age-related risk. Women who had received a graphical display were more likely to choose a graphical display as their preferred format. There was no significant effect between the intervention groups with regard to risk accuracy. Overall, women given risk estimates in their preferred format had a slightly better understanding of risk. CONCLUSION The results suggest that the accuracy of breast cancer risk estimation is slightly better for women who had received this information in their preferred format, but the risk format used had no effect on women's risk accuracy. To meet the most frequent preference, counselors should consider providing a time frame of reference (eg, risk in the next 10 years) in a numerical format, in addition to lifetime risk.
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Affiliation(s)
- Lidewij Henneman
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
- Correspondence: Lidewij Henneman Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit, PO Box 7057, 1007 MB, Amsterdam, the NetherlandsTel +31 20-4449815 Email
| | - Christi J van Asperen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan C Oosterwijk
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Fred H Menko
- Family Cancer Clinic, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Liesbeth Claassen
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Daniëlle RM Timmermans
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
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Lee J, Lee EH, Chae D, Kim CJ. Patient-reported outcome measures for diabetes self-care: A systematic review of measurement properties. Int J Nurs Stud 2019; 105:103498. [PMID: 32203756 DOI: 10.1016/j.ijnurstu.2019.103498] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 11/25/2019] [Accepted: 11/30/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The aims of the present systematic review were to identify currently available patient-reported outcome measures for diabetes self-care that have been psychometrically evaluated and to evaluate their measurement properties. DESIGN A systematic literature review with a meta-analysis. DATA SOURCES A systematic literature search was conducted of the MEDLINE, EMBASE, and CINAHL databases. REVIEW METHODS The updated COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) was applied using the following steps to evaluate the measurement properties of the diabetes self-care measures: (1) evaluating the methodological quality, (2) evaluating either quantitatively summarized or quantitatively pooled data against criteria for good measurement properties, and (3) the evaluating the quality of evidence by applying the modified Grading of Recommendations Assessment, Development, and Evaluation approach. RESULTS Among 8434 articles yielded by the database search, 27 full-text articles that reported 34 studies of 13 different patient-reported outcome measures were included in this systematic review. The Diabetes Self-Management Instrument demonstrated the best content validity, with sufficient moderate-quality evidence for relevance, comprehensiveness, and comprehensibility. The Diabetes Self-Management Instrument exhibited sufficient moderate-quality evidence for structural validity and internal consistency, and sufficient high-quality evidence for convergent validity of hypothesis testing and sufficient low-quality evidence for reliability. The eight-item Summary of Diabetes Self-Care Activities-Revised was the most frequently investigated and shortest instrument with sufficient high-quality evidence for structural validity and internal consistency. However, the sufficient but very-low-quality comprehensiveness and the inconsistent very-low-quality comprehensibility for content validity, and the insufficient low-quality evidence for reliability must be considered when selecting this instrument. CONCLUSIONS None of the identified diabetes self-care instruments appears to be universally superior to the others. The Diabetes Self-Management Instrument might be the best based on current evidence, but this requires further evaluation of the measurement of invariance across languages. The eight-item Summary of Diabetes Self-Care Activities-Revised is the shortest instrument, but current evidence with regards to its content validity and reliability needs to be considered before applying this instrument. Further studies are recommended to evaluate the reliability, measurement error, and responsiveness of the diabetes self-care measurements.
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Affiliation(s)
- Jiyeon Lee
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea.
| | - Eun-Hyun Lee
- Graduate School of Public health, Ajou University, Suwon, Republic of Korea.
| | - Duckhee Chae
- College of Nursing, Chonnam National University, Gwangju, Republic of Korea.
| | - Chun-Ja Kim
- College of Nursing and Research Institute of Nursing Science, Ajou University, Suwon, Republic of Korea.
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Feufel MA, Rauwolf G, Meier FC, Karapinar-Çarkit F, Heibges M. Heuristics for designing user-centric drug products: Lessons learned from Human Factors and Ergonomics. Br J Clin Pharmacol 2019; 86:1989-1999. [PMID: 31663157 PMCID: PMC7495287 DOI: 10.1111/bcp.14134] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/19/2019] [Accepted: 09/02/2019] [Indexed: 11/27/2022] Open
Abstract
Even the most effective drug product may be used improperly and thus ultimately prove ineffective if it does not meet the perceptual, motor and cognitive capacities of its target users. Currently, no comprehensive guideline for systematically designing user‐centric drug products that would help prevent such limitations exists. We have compiled a list of approximate but nonetheless useful strategies—heuristics—for implementing a user‐centric design of drug products and drug product portfolios. First, we present a general heuristic for user‐centric design based on the framework of Human Factors and Ergonomics (HF/E). Then we demonstrate how to implement this general heuristic for older drug users (i.e., patients and caregivers aged 65 years and older) and with respect to three specific challenges (use‐cases) of medication management: (A) knowing what drug product to take/administer, (B) knowing how and when to take/administer it, and (C) actually taking/administering it. The presented heuristics can be applied prospectively to include existing knowledge about user‐centric design at every step during drug discovery, pharmaceutical drug development, and pre‐clinical and clinical trials. After a product has been released to the market, the heuristics may guide a retrospective analysis of medication errors and barriers to product usage as a basis for iteratively optimizing both the drug product and its portfolio over their life cycle.
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Affiliation(s)
- Markus A Feufel
- Department of Psychology and Ergonomics, Division of Ergonomics, Technische Universität Berlin, Berlin, Germany
| | - Gudrun Rauwolf
- Department of Psychology and Ergonomics, Division of Ergonomics, Technische Universität Berlin, Berlin, Germany
| | - Felix C Meier
- Department of Psychology and Ergonomics, Division of Ergonomics, Technische Universität Berlin, Berlin, Germany
| | | | - Maren Heibges
- Department of Psychology and Ergonomics, Division of Ergonomics, Technische Universität Berlin, Berlin, Germany
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Numeracy and Interpretation of Prognostic Estimates in Intracerebral Hemorrhage Among Surrogate Decision Makers in the Neurologic ICU. Crit Care Med 2019; 46:264-271. [PMID: 29215368 DOI: 10.1097/ccm.0000000000002887] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Clinicians caring for patients with intracerebral hemorrhage must often discuss prognosis and goals of care with their patients' surrogate decision makers, and may make numeric estimates of likelihood of survival and functional independence, informed by validated prediction models. Surrogates' prognostic estimates are often discordant with physicians', suggesting that physicians' numeric statements may not be accurately interpreted. We sought to assess the relationship between numeracy and interpretation of prognostic estimates in intracerebral hemorrhage among surrogate decision makers. We also assessed surrogates' application of prognostic estimates to decisions regarding goals of care. DESIGN Single-center, survey-based, cross-sectional study. SETTING Twenty-two-bed neurologic ICU at an urban, academic hospital. SUBJECTS Surrogate decision makers for patients admitted to the neurologic ICU. INTERVENTIONS Participants completed a survey containing five clinical vignettes describing patients with nontraumatic intracerebral hemorrhage. For each patient, numerical estimates of survival and functional independence were explicitly provided, based on the validated outcome risk stratification scale (intracerebral hemorrhage score) and the Prediction of Functional Outcome in Patients with Primary Intracerebral Hemorrhage score. MEASUREMENTS AND MAIN RESULTS Participants were asked to make their own prognostic estimates, as well as to describe their preferred goals of care for each hypothetical patient. Respondent demographics were collected, and numeracy was assessed using a modified Lipkus 11-item scale. Poor numeracy was common (42 of 96 total subjects) in this relatively highly educated population. Most prognostic estimates (55%) made by surrogates were discordant with the provided estimates. High numeracy correlated with better concordance (odds ratio, 23.9 [5.57-97.64]; p < 0.001), independent of several factors, including level of education and religion. Numeracy also affected goals-of-care decisions made by surrogates. CONCLUSIONS Poor numeracy is common among surrogate decision makers in an intensive care setting and poses a barrier to communication between surrogates and clinicians regarding prognosis and goals of care.
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Cancer screening risk literacy of physicians in training: An experimental study. PLoS One 2019; 14:e0218821. [PMID: 31269051 PMCID: PMC6608976 DOI: 10.1371/journal.pone.0218821] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 06/10/2019] [Indexed: 12/29/2022] Open
Abstract
We investigated what factors may foster or hinder physicians' cancer screening risk literacy-specifically the ability to understand evidence regarding screening effectiveness and make evidence-based recommendations to patients. In an experiment, physicians in training (interns and residents) read statistical information about outcomes from screening for cancer, and had to decide whether to recommend it to a patient. We manipulated the effectiveness of the screening (effective vs. ineffective at reducing mortality) and the demand of the patient to get screened (demand vs. no demand). We assessed participants' comprehension of the presented evidence and recommendation to the patient, as well as a-priori screening beliefs (e.g., that screening is always a good choice), numeracy, science literacy, knowledge of screening statistics, statistical education, and demographics. Stronger positive a-priori screening beliefs, lower knowledge of screening statistics, and lower numeracy were related to worse comprehension of the evidence. Physicians recommended against the ineffective screening but only if they showed good comprehension of the evidence. Physicians' recommendations were further based on the perceived benefits from screening but not on perceived harms, nor the patient's demands. The current study demonstrates that comprehension of cancer screening statistics and the ability to infer the potential benefits for patients are essential for evidence-based recommendations. However, strong beliefs in favor of screening fostered by promotion campaigns may influence how physicians evaluate evidence about specific screenings. Fostering physician numeracy skills could help counteract such biases and provide evidence-based recommendations to patients.
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Schapira MM, Fletcher KE, Ganschow PS, Jacobs EA, Walker CM, Smallwood AJ, Gil D, Faghri A, Kong AL, Yen TW, McDunn S, Marcus E, Neuner JM. Improving Communication in Breast Cancer Treatment Consultation: Use of a Computer Test of Health Numeracy. J Womens Health (Larchmt) 2019; 28:1407-1417. [PMID: 31237471 DOI: 10.1089/jwh.2018.7347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: Communication of statistics and probability is challenging in the cancer care setting. The objectives of this study are to evaluate a novel approach to cancer communication through the use of a computer assessment of patient health numeracy. Methods: We conducted a pilot study of the Computer Adapted Test of Numeracy Understanding in Medicine Instrument (CAT-NUMi) before the cancer treatment consultation for women with stage 0-3 breast cancer. Patient outcomes included the interpersonal processes of care (IPC) and the decisional conflict scale. We evaluated clinician use of numeric information in the cancer consultation and assessed feasibility outcomes from the clinician and patient perspective. Results: Patient participants (n = 50) had a median (interquartile range) age of 51 years (46-61), 70% were English speaking, and 30% Spanish speaking. Decisional conflict was low with a mean (standard deviation [SD]) decisional conflict score of 17.4 (12.3). The lack of clarity score (range 1-5) on the IPC was low (mean, SD),1.70 (0.71), indicating clear communication. Clinicians more often used percentages in communicating prognosis among those with higher numeracy scores (median, range): high (2, 0-8), medium (1, 0-7), and low (0, 0-8); p = 0.04. The patient experience of taking the CAT-NUMi was rated as very good or excellent by 65%, fair by 33%, and poor by 2% of patients. Conclusion: Screening for health numeracy with a short computer-based test may be a feasible strategy to optimize clear communication in the cancer treatment consultation. Further studies are needed to evaluate this strategy across cancer treatment clinical settings and populations.
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Affiliation(s)
- Marilyn M Schapira
- Division of General Internal Medicine, Perelman School of Medicine at the University of Pennsylvania and the Philadelphia VA Medical Center, Philadelphia, Pennsylvania
| | - Kathlyn E Fletcher
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | | | - Cindy M Walker
- School of Education, Duquesne University, Pittsburgh, Pennsylvania
| | - Alicia J Smallwood
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Denisse Gil
- Department of Medicine, Cook County Health, Chicago, Illinois
| | - Arshia Faghri
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amanda L Kong
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Tina W Yen
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Susan McDunn
- Department of Medicine, Cook County Health, Chicago, Illinois
| | - Elizabeth Marcus
- Department of Surgery, Cook County Health and Hospital System, Chicago, Illinois
| | - Joan M Neuner
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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Nouri SS, Damschroder LJ, Olsen MK, Gierisch JM, Fagerlin A, Sanders LL, McCant F, Oddone EZ. Health Coaching Has Differential Effects on Veterans with Limited Health Literacy and Numeracy: a Secondary Analysis of ACTIVATE. J Gen Intern Med 2019; 34:552-558. [PMID: 30756302 PMCID: PMC6445901 DOI: 10.1007/s11606-019-04861-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 10/25/2018] [Accepted: 12/18/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Health coaching is an effective behavior change strategy. Understanding if there is a differential impact of health coaching on patients with low health literacy has not been well investigated. OBJECTIVE To determine whether a telephone coaching intervention would result in similar improvements in enrollment in prevention programs and patient activation among Veterans with low versus high health literacy (specifically, reading literacy and numeracy). DESIGN Secondary analysis of a randomized controlled trial. PARTICIPANTS Four hundred seventeen Veterans with at least one modifiable risk factor: current smoker, BMI ≥ 30, or < 150 min of moderate physical activity weekly. METHODS A single-item assessment of health literacy and a subjective numeracy scale were assessed at baseline. A logistic regression and general linear longitudinal models were used to examine the differential impact of the intervention compared to control on enrollment in prevention programs and changes in patient activation measures (PAM) scores among patients with low versus high health literacy. RESULTS The coaching intervention resulted in higher enrollment in prevention programs and improvements in PAM scores compared to usual care regardless of baseline health literacy. The coaching intervention had a greater effect on the probability of enrollment in prevention programs for patients with low numeracy (intervention vs control difference of 0.31, 95% CI 0.18, 0.45) as compared to those with high numeracy (0.13, 95% CI - 0.01, 0.27); the low compared to high differential effect was clinically, but not statistically significant (0.18, 95% CI - 0.01, 0.38; p = 0.07). Among patients with high numeracy, the intervention group had greater increases in PAM as compared to the control group at 6 months (mean difference in improvement 4.8; 95% CI 1.7, 7.9; p = 0.003). This led to a clinically and statistically significant differential intervention effect for low vs high numeracy (- 4.6; 95% CI - 9.1, - 0.15; p = 0.04). CONCLUSIONS We suggest that health coaching may be particularly beneficial in behavior change strategies in populations with low numeracy when interpretation of health risk information is part of the intervention. CLINICALTRIALS. GOV IDENTIFIER NCT01828567.
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Affiliation(s)
- Sarah S Nouri
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA.
| | - Laura J Damschroder
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Maren K Olsen
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Jennifer M Gierisch
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA
| | - Angela Fagerlin
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS 2.0) Center for Innovation, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Linda L Sanders
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA
| | - Felicia McCant
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA
| | - Eugene Z Oddone
- Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, NC, USA
- Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health Care System, Durham, NC, USA
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Zikmund-Fisher BJ. Helping People Know Whether Measurements Have Good or Bad Implications: Increasing the Evaluability of Health and Science Data Communications. ACTA ACUST UNITED AC 2019. [DOI: 10.1177/2372732218813377] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Patients, policy makers, and the public have access to many types of health and scientific data relevant to various individual and societal decisions. Yet, these audiences often struggle with the meaning and the potential usefulness of those data, so they may choose not to engage with the data at all. Scientific and health data are generally difficult to interpret, yet presentations often implicitly assume that the recipient has the necessary contextual knowledge to identify the data’s meaning. To address this problem, designers of data communications should go beyond considering audience characteristics (e.g., numeracy) and focus more on increasing information evaluability (a concept from the judgment and decision-making literatures). The challenge is understanding which data characteristics guide people’s ability to extract meaning from data in a given situation. Prioritizing use-relevant contextual information (e.g., by defining action thresholds, comparison standards, meaningful categories, and/or significant differences) is the single best thing experts can do to improve data communication effectiveness. Doing so increases the chances that the patient, public, or policy maker audience does not just know what their numbers are but also what they mean.
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Molina F, Dehlendorf C, Gregorich SE, Kuppermann M. Women's preferences for and experiences with prenatal genetic testing decision making: Sociodemographic disparities in preference-concordant decision making. PATIENT EDUCATION AND COUNSELING 2019; 102:595-601. [PMID: 30502029 PMCID: PMC6421100 DOI: 10.1016/j.pec.2018.10.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 09/24/2018] [Accepted: 10/26/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To investigate women's preferred approach to prenatal genetic testing decision making and assess concordance between preference and experience. METHODS We conducted a secondary analysis of data from two randomized trials conducted between 2007-2012. Survey items assessed participants' preferred approach to decision making and whether they experienced a preference-concordant decision process. Logistic regression estimated relationships between patient characteristics and these outcomes. RESULTS 56% of women preferred autonomous decision making, 39% preferred shared decision making, and 5% preferred a provider-driven approach. Only 57% experienced preference-concordant decision making. On bivariate analysis, black women, Spanish-speaking Latinas and women with less education were less likely to experience this outcome than white, more educated women. Numeracy and preferring a provider-driven approach fully mediated observed disparities in preference-concordant decision making for most participants, except for Spanish-speaking Latinas, who were still less likely to have experienced this outcome after accounting for these factors. CONCLUSION Numeracy, preference for provider-driven decision processes, and language barriers were key drivers of disparities in preference-concordant decision making. PRACTICE IMPLICATIONS Given the values-sensitive and quantitative nature of prenatal testing decisions, nuanced counseling and interventions to address language barriers, numeracy gaps, and decision-making preferences are needed to tailor counseling to patient's backgrounds and desires.
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Affiliation(s)
- Fabiola Molina
- Department of Medicine, Brigham and Women's Hospital, Boston, USA
| | - Christine Dehlendorf
- Department of Family & Community Medicine, University of California, San Francisco, San Francisco, USA; Department of Obstetrics, Gynecology & Reproductive Sciences and Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, USA
| | - Steven E Gregorich
- Department of Medicine, University of California, San Francisco, San Francisco, USA
| | - Miriam Kuppermann
- Department of Obstetrics, Gynecology & Reproductive Sciences and Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, USA.
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Wegier P, Armstrong BA, Shaffer VA. Aiding Risk Information learning through Simulated Experience (ARISE): A Comparison of the Communication of Screening Test Information in Explicit and Simulated Experience Formats. Med Decis Making 2019; 39:196-207. [PMID: 30819033 DOI: 10.1177/0272989x19832882] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine whether the use of Aiding Risk Information learning through Simulated Experience (ARISE) to communicate conditional probabilities about maternal serum screening results for Down syndrome promotes more accurate positive predictive value (PPV) estimates and conceptual understanding of screening, compared with explicitly providing individuals with this information via numerical summary or icon array. METHOD In experiment 1, 582 participants completed an online study in which they were asked to estimate the PPV and rate their attitudes toward a screening test when information was presented in either a description (required calculation of the PPV), explicit (PPV was provided and had to be identified), or an ARISE format (PPV was inferred through experience-based learning). In experiment 2, 316 participants estimated the PPV and rated their attitudes toward screening based on information presented in either an icon array (identify the icons that represent the PPV) or ARISE format. RESULTS In experiment 1, ARISE elicited the most accurate PPV estimates compared with the description and explicit formats, and both the explicit and ARISE formats led to more unfavorable attitudes toward screening. In experiment 2, both the icon array and ARISE resulted in similar PPV estimates; however, ARISE led to more negative attitudes toward screening. CONCLUSIONS These findings suggest that ARISE may be superior to other formats in the communication of PPV information for screening tests. However, differences in the complexity of the formats vary and require further investigation.
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Affiliation(s)
- Pete Wegier
- Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, ON, Canada.,Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada.,Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Victoria A Shaffer
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
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When numbers make you feel: Impact of round versus precise numbers on preventive health behaviors. ORGANIZATIONAL BEHAVIOR AND HUMAN DECISION PROCESSES 2019. [DOI: 10.1016/j.obhdp.2018.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Prokhorov AV, Khalil GE, Calabro KS, Machado TC, Russell S, Czerniak KW, Botello GC, Chen M, Perez A, Vidrine DJ, Perry CL. Mobile Phone Text Messaging for Tobacco Risk Communication Among Young Adult Community College Students: Protocol and Baseline Overview for a Randomized Controlled Trial. JMIR Res Protoc 2018; 7:e10977. [PMID: 30322833 PMCID: PMC6231779 DOI: 10.2196/10977] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 12/18/2022] Open
Abstract
Background Community-college students are at high risk for tobacco use. Because the use of mobile phone text messaging is nearly ubiquitous today, short message service (SMS) may be an effective strategy for tobacco risk communication in this population. Little is known, however, concerning the message structure significantly influencing perceived tobacco risk. Objective We aim to outline the rationale and design of Project Debunk, a randomized trial comparing the effects of different SMS text message structures. Methods We conducted a 6-month randomized trial comparing 8 arms, based on the combination of the 3 message structures delivered to young adults in a 2×2×2 study design: framing (gain-framed or loss-framed), depth (simple or complex), and appeal (emotional or rational). Participants were invited to participate from 3 community colleges in Houston from September 2016 to July 2017. Participants were randomized to 1 arm and received text messages in 2 separate campaigns. Each campaign consisted of 2 text messages per day for 30 days. Perceived tobacco risk was assessed at baseline, 2 months after the first campaign, and 2 months after the second campaign. We assessed the perceived risk of using conventional products (eg, combustible cigarettes) and new and emerging products (eg, electronic cigarettes). The validity of message structures was assessed weekly for each campaign. A 1-week follow-up assessment was also conducted to understand immediate reactions from participants. Results We completed data collection for the baseline survey on a rolling basis during this time and assessed the validity of the message structure after 1 week of SMS text messages. For the entire sample (N=636), the average age was 20.92 years (SD 2.52), about two-thirds were male (430/636, 67.6%), and most were black or African American (259/636, 40.7%) or white (236/636, 37.1%). After 1 week of receiving text messages, the following was noted: (a) loss-framed messages were more likely to be perceived as presenting a loss than gain-framed messages (F7,522=13.13, P<.001), (b) complex messages were perceived to be more complex than simple messages (F7,520=2.04, P=.05), and (c) emotional messages were perceived to be more emotionally involving than rational messages (F7,520=6.46, P<.001). Conclusions This study confirms that the recruitment, randomization, and message composition have been successfully implemented. Further analyses will identify specific types of messages that are more effective than others in increasing the perceived risk of tobacco use. If our results suggest that any of the 8 specific message structures are more effective for helping young adults understand tobacco risk, this would provide evidence to include such messages as part of a larger technology-based campaign such as mobile phone apps, entertainment-based campaigns, and social media. Trial Registration ClinicalTrials.gov NCT03457480; https://clinicaltrials.gov/ct2/show/NCT03457480 (Archived by WebCite at http://www.webcitation.org/6ykd4IIap) Registered Report Identifier RR1-10.2196/10977
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Affiliation(s)
- Alexander V Prokhorov
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Georges Elias Khalil
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Karen Sue Calabro
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Tamara Costello Machado
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Sophia Russell
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Katarzyna W Czerniak
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Gabrielle C Botello
- Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Minxing Chen
- Department of Biostatistics, MD Anderson Cancer Center, The University of Texas, Houston, TX, United States
| | - Adriana Perez
- Department of Biostatistics and Data Science, School of Public Health in Austin, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, United States
| | - Damon J Vidrine
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, The University of Oklahoma, Oklahoma City, OK, United States
| | - Cheryl L Perry
- School of Public Health in Austin, The University of Texas Health Science Center at Houston (UTHealth), Austin, TX, United States
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Shaffer VA, Scherer LD, Focella ES, Hinnant A, Len-Ríos ME, Zikmund-Fisher BJ. What Is the Story with Narratives? How Using Narratives in Journalism Changes Health Behavior. HEALTH COMMUNICATION 2018; 33:1151-1157. [PMID: 28657356 DOI: 10.1080/10410236.2017.1333562] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Health journalists frequently use narratives to bring news stories to life, with little understanding about how this influences the health behavior of readers. This study was designed to examine the effect of a New York Times health news article about a person who developed a life-threatening illness after using ibuprofen on readers' future use of ibuprofen. We recruited an Internet sample (N = 405) to participate in a longitudinal study examining ibuprofen use before, immediately following, and two weeks after reading the story. Ibuprofen use two-weeks after reading the heath news article was significantly lower than baseline use. Furthermore, intentions to use ibuprofen were also significantly reduced suggesting that the observed behavior change may persist beyond the two-week period studied. Health journalists should be cautious in their use of stories about health outcomes, particularly when those stories deviate from data about objective risks.
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Affiliation(s)
- Victoria A Shaffer
- a Department of Health Sciences, School of Health Professions, Department of Psychological Sciences, College of Arts and Science , University of Missouri
| | - Laura D Scherer
- b Department of Psychological Sciences, College of Arts and Science , University of Missouri
| | | | - Amanda Hinnant
- d Department of Magazine Journalism, School of Journalism , University of Missouri
| | - María E Len-Ríos
- e Department of Advertising and Public Relations, College of Journalism & Mass Communications , University of Georgia
| | - Brian J Zikmund-Fisher
- f Department of Health Behavior & Health Education, School of Public Health, Department of Internal Medicine, School of Medicine , University of Michigan
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Stahl LE, Stewart R, Carr MM, Goldenberg D, Schubart JR. Treatment preferences and decision-making in patients diagnosed with indeterminate thyroid nodules. Psychooncology 2018; 27:2862-2864. [PMID: 30144220 DOI: 10.1002/pon.4865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/09/2018] [Accepted: 08/16/2018] [Indexed: 11/08/2022]
Affiliation(s)
- Lauren E Stahl
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Renee Stewart
- Department of Humanities, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Michele M Carr
- Department of Otolaryngology, West Virginia University, Morgantown, WV, USA
| | - David Goldenberg
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Jane R Schubart
- Department of Surgery, Division of Outcomes, Research and Quality, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
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Janssen E, Ruiter RAC, Waters EA. Combining risk communication strategies to simultaneously convey the risks of four diseases associated with physical inactivity to socio-demographically diverse populations. J Behav Med 2018; 41:318-332. [PMID: 29027602 PMCID: PMC5899069 DOI: 10.1007/s10865-017-9894-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 10/07/2017] [Indexed: 12/17/2022]
Abstract
A single risk factor can increase the risk of developing multiple diseases, but most risk communication research has been conducted in the context of a single disease. We explored which combination of three recommended risk communication strategies is most effective in simultaneously conveying risk estimates of four diseases associated with physical inactivity: colon cancer, stroke, diabetes, and heart disease. Participants (N = 1161, 50% no college experience, 50% racial/ethnic minority) were shown hypothetical risk estimates for each of the four diseases. All four diseases were placed at varying heights on 1 of 12 vertical bar charts (i.e., "risk ladders") to indicate their respective probabilities. The risk ladders varied in a 2 (risk reduction information: present/absent) × 2 (numerical format: words/words and numbers) × 3 (social comparison information: none/somewhat higher than average/much higher than average) full factorial design. Participants were randomly assigned to view one of the risk ladders and then completed a questionnaire assessing message comprehension, message acceptance, physical activity-related risk and efficacy beliefs, and physical activity intentions. Higher message acceptance was found among (1) people who received risk reduction information versus those who did not (p = .01), and (2) people who did not receive social comparison information versus those told that they were at higher than average risk (p = .03). Further, absolute cognitive perceived risk of developing "any of the diseases shown in the picture" was higher among people who did not receive social comparison information (p = .03). No other main effects and only very few interactions with demographic variables were found. Combining recommended risk communication strategies did not improve or impair key cognitive or affective precursors of health behavior change. It might not be necessary to provide people with extensive information when communicating risk estimates of multiple diseases.
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Affiliation(s)
- Eva Janssen
- Department of Work and Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Robert A C Ruiter
- Department of Work and Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Erika A Waters
- School of Medicine, Department of Surgery (Division of Public Health Sciences), Washington University in Saint Louis, Campus Box 8100, 600 S. Euclid Ave, Saint Louis, MO, 63110, USA.
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Abstract
BACKGROUND Multicriteria decision-making (MCDM) methods are well-suited to serve as the foundation for clinical decision support systems. To do so, however, they need to be appropriate for use in busy clinical settings. We compared decision-making processes and outcomes of patient-level analyses done with a range of multicriteria methods that vary in ease of use and intensity of decision support, 2 factors that could affect their ease of implementation into practice. METHODS We conducted a series of Internet surveys to compare the effects of 5 multicriteria methods that differ in user interface and required user input format on decisions regarding selection of a preferred method for lowering the risk of cardiovascular disease. The study sample consisted of members of an online Internet panel maintained by Fluidsurveys, an Internet survey company. Study outcomes were changes in preferred option, decision confidence, preparation for decision making, the Values Clarification and Decisional Uncertainty subscales of the Decisional Conflict Scale, and method ease of use. RESULTS The frequency of changes in the preferred option ranged from 9% to 38%, P < 0.001, and rose progressively as the level of decision support provided by the MCDM method increased. The proportion of respondents who rated the method as easy ranged from 57% to 79% and differed significantly among MCDM methods, P = 0.003, but was not consistently related to intensity of decision support or ease of use. CONCLUSION Decision support based on MCDM methods is not necessarily limited by decreases in ease of use. This result suggests that it is possible to develop decision support tools using sophisticated multicriteria techniques suitable for use in routine clinical care settings.
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Affiliation(s)
- James G Dolan
- Department of Public Health Sciences, University of Rochester, Rochester, NY
| | - Peter J Veazie
- Department of Public Health Sciences, University of Rochester, Rochester, NY
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Janssen E, Verduyn P, Waters EA. Don't know responses to cognitive and affective risk perception measures: Exploring prevalence and socio-demographic moderators. Br J Health Psychol 2018; 23:407-419. [PMID: 29393593 DOI: 10.1111/bjhp.12296] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 11/28/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Many people report uncertainty when appraising their risk of cancer and other diseases, but prior research about the topic has focused solely on cognitive risk perceptions. We investigated uncertainty related to cognitive and affective risk questions. We also explored whether any differences in uncertainty between cognitive and affective questions varied in magnitude by item-specific or socio-demographic characteristics. DESIGN Secondary analysis of data collected for a 2 × 2 × 3 full-factorial risk communication experiment (N = 835) that was embedded within an online survey. METHODS We investigated the frequency of 'don't know' responses (DKR) to eight perceived risk items that varied according to whether they assessed (1) cognitive versus affective perceived risk, (2) absolute versus comparative risk, and (3) colon cancer versus 'any exercise-related diseases'. Socio-demographics were as follows: sex, age, education, family history, and numeracy. We analysed the data using multilevel logistic regression. RESULTS The odds of DKR were lower for affective than cognitive perceived risk (OR = 0.64, p < .001). This difference occurred for absolute but not comparative risk perceptions (interaction effect, p = .004), but no interactions for disease type or demographic characteristics were found (ps > .05). CONCLUSIONS Lower uncertainty for affective (vs. cognitive) absolute perceived risk items is consistent with research stating: (1) Risk perceptions are grounded in people's feelings about a hazard, and (2) feelings are easier for people to access than facts. Including affective perceived risk items in health behaviour surveys may reduce missing data and improve data quality. Statement of contribution What is already known on this subject? Many people report that they don't know their risk (i.e., risk uncertainty). Evidence is growing for the importance of feelings of risk in explaining health behaviour. Feelings are easier for people to access than facts. What does this study add? Don't know responding is higher for absolute cognitive than absolute affective risk questions. This difference does not vary in magnitude by demographic characteristics. Affective perceived risk questions in surveys may reduce missing data and improve data quality.
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Affiliation(s)
- Eva Janssen
- Department of Work and Social Psychology, Maastricht University, The Netherlands
| | - Philippe Verduyn
- Department of Work and Social Psychology, Maastricht University, The Netherlands
| | - Erika A Waters
- Division of Public Health Sciences, Department of Surgery, School of Medicine, Washington University, Saint Louis, Missouri, USA
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