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Chandra A, Goldstein J, Peters K, Roberts WO, Satin DJ. Bias and Conflict of Interest in the Underreporting of Sexual Abuse in Competitive Sports: A Literature Review. Curr Sports Med Rep 2024; 23:105-110. [PMID: 38437495 DOI: 10.1249/jsr.0000000000001146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
ABSTRACT The prevalence of sexual abuse in competitive sports is increasing worldwide and requires a united call to action. The underreporting of such abuses gained media attention resulting from recent high-profile cases. In this article, we report the results of a systematic literature review, identifying root causes of underreporting sexual abuse in competitive sports. We identify that biases and conflicts of interest work against effective reporting of abuse by athletes at the individual, organizational, and cultural levels. We offer conflict of interest and bias mitigation approaches from the social science, law, business, research, and diagnostic error literature that may apply. Competitive sports organizations may use this analysis to identify barriers and improve the effective reporting of sexual abuse.
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Affiliation(s)
| | - Jack Goldstein
- Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN
| | - Krystina Peters
- Obstetrics and Gynecology, University of Nebraska, Lincoln, NE
| | - William O Roberts
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN
| | - David J Satin
- Department of Family Medicine and Community Health, Center for Bioethics, University of Minnesota, Minneapolis, MN
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2
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Conti L, Pizzoli SFM, Marzorati C, Grasso R, Petralia G, Pravettoni G. Cognitive alterations and brain functional changes following chemotherapy treatment in breast cancer patients: A systematic review on resting-state fMRI studies. APPLIED NEUROPSYCHOLOGY. ADULT 2024:1-16. [PMID: 38261545 DOI: 10.1080/23279095.2024.2303362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Cognitive dysfunctions and functional brain modifications are among the side effects reported by breast cancer patients that persist beyond the chemotherapy. This paper aims at synthesizing the evidence on cognitive and functional brain changes and their associations in breast cancer patients treated with chemotherapy. A systematic literature search was performed using PubMed, Ovid MEDLINE, Scopus, and Embase up to July 2022. Eligible studies evaluated adult women with breast cancer treated with systemic chemotherapy, that performed cognitive assessment and resting-state functional MRI. Methodological quality was assessed. Sixteen studies were included, with a total of 1054 female participants. All studies reported alterations mainly concerned the fronto-parieto-temporal system and specifically involved the disruption of the DMN. Consistent with these findings, BCPs showed changes in cognitive performance reporting dysfunctions in executive ability, memory, and attention. However, not all the studies found a significant association between functional brain alterations and cognitive dysfunction. Some limitations including lack of sample homogeneity and different methodological approaches were reported. This work highlighted the presence of cognitive dysfunctions and functional brain alteration in breast cancer patients treated with chemotherapy. This allows a greater awareness of the side effects, promoting better clinical management. However, further research is needed to investigate the cause-effect relationship between cognitive and functional alterations.
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Affiliation(s)
- Lorenzo Conti
- Applied Research Division for Cognitive and Psychological Science, IRCCS European Institute of Oncology, Milan, Italy
| | | | - Chiara Marzorati
- Applied Research Division for Cognitive and Psychological Science, IRCCS European Institute of Oncology, Milan, Italy
| | - Roberto Grasso
- Applied Research Division for Cognitive and Psychological Science, IRCCS European Institute of Oncology, Milan, Italy
- Department of Oncology and Haemato-Oncology, University of Milan, Milano, Italy
| | - Giuseppe Petralia
- Department of Oncology and Haemato-Oncology, University of Milan, Milano, Italy
- Division of Radiology, IRCCS European Institute of Oncology, Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IRCCS European Institute of Oncology, Milan, Italy
- Department of Oncology and Haemato-Oncology, University of Milan, Milano, Italy
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3
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Pergande AE, Belshaw Z, Volk HA, Packer RMA. Owner perspectives on the impact of veterinary surgeons upon their decision making in the management of dogs with idiopathic epilepsy. Vet Rec 2022:e2482. [PMID: 36529783 DOI: 10.1002/vetr.2482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/10/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Idiopathic epilepsy is a prevalent canine condition that can be challenging to manage. A positive vet-owner relationship contributes to satisfaction and compliance, but its impact on management is unclear. The aim of this study was to investigate owner perspectives about the impact of veterinary surgeons on decision making and management. METHODS Qualitative methods were utilised, and semi-structured interviews were completed with 21 owners of dogs with epilepsy who lived in England. Transcripts were thematically analysed, and this study discusses the theme 'influences of the veterinary surgeon'. RESULTS Many owners felt that more precise expectations could have improved interactions with their veterinary surgeon(s), and their experiences of caring for their dog. Most owners referred to a specialist reported a positive experience, often due to specialists being perceived to have greater experience or knowledge. Owners who reported predominantly negative experiences were often less trusting of the veterinary profession, and more likely to perform self-directed research. LIMITATIONS These results represent the experiences of a small subset of owners, and larger scale studies are required to support these findings. CONCLUSION Owners appear to value the formation of partnerships of care with their veterinary surgeon, and greater availability of educational resources could further improve owner satisfaction.
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Affiliation(s)
- Amy E Pergande
- Clinical Science and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK
| | | | - Holger A Volk
- Department of Small Animal Medicine and Surgery, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Rowena M A Packer
- Clinical Science and Services, Royal Veterinary College, Hatfield, Hertfordshire, UK
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4
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Vandermause M, Webb J, Xu KT, Richman P. Influence of color priming on comfort with emergency department discharge for low HEART score patients. Am J Emerg Med 2022; 60:177-178. [DOI: 10.1016/j.ajem.2022.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/13/2022] [Accepted: 07/13/2022] [Indexed: 10/17/2022] Open
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Gurmu Y. Patient Preferences in Shared Decision Making During Healthcare and Associated Factors Among Adult Admitted Patients at Public Hospitals of West Shoa Oromia, Ethiopia. Patient Prefer Adherence 2022; 16:1781-1786. [PMID: 35923655 PMCID: PMC9342655 DOI: 10.2147/ppa.s376600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/21/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Patient preferences mean the choices of individuals to make decisions about health and medical treatment by using their own experiences, beliefs, and values. The aim of this study was to assess patient preferences in shared decision making during healthcare and associated factors among adult admitted patients at public hospitals of West Shoa Oromia, Ethiopia. METHODS A cross-sectional study was carried out among adult admitted patients at public hospitals of West Shoa Oromia, Ethiopia. An interviewer-administered with the Control Preference Scale questionnaire instrument tool was used to assess patient preferences in shared decision making. All statistical analysis was performed using SPSS for windows program version 21. RESULTS A total of 403 respondents participated. Out of the total respondents, 168 (41.7%) were females. Overall, 64.8% (n=261) of the respondents prefer a collaborative role in shared decision making. Age (AOR 4.11, 95% CI 2.21-7.64), marital status (AOR 0.37, 95% CI 0.20-0.68), and education level (AOR 2.45, 95% CI 1.13-4.87) are significant in patient preference in shared decision making. CONCLUSION AND RECOMMENDATION More than half of respondents 261 (64.8%) prefer shared decision making in a collaborative role with healthcare providers. Age, marital status, and level of education are factors associated with the patient preferences in shared decision making. The Ethiopian ministry of health should work on policy of shared decision making. Healthcare providers have to consider patients in shared decision making.
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Affiliation(s)
- Yonas Gurmu
- Department of Nursing, College of Medicine & Health Sciences, Ambo University, Ambo, Ethiopia
- Correspondence: Yonas Gurmu, Department of Nursing, College of Medicine & Health Sciences, Ambo University, P. O. Box: 19, Ambo, Ethiopia, Email
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6
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Mansoori JN, Clark BJ, Havranek EP, Douglas IS. The Impact of Choice Architecture on Sepsis Fluid Resuscitation Decisions: An Exploratory Survey-Based Study. MDM Policy Pract 2022; 7:23814683221099454. [PMID: 35592271 PMCID: PMC9112319 DOI: 10.1177/23814683221099454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background Discordance with well-known sepsis resuscitation guidelines is often
attributed to rational assessments of patients at the point of care.
Conversely, we sought to explore the impact of choice architecture (i.e.,
the environment, manner, and behavioral psychology within which options are
presented and decisions are made) on decisions to prescribe
guideline-discordant fluid volumes. Design We conducted an electronic, survey-based study using a septic shock clinical
vignette. Physicians from multiple specialties and training levels at an
academic tertiary-care hospital and academic safety-net hospital were
randomized to distinct answer sets: control (6 fluid options), time
constraint (6 fluid options with a 10-s limit to answer), or choice overload
(25 fluid options). The primary outcome was discordance with Surviving
Sepsis Campaign fluid resuscitation guidelines. We also measured response
times and examined the relationship between each choice architecture
intervention group, response time, and guideline discordance. Results A total of 189 of 624 (30.3%) physicians completed the survey. Time spent
answering the vignette was reduced in time constraint (9.5 s, interquartile
range [IQR] 7.3 s to 10.0 s, P < 0.001) and increased in
choice overload (56.8 s, IQR 35.9 s to 86.7 s, P <
0.001) groups compared with control (28.3 s, IQR 20.0 s to 44.6 s). In
contrast, the relative risk of guideline discordance was higher in time
constraint (2.07, 1.33 to 3.23, P = 0.001) and lower in
choice overload (0.75, 0.60, to 0.95, P =0.02) groups.
After controlling for time spent reading the vignette, the overall odds of
choosing guideline-discordant fluid volumes were reduced for every
additional second spent answering the vignette (OR 0.98, 0.97, to 0.99,
P < 0.001). Conclusions Choice architecture may affect fluid resuscitation decisions in sepsis
regardless of patient conditions, warranting further investigation in
real-world contexts. These effects should be considered when implementing
practice guidelines. Highlights
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Affiliation(s)
- Jason N. Mansoori
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Denver Health Medical Center, Denver, CO, USA
| | - Brendan J. Clark
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Edward P. Havranek
- Division of Cardiology, Department of Medicine, Denver, CO, USA
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Ivor S. Douglas
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Denver Health Medical Center, Denver, CO, USA
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
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7
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Behavioral Economics: A Primer and Applications to the UN Sustainable Development Goal of Good Health and Well-Being. REPORTS 2021. [DOI: 10.3390/reports4020016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Behavioral economics (BE) is a relatively new field within economics that incorporates insights from psychology that can be harnessed to improve economic decision making with the potential to enhance good health and well-being of individuals and societies, the third of the United Nations Sustainable Development Goals. While some of the psychological principles of economic decision making were described as far back as the 1700s by Adam Smith, BE emerged as a discipline in the 1970s with the groundbreaking work of psychologists Daniel Kahneman and Amos Tversky. We describe the basic concepts of BE, heuristics (decision-making shortcuts) and their associated biases, and the BE strategies framing, incentives, and economic nudging to overcome these biases. We survey the literature to identify how BE techniques have been employed to improve individual choice (focusing on childhood obesity), health policy, and patient and healthcare provider decision making. Additionally, we discuss how these BE-based efforts to improve health-related decision making can lead to sustaining good health and well-being and identify additional health-related areas that may benefit from including principles of BE in decision making.
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8
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Mazzoni D, Vener C, Mazzocco K, Monzani D, Pravettoni G. The Psychological Risks Associated With the Non-medical Switch From Biologics to Biosimilars. Front Psychol 2021; 12:605643. [PMID: 33584474 PMCID: PMC7873288 DOI: 10.3389/fpsyg.2021.605643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 01/07/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Davide Mazzoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Claudia Vener
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Ketti Mazzocco
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Dario Monzani
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
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9
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Savioni L, Triberti S. Cognitive Biases in Chronic Illness and Their Impact on Patients' Commitment. Front Psychol 2020; 11:579455. [PMID: 33192894 PMCID: PMC7655771 DOI: 10.3389/fpsyg.2020.579455] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/22/2020] [Indexed: 12/21/2022] Open
Affiliation(s)
- Lucrezia Savioni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Stefano Triberti
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, IEO European Institute of Oncology IRCCS, Milan, Italy
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10
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Gorini A, Giuliani M, Marton G, Vergani L, Barbieri S, Veglia F, Tremoli E. Spontaneous Participation in Secondary Prevention Programs: The Role of Psychosocial Predictors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176298. [PMID: 32872473 PMCID: PMC7503236 DOI: 10.3390/ijerph17176298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 11/25/2022]
Abstract
Disease prevention is a multifaceted construct that has been widely studied. Nevertheless, in spite of its importance, it is still not sufficiently considered by the general population. Since the reasons for this lack of consideration are not yet fully understood, we created an Online Prevention Survey (OPS) to investigate the role of both sociodemographic and psychological factors in predicting individuals’ spontaneous participation in secondary prevention programs. The results revealed that younger people, men, manual workers, unemployed people, and those who do not regularly practise physical activity were less likely to spontaneously participate in such programs. Furthermore, an analysis of the psychological determinants of the willingness to participate in secondary prevention programs showed that depressive symptoms negatively predict it, while an individual’s perception of receiving high social support acts as a positive predictor. Based on these results, we suggest the need for implementing new tailored approaches to promote prevention initiatives to those segments of the population which are more reluctant to spontaneously undertake prevention paths.
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Affiliation(s)
- Alessandra Gorini
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (G.M.); (L.V.)
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, 20141 Milan, Italy
- Correspondence: ; Tel.: +39-025-800-246
| | - Mattia Giuliani
- IRCCS Centro Cardiologico Monzino, 20138 Milan, Italy; (M.G.); (S.B.); (F.V.); (E.T.)
| | - Giulia Marton
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (G.M.); (L.V.)
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Laura Vergani
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; (G.M.); (L.V.)
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Simone Barbieri
- IRCCS Centro Cardiologico Monzino, 20138 Milan, Italy; (M.G.); (S.B.); (F.V.); (E.T.)
| | - Fabrizio Veglia
- IRCCS Centro Cardiologico Monzino, 20138 Milan, Italy; (M.G.); (S.B.); (F.V.); (E.T.)
| | - Elena Tremoli
- IRCCS Centro Cardiologico Monzino, 20138 Milan, Italy; (M.G.); (S.B.); (F.V.); (E.T.)
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11
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La Rosa VL, Shah M, Kahramanoglu I, Cerentini TM, Ciebiera M, Lin LT, Dirnfeld M, Minona P, Tesarik J. Quality of life and fertility preservation counseling for women with gynecological cancer: an integrated psychological and clinical perspective. J Psychosom Obstet Gynaecol 2020; 41:86-92. [PMID: 31373525 DOI: 10.1080/0167482x.2019.1648424] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose: Relational and sexual problems are frequent in patients with a diagnosis of gynecological cancer, because this disease has a strong negative impact on female identity and sexuality. Psychological and sexual functioning is affected by inauspicious diagnosis. Furthermore, therapies may compromise reproductive function. The aim of this study is to propose a general overview on the impact of gynecological cancer on quality of life and psychological and sexual functioning, as well as on the importance of adequate counseling related to fertility preservation techniques.Materials and methods: We provide a narrative overview of the recent literature about quality of life and fertility preservation counselling in women with gynecological cancer.Results and conclusions: According to recent studies, 75% of women between 18 and 45 years with a diagnosis of cancer wish to have children. When cancer affects the reproductive system, the psychological distress is even stronger because there is a loss of menstrual function and fertility. Currently, fertility preservation techniques in women with gynecological cancer are beneficial and lead to an improvement in the quality of life.
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Affiliation(s)
| | - Mohsin Shah
- Department of Physiology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Ilker Kahramanoglu
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Michal Ciebiera
- Second Department of Obstetrics and Gynecology, The Center of Postgraduate Medical Education, Warsaw, Poland
| | - Li-Te Lin
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Martha Dirnfeld
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology-IVF, Carmel Medical Center, Bruce & Ruth Rappaport Faculty of Medicine, Technion Haifa, Haifa, Israel
| | | | - Jan Tesarik
- Molecular Assisted Reproduction and Genetics, MARGen Clinic, Granada, Spain
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12
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La Rosa VL, Garzon S, Gullo G, Fichera M, Sisti G, Gallo P, Riemma G, Schiattarella A. Fertility preservation in women affected by gynaecological cancer: the importance of an integrated gynaecological and psychological approach. Ecancermedicalscience 2020; 14:1035. [PMID: 32419847 PMCID: PMC7221134 DOI: 10.3332/ecancer.2020.1035] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Indexed: 12/24/2022] Open
Abstract
Gynaecological cancer treatment significantly affects the fertility of women in reproductive age. Surgery, chemotherapy and radiotherapy are the mainstays of ovarian, cervical and endometrial cancers and anatomically or functionally impact the uterus and ovaries. Moreover, the sexual function and psychological wellbeing of patients are highly weakened after a cancer diagnosis: depression, anxiety and impairment of quality of life represent a relevant concern for patient care. The potential loss of fertility could be more distressing than cancer itself. For this reason, it is of paramount importance to try to preserve fertility in women affected by gynaecological cancers. Recently, tailored fertility preservation therapies have been developed to meet the childbearing demand from more than half of women between 18 and 40 years with a diagnosis of cancer. Currently, fertility preservation techniques play a significant role in improving the quality of life of women with gynaecological cancer. In this scenario, we propose a narrative overview of the recent literature about the importance of a multidisciplinary approach in the management of fertility preservation in the case of gynaecological cancers.
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Affiliation(s)
| | - Simone Garzon
- Department of Obstetrics and Gynaecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Giuseppe Gullo
- Department of Obstetrics and Gynaecology, AOOR Villa Sofia Cervello, IVF Public Center, Palermo, Italy
| | - Michele Fichera
- Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Giovanni Sisti
- Lincoln Medical and Mental Health Center, 234 East 149 Street, 5th Floor, Bronx, NY 10451, USA
| | - Pasquale Gallo
- Obstetrics and Gynaecology Unit, "Santa Maria delle Grazie" Hospital, Pozzuoli, Naples, Italy
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialised Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Schiattarella
- Department of Woman, Child and General and Specialised Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
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13
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Marton G, Pizzoli SFM, Vergani L, Mazzocco K, Monzani D, Bailo L, Pancani L, Pravettoni G. Patients' health locus of control and preferences about the role that they want to play in the medical decision-making process. PSYCHOL HEALTH MED 2020; 26:260-266. [PMID: 32323553 DOI: 10.1080/13548506.2020.1748211] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Health locus of control (HLOC) may influence people's behavior regarding their health as well as their desires to be involved in the medical decision-making. Our study aimed to examine HLOC's relations with people's control preferences about the medical decision-making. A total of 153 people filled out the self-administered version of the Control Preference Scale and the Multidimensional Health Locus of Control Scale - form C. The most preferred role is the collaborative one. However, HLOC explained heterogeneity in people's control preferences: lower scores in external HLOC were related to a greater preference for the active and the collaborative role. From the personalized medicine perspective, an accurate evaluation of the patient's HLOC could help tailoring the decision-making process within the clinical context.
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Affiliation(s)
- Giulia Marton
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS , Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan , Milan, Italy
| | - Silvia Francesca Maria Pizzoli
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS , Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan , Milan, Italy
| | - Laura Vergani
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS , Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan , Milan, Italy
| | - Ketti Mazzocco
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS , Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan , Milan, Italy
| | - Dario Monzani
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS , Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan , Milan, Italy
| | - Luca Bailo
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS , Milan, Italy
| | - Luca Pancani
- Department of Psychology, University of Milan - Bicocca , Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS , Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan , Milan, Italy
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14
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Faccio F, Mascheroni E, Ionio C, Pravettoni G, Alessandro Peccatori F, Pisoni C, Cassani C, Zambelli S, Zilioli A, Nastasi G, Giuntini N, Bonassi L. Motherhood during or after breast cancer diagnosis: A qualitative study. Eur J Cancer Care (Engl) 2020; 29:e13214. [PMID: 31904906 DOI: 10.1111/ecc.13214] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 10/25/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Little is known about the process of becoming a mother in women who experienced a breast cancer diagnosis (BC). In this qualitative study, we investigated maternal representations in pregnant women with experience of BC and those with no oncological history. METHODS A total of 38 women were recruited, 19 women who experienced a BC diagnosis and 19 who had not. To explore maternal representations, semi-structured interviews were conducted and analysed through thematic analysis. RESULTS Four main themes were identified: fears and worries, meaning of motherhood, mother-foetus relationship and partner support. Across themes, differences between primiparous and multiparous are reported. Women with gestational breast cancer (GBC) described fear for their own and their child's survival. Women with previous BC recall contrasting emotions. All women with experience of BC perceived breastfeeding as fundamental and inability to do so provoked worry. Relationship with the partner was considered central, while healthy women were projected towards the future triadic relationship. CONCLUSIONS Finding a mental space during pregnancy for the representation of the future child could be hard for women with GBC. Dissimilarities in the experience of motherhood in cancer patients provide insight into psychological aspects that should be taken into account in clinical practice.
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Affiliation(s)
- Flavia Faccio
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Eleonora Mascheroni
- CRIdee, Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Chiara Ionio
- CRIdee, Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Fedro Alessandro Peccatori
- Fertility and Procreation Unit, Gynecologic Oncology Division, European Institute of Oncology IRCCS, Milan, Italy
| | - Camilla Pisoni
- Neonatal Intensive Care Unit, IRCCS Foundation Policlinico San Matteo, Pavia, Italy
| | - Chiara Cassani
- Department of Obstetrics and Gynecology, IRCCS Foundation Policlinico San Matteo, Pavia, Italy
| | - Sara Zambelli
- Department of Mental Health, ASST Bergamo Est, Seriate, Italy
| | - Anna Zilioli
- Department of Mental Health, ASST Bergamo Est, Seriate, Italy
| | | | | | - Lucia Bonassi
- Department of Mental Health, ASST Bergamo Est, Seriate, Italy
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16
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Preisz A. Fast and slow thinking; and the problem of conflating clinical reasoning and ethical deliberation in acute decision-making. J Paediatr Child Health 2019; 55:621-624. [PMID: 30932284 DOI: 10.1111/jpc.14447] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 12/14/2022]
Abstract
Expertise in a medical specialty requires countless hours of learning and practice and a combination of neural plasticity and contextual case experience resulting in advanced gestalt clinical reasoning. This holistic thinking assimilates complex segmented information and is advantageous for timely clinical decision-making in the emergency department and paediatric or neonatal intensive care units. However, the same agile reasoning that is essential acutely may be at odds with the slow deliberative thought required for ethical reasoning and weighing the probability of patient morbidity. Recent studies suggest that inadequate ethical decision-making results in increased morbidity for patients and that clinical ethics consultation may reduce the inappropriate use of life-sustaining treatment. Behavioural psychology research suggests there are two systems of thinking - fast and slow - that control our thoughts and therefore our actions. The problem for experienced clinicians is that fast thinking, which is instinctual and reflexive, is particularly vulnerable to experiential biases or assumptions. While it has significant utility for clinical reasoning when timely life and death decisions are crucial, I contend it may simultaneously undermine the deliberative slow thought required for ethical reasoning to determine appropriate therapeutic interventions that reduce future patient morbidity. Whilst health-care providers generally make excellent therapeutic choices leading to good outcomes, a type of substitutive thinking that conflates clinical reasoning and ethical deliberation in acute decision-making may impinge on therapeutic relationships, have adverse effects on patient outcomes and inflict lifelong burdens on some children and their families.
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Affiliation(s)
- Anne Preisz
- Clinical Ethics, Clinical Governance Unit, Sydney Children's Hospital Network, Sydney, New South Wales, Australia.,Sydney Health Ethics, University of Sydney, Sydney, New South Wales, Australia.,School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
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Boulet S, Ursino M, Thall P, Jannot A, Zohar S. Bayesian variable selection based on clinical relevance weights in small sample studies-Application to colon cancer. Stat Med 2019; 38:2228-2247. [PMID: 30672015 PMCID: PMC6590366 DOI: 10.1002/sim.8107] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 10/19/2018] [Accepted: 01/08/2019] [Indexed: 11/17/2022]
Abstract
Using clinical data to model the medical decisions behind sequential treatment actions raises methodological challenges. Physicians often have access to many covariates that may be used when making sequential treatment decisions for individual patients. Statistical variable selection methods may help finding which of these variables are used for this decision in everyday practice. When the sample size is not large, Bayesian variable selection methods can address this setting and allow for expert information to be incorporated into prior distributions. Motivated by clinical practice data involving repeated dose adaptation for Irinotecan in colorectal metastatic cancer, we propose a modification of the stochastic search variable selection (SSVS) method, which we call weight-based SSVS (WBS). We use clinical relevance weights elicited from physician experts to construct prior distributions, with the goal to identify the most influential toxicities and other covariates used for dose adjustment. We evaluate and compare the WBS model performance to the Lasso and SSVS through an extensive simulation study. The simulations show that WBS has better performance and lower rates of false positives and false negatives than the other methods but depends strongly on the covariate weights.
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Affiliation(s)
- Sandrine Boulet
- INSERM U1138, Team 22, Centre de Recherche des CordeliersUniversity Paris Descartes, University Pierre et Marie CurieParisFrance
| | - Moreno Ursino
- INSERM U1138, Team 22, Centre de Recherche des CordeliersUniversity Paris Descartes, University Pierre et Marie CurieParisFrance
| | - Peter Thall
- Department of Biostatistics, MD Anderson Cancer CenterHoustonTexas
| | - Anne‐Sophie Jannot
- INSERM U1138, Team 22, Centre de Recherche des CordeliersUniversity Paris Descartes, University Pierre et Marie CurieParisFrance
- Department of Statistics, Computing and Public Health, Hôpital Européen Georges‐Pompidou, AP‐HPParisFrance
| | - Sarah Zohar
- INSERM U1138, Team 22, Centre de Recherche des CordeliersUniversity Paris Descartes, University Pierre et Marie CurieParisFrance
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Pizzoli SFM, Renzi C, Arnaboldi P, Russell-Edu W, Pravettoni G. From life-threatening to chronic disease: Is this the case of cancers? A systematic review. COGENT PSYCHOLOGY 2019. [DOI: 10.1080/23311908.2019.1577593] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Silvia Francesca Maria Pizzoli
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, Milan 20141, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, 20141, Italy
| | - Chiara Renzi
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, 20141, Italy
| | - Paola Arnaboldi
- Service of Psychiatry and Psychological Medicine (SPPM), Cantonal Socio-psychiatric Organization, Lugano Savosa, Switzerland
| | | | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, Milan 20141, Italy
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, 20141, Italy
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Ramos JGR, Ranzani OT, Perondi B, Dias RD, Jones D, Carvalho CRR, Velasco IT, Forte DN. A decision-aid tool for ICU admission triage is associated with a reduction in potentially inappropriate intensive care unit admissions. J Crit Care 2019; 51:77-83. [PMID: 30769294 DOI: 10.1016/j.jcrc.2019.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 02/01/2019] [Accepted: 02/01/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE Intensive care unit (ICU) admission triage occurs frequently and often involves highly subjective decisions that may lead to potentially inappropriate ICU admissions. In this study, we evaluated the effect of implementing a decision-aid tool for ICU triage on ICU admission decisions. METHODS This was a prospective, before-after study. Urgent ICU referrals to ten ICUs in a tertiary hospital in Brazil were assessed before and after the implementation of the decision-aid tool. Our primary outcome was the proportion of potentially inappropriate ICU referrals (defined as priority 4B or 5 referrals, accordingly to the Society of Critical Care Medicine guidelines of 1999 and 2016, respectively) admitted to the ICU within 48 h. We conducted multivariate analyses to adjust for potential confounders and evaluated the interaction between phase and triage priority. RESULTS Of the 2201 patients analyzed, 1184 (53.8%) patients were admitted to the ICU. After adjustment for confounders, implementation of the decision-aid tool was associated with a reduction in potentially inappropriate ICU admissions using either the 1999 [adjOR (95% CI) = 0.36 (0.13-0.97)] or 2016 [adjOR (95%CI) = 0.35 (0.13-0.96)] definitions. CONCLUSION Implementation of a decision-aid tool for ICU triage was associated with a reduction in potentially inappropriate ICU admissions.
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Affiliation(s)
- Joao Gabriel Rosa Ramos
- Medical Sciences PhD program, Faculdade de Medicina FMUSP, Universidade de São Paulo, Sao Paulo, Brazil; Intensive Care Unit, Hospital Sao Rafael, Salvador, Brazil.
| | - Otavio T Ranzani
- Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Beatriz Perondi
- Emergency Department, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil
| | - Roger Daglius Dias
- Emergency Department, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil; Emergency Department, Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - Daryl Jones
- Monash University, School of Public Health and Preventive Medicine, Australia; University of Melbourne, Australia; Austin Health, Melbourne, Australia.
| | - Carlos Roberto Ribeiro Carvalho
- Pulmonary Division, Heart Institute (InCor), Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
| | - Irineu Tadeu Velasco
- Emergency Medicine Discipline, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo, Brazil.
| | - Daniel Neves Forte
- Medical Sciences PhD program, Faculdade de Medicina FMUSP, Universidade de São Paulo, Sao Paulo, Brazil; Teaching and Research on Palliative Care Program, Hospital Sirio-Libanes, Sao Paulo, Brazil
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20
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Bailo L, Vergani L, Pravettoni G. Patient Preferences as Guidance for Information Framing in a Medical Shared Decision-Making Approach: The Bridge Between Nudging and Patient Preferences. Patient Prefer Adherence 2019; 13:2225-2231. [PMID: 31920292 PMCID: PMC6935300 DOI: 10.2147/ppa.s205819] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/20/2019] [Indexed: 01/03/2023] Open
Abstract
Guidelines and policies support the decision process to make sure that patients can benefit from the best treatment for their condition. The implementation of guidelines and policies is evolving, allowing decision makers to be able to choose between alternatives while considering the effect of biases and fallacies that may hinder their choice. Patient preferences play a precious role in those decisions in which is not possible to recognize an objective "best" alternative and it's not possible to nudge them toward one alternative based on scientific evidence and clinical experience. Having patient input as part of the decision process itself would allow the recognition of the attributes related to what is relevant for patients, which can be considered as important as clinical data. The authors advocate that the integration of preference-sensitive attributes with decision policies could provide a benefit against fallacies in the decision process when there is not a "best" alternative, and a shared decision-making paradigm allows both patient and clinician to recognize and pursue the option that best fits the individual case.
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Affiliation(s)
- Luca Bailo
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan20141, Italy
- Correspondence: Luca Bailo Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, via Ripamonti 435, Milan20141, ItalyTel +39 0257489207 Email
| | - Laura Vergani
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan20141, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan20122, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan20141, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan20122, Italy
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21
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Adams AS, Schmittdiel JA, Altschuler A, Bayliss EA, Neugebauer R, Ma L, Dyer W, Clark J, Cook B, Willyoung D, Jaffe M, Young JD, Kim E, Boggs JM, Prosser L, Wittenberg E, Callaghan B, Shainline M, Hippler RM, Grant RW. Automated symptom and treatment side effect monitoring for improved quality of life among adults with diabetic peripheral neuropathy in primary care: a pragmatic, cluster, randomized, controlled trial. Diabet Med 2019; 36:52-61. [PMID: 30343489 PMCID: PMC7236318 DOI: 10.1111/dme.13840] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2018] [Indexed: 01/19/2023]
Abstract
AIMS To evaluate the effectiveness of automated symptom and side effect monitoring on quality of life among individuals with symptomatic diabetic peripheral neuropathy. METHODS We conducted a pragmatic, cluster randomized controlled trial (July 2014 to July 2016) within a large healthcare system. We randomized 1834 primary care physicians and prospectively recruited from their lists 1270 individuals with neuropathy who were newly prescribed medications for their symptoms. Intervention participants received automated telephone-based symptom and side effect monitoring with physician feedback over 6 months. The control group received usual care plus three non-interactive diabetes educational calls. Our primary outcomes were quality of life (EQ-5D) and select symptoms (e.g. pain) measured 4-8 weeks after starting medication and again 8 months after baseline. Process outcomes included receiving a clinically effective dose and communication between individuals with neuropathy and their primary care provider over 12 months. Interviewers collecting outcome data were blinded to intervention assignment. RESULTS Some 1252 participants completed the baseline measures [mean age (sd): 67 (11.7), 53% female, 57% white, 8% Asian, 13% black, 20% Hispanic]. In total, 1179 participants (93%) completed follow-up (619 control, 560 intervention). Quality of life scores (intervention: 0.658 ± 0.094; control: 0.653 ± 0.092) and symptom severity were similar at baseline. The intervention had no effect on primary [EQ-5D: -0.002 (95% CI -0.01, 0.01), P = 0.623; pain: 0.295 (-0.75, 1.34), P = 0.579; sleep disruption: 0.342 (-0.18, 0.86), P = 0.196; lower extremity functioning: -0.079 (-1.27, 1.11), P = 0.896; depression: -0.462 (-1.24, 0.32); P = 0.247] or process outcomes. CONCLUSIONS Automated telephone monitoring and feedback alone were not effective at improving quality of life or symptoms for people with symptomatic diabetic peripheral neuropathy. TRIAL REGISTRATION ClinicalTrials.gov (NCT02056431).
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Affiliation(s)
- Alyce S. Adams
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | | | | | - Elizabeth A. Bayliss
- Kaiser Permanente Colorado Institute for Health Research, Denver, CO, USA
- University of Colorado School of Medicine, Denver, CO, USA
| | | | - Lin Ma
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Wendy Dyer
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Joel Clark
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | - Bonieta Cook
- Kaiser Permanente Division of Research, Oakland, CA, USA
| | | | - Marc Jaffe
- Kaiser Permanente South San Francisco Medical Center, South San Francisco, CA, USA
| | | | - Eileen Kim
- Kaiser Permanente Oakland Medical Center, Oakland, CA, USA
| | - Jennifer M. Boggs
- Kaiser Permanente Colorado Institute for Health Research, Denver, CO, USA
| | - Lisa Prosser
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | - Brian Callaghan
- University of Michigan, Michigan Medicine, Neurology Clinic, Ann Arbor, MI, USA
| | - Michael Shainline
- Kaiser Permanente Colorado Institute for Health Research, Denver, CO, USA
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22
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Callus E, Bertoldo EG, Beretta M, Boveri S, Cardani R, Fossati B, Brigonzi E, Meola G. Neuropsychological and Psychological Functioning Aspects in Myotonic Dystrophy Type 1 Patients in Italy. Front Neurol 2018; 9:751. [PMID: 30298045 PMCID: PMC6160752 DOI: 10.3389/fneur.2018.00751] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 08/17/2018] [Indexed: 12/12/2022] Open
Abstract
Introduction: Myotonic Dystrophy Type 1 (DM1) is an autosomal dominant genetic illness, characterized by a progressive loss of strength. Important deficits in cognitive functioning and a significant prevalence of psychiatric disorders have been previously reported. Methods:A neuropsychological and psychological assessment was carried out in 31 DM1 patients (61% males) in order to measure the cognitive functioning and explore their personality profiles. The MMSE Mini-Mental State Examination, Frontal Assessment Battery (FAB), ENB-2 Battery assessing memory (short term, long term and working memory), integration capacities, visual-spatial ability, attention (selective, divided, shifting/switching) executive functions, praxis, discrimination and logic capabilities and psychopathology Symptom Check List 90-R (SCL-90-R) were administered. The neuropsychological and psychological evaluation of DM1 patients was carried out taking into consideration the clinical parameters (CTG repeat, age at onset, disease duration, Muscular Impairment Rate Scale (MIRS), Medical Research Council Scale (MRC) and the Epworth Sleepiness Scales (EPS)). Results: Regarding psychopathology 19.4% of patients scored a moderate or high level of symptoms intensity index (GSI), 12.9% reported a high number of symptoms (PST) and 16.1% reported a high intensity level of the perceived symptoms (PSDI). Fatigue and daytime sleepiness resulted as being associated with higher levels of psychoticism (PSY). Only 1 patient reported a severe impairment in the spatial and temporal orientation, memory, language, praxis, attention and calculation. Longer disease duration was also associated with cognitive impairment evaluated through ENB-2 (p < 0.05). Discussions and Conclusions:There are indications of the utility of neuropsychological and psychological screening and support for these patients and their families due to the link between disease duration and cognitive performances. A proposal of a clinical protocol, with an illustration of a clinical case report of a family is presented.
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Affiliation(s)
- Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Enrico G Bertoldo
- Clinical Psychology Service, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Maria Beretta
- Clinical Psychology Service, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Sara Boveri
- Scientific Directorate, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Rosanna Cardani
- Laboratory of Muscle Histopathology and Molecular Biology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Barbara Fossati
- Department of Neurology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Elisa Brigonzi
- Department of Neurology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Giovanni Meola
- Department of Neurology, IRCCS Policlinico San Donato, San Donato Milanese, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Condello C, Rescigno P, Ottaviano M, Nappi L, Tortora M, de Placido S, Palmieri G. Clinical features and psychological aspects of the decision-making process in stage I testicular germ cell tumors. Future Oncol 2018; 14:1591-1599. [PMID: 29956548 DOI: 10.2217/fon-2017-0670] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Testicular germ cell tumors (TGCTs) are the most prevalent malignancies in young Caucasian men. Clinical stage I (CSI) TGCTs present the highest cure rate and treatment options after orchiectomy depend on histology and risk factors. Nevertheless, the management of CSI TGCTs is controversial due to the availability of multiple treatments and the lack of randomized trials. An integrated multidisciplinary approach that includes clinicians (surgeons, radiotherapists and oncologists) and psychologists is crucial to maximize the patients' compliance and must be acknowledged with appropriate tools. The aim of our work is to review the oncological and psychological aspects of the decision-making process, discussing the fundamental role of the patient involvement in the personalized management of CSI TGCTs.
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Affiliation(s)
- Caterina Condello
- Department of Clinical Medicine and Surgery, Oncology Unit, University of Naples Federico II, Naples, Italy
| | - Pasquale Rescigno
- Department of Clinical Medicine and Surgery, Oncology Unit, University of Naples Federico II, Naples, Italy.,The Institute of Cancer Research, 15 Cotswold Road, Sutton, London, UK
| | - Margaret Ottaviano
- Department of Clinical Medicine and Surgery, Oncology Unit, University of Naples Federico II, Naples, Italy.,CRTR Rare Tumors Reference Center, University of Naples Federico II, Naples, Italy
| | - Lucia Nappi
- British Columbia Cancer Agency, Vancouver Cancer Centre, British Columbia, Canada
| | - Marianna Tortora
- CRTR Rare Tumors Reference Center, University of Naples Federico II, Naples, Italy
| | - Sabino de Placido
- Department of Clinical Medicine and Surgery, Oncology Unit, University of Naples Federico II, Naples, Italy
| | - Giovannella Palmieri
- CRTR Rare Tumors Reference Center, University of Naples Federico II, Naples, Italy
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Belshaw Z, Robinson NJ, Dean RS, Brennan ML. Motivators and barriers for dog and cat owners and veterinary surgeons in the United Kingdom to using preventative medicines. Prev Vet Med 2018; 154:95-101. [PMID: 29685450 DOI: 10.1016/j.prevetmed.2018.03.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 02/21/2018] [Accepted: 03/22/2018] [Indexed: 11/19/2022]
Abstract
Routine use of preventative medicines is advocated as part of responsible dog and cat ownership. However, it has been suggested that the number of owners in the United Kingdom (UK) using preventative medicines to protect their pets is in decline. The aim of this novel study was to use a qualitative methodology to explore the attitudes of pet owners and veterinary surgeons in the UK to using preventative medicine products in dogs and cats. Preventative medicine was defined as "a drug or any other preparation used to prevent disease, illness or injury." Semi-structured interviews were conducted by telephone with owners and veterinary surgeons who had recently participated in a preventative healthcare consultation. Thematic analysis of transcribed recordings of these interviews identified four themes. This paper reports the theme related to motivators and barriers to using preventative medicines. Owners' understanding varied widely about the importance of preventative medicines for pets, as did their confidence in the safety of prescription products. A good relationship with their veterinary surgeon or practice, seeing adverts on the television about specific diseases, advice from a breeder and having personally seen infected animals appeared to be motivators for owners to use preventative medicines. Concern about adverse events and uncertainty about the necessity of using preventative medicines were barriers. Owners who trusted their veterinary surgeons to advise them on preventative medicine products described little use of alternative information sources when making preventative medicine choices. However, owners who preferred to do their own research described reading online opinions, particular in relation to the safety of preventative medicines, which they found confusing. In contrast, veterinary surgeons described broad confidence in the safety and efficacy of prescription preventative medicines and described protection of pet health as a strong motivator for their use. Several expressed some concern about being seen to "sell" products, which may present a barrier to their advocacy. Veterinary surgeons were unsure about owners' level of understanding of the necessity of preventative medicines, particularly in relation to vaccinations, and few recalled instigating conversations with owners about product safety. Owner uncertainties about preventative medicine products may not be adequately addressed in the consulting room. This first qualitative study to investigate dog and cat preventative medicines suggests strategies are needed to increase discussion between pet owners and veterinary surgeons in the UK about the necessity, safety, efficacy and cost of preventative medicines.
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Affiliation(s)
- Zoe Belshaw
- Centre for Evidence-based Veterinary Medicine, School of Veterinary Medicine and Science, University of Nottingham Sutton Bonington Campus, LE12 5RD United Kingdom
| | - Natalie J Robinson
- Centre for Evidence-based Veterinary Medicine, School of Veterinary Medicine and Science, University of Nottingham Sutton Bonington Campus, LE12 5RD United Kingdom
| | - Rachel S Dean
- Centre for Evidence-based Veterinary Medicine, School of Veterinary Medicine and Science, University of Nottingham Sutton Bonington Campus, LE12 5RD United Kingdom
| | - Marnie L Brennan
- Centre for Evidence-based Veterinary Medicine, School of Veterinary Medicine and Science, University of Nottingham Sutton Bonington Campus, LE12 5RD United Kingdom.
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Arenas Jiménez MD, Macía-Heras M. Seguridad en hemodiálisis: paradigma del trabajo en equipo. Nefrologia 2018; 38:1-3. [DOI: 10.1016/j.nefro.2017.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/13/2017] [Indexed: 11/26/2022] Open
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Marzorati C, Pravettoni G. Value as the key concept in the health care system: how it has influenced medical practice and clinical decision-making processes. J Multidiscip Healthc 2017; 10:101-106. [PMID: 28356752 PMCID: PMC5367583 DOI: 10.2147/jmdh.s122383] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In the last 10 years, value has played a key role in the health care system. In this concept, innovations in medical practice and the increasing importance of patient centeredness have contributed to draw the attention of the medical community. Nonetheless, a large consensus on the meaning of "value" is still lacking: patients, physicians, policy makers, and other health care professionals have different ideas on which component of value may play a prominent role. Yet, shared clinical decision-making and patient empowerment have been recognized as fundamental features of the concept of value. Different paradigms of health care system embrace different meanings of value, and the absence of common and widely accepted definition does not help to identify a unique model of care in health care system. Our aim is to provide an overview of those paradigms that have considered value as a key theoretical concept and to investigate how the presence of value can influence the medical practice. This article may contribute to draw attention toward patients and propose a possible link between health care system based on "value" and new paradigms such as patient-centered system (PCS), patient empowerment, and P5 medicine, in order to create a predictive, personalized, preventive, participatory, and psycho-cognitive model to treat patients. Indeed, patient empowerment, value-based system, and P5 medicine seem to shed light on different aspects of a PCS, and this allows a better understanding of people under care.
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Affiliation(s)
- Chiara Marzorati
- Foundations of the Life Sciences, Bioethics and Cognitive Science, European School of Molecular Medicine (SEMM)
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Laganà AS, La Rosa VL, Rapisarda AMC, Platania A, Vitale SG. Psychological impact of fertility preservation techniques in women with gynaecological cancer. Ecancermedicalscience 2017; 11:ed62. [PMID: 28275393 PMCID: PMC5336386 DOI: 10.3332/ecancer.2017.ed62] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Indexed: 02/01/2023] Open
Abstract
Gynaecological cancer is a very stressful experience for women and treatments can compromise fertility and reproductive capacity. Fertility preservation techniques in women with gynaecological cancer can play an important role in improving the quality of life of these patients but, in many cases, the information about this type of treatment is not adequate. It is important to further investigate this topic in order to reduce the impact of gynaecological cancer on the quality of life of survivors as much as possible.
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Affiliation(s)
- Antonio Simone Laganà
- Unit of Gynaecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G Barresi", University of Messina, Messina, 98125, Italy
| | - Valentina Lucia La Rosa
- Unit of Psychodiagnostics and Clinical Psychology, University of Catania, Catania, 95124, Italy
| | | | - Alessio Platania
- Department of Health Services and Epidemiological Observatory, Palermo, 90121, Italy
| | - Salvatore Giovanni Vitale
- Unit of Gynaecology and Obstetrics, Department of Human Pathology in Adulthood and Childhood "G Barresi", University of Messina, Messina, 98125, Italy
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Health Orientation, Knowledge, and Attitudes toward Genetic Testing and Personalized Genomic Services: Preliminary Data from an Italian Sample. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6824581. [PMID: 28105428 PMCID: PMC5220460 DOI: 10.1155/2016/6824581] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 11/14/2016] [Accepted: 12/12/2016] [Indexed: 11/30/2022]
Abstract
Objective. The study aims at assessing personality tendencies and orientations that could be closely correlated with knowledge, awareness, and interest toward undergoing genetic testing. Methods. A sample of 145 subjects in Italy completed an online survey, investigating demographic data, health orientation, level of perceived knowledge about genetic risk, genetic screening, and personal attitudes toward direct to consumer genetic testing (DTCGT). Results. Results showed that respondents considered genetic assessment to be helpful for disease prevention, but they were concerned that results could affect their life planning with little clinical utility. Furthermore, a very high percentage of respondents (67%) had never heard about genetic testing directly available to the public. Data showed that personality tendencies, such as personal health consciousness, health internal control, health esteem, and confidence, motivation to avoid unhealthiness and motivation for healthiness affected the uptake of genetic information and the interest in undergoing genetic testing. Conclusions. Public knowledge and attitudes toward genetic risk and genetic testing among European countries, along with individual personality and psychological tendencies that could affect these attitudes, remain unexplored. The present study constitutes one of the first attempts to investigate how such personality tendencies could motivation to undergo genetic testing and engagement in lifestyle changes.
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Neamţiu L, Deandrea S, Pylkkänen L, Freeman C, López Alcalde J, Bramesfeld A, Saz-Parkinson Z, Ulutürk A, Lerda D. Psycho-oncological support for breast cancer patients: A brief overview of breast cancer services certification schemes and national health policies in Europe. Breast 2016; 29:178-80. [PMID: 27526300 DOI: 10.1016/j.breast.2016.07.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 06/29/2016] [Accepted: 07/02/2016] [Indexed: 11/24/2022] Open
Abstract
Psycho-oncology addresses the psychological, social, behavioural, and ethical aspects of cancer. Identification and proper management of the patients' psychosocial needs, as well as the needs of their caregivers and family are essential for a person-centred concept of breast cancer care. The aim of this overview is to describe how psychosocial support in breast cancer is incorporated in cancer-related policy documents, such as national cancer plans and breast cancer care certification schemes.
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Affiliation(s)
- L Neamţiu
- European Commission, Directorate General Joint Research Centre, Directorate F - Health, Consumers and Reference Materials, Unit F1 "Health in Society", Via E. Fermi 2749, TP 127, I-21027 Ispra, VA, Italy.
| | - S Deandrea
- European Commission, Directorate General Joint Research Centre, Directorate F - Health, Consumers and Reference Materials, Unit F1 "Health in Society", Via E. Fermi 2749, TP 127, I-21027 Ispra, VA, Italy
| | - L Pylkkänen
- European Commission, Directorate General Joint Research Centre, Directorate F - Health, Consumers and Reference Materials, Unit F1 "Health in Society", Via E. Fermi 2749, TP 127, I-21027 Ispra, VA, Italy
| | - C Freeman
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, Gran Via de l'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
| | - J López Alcalde
- Unidad de Bioestadistica Clinica, Hospital Universitario Ramon y Cajal (IRYCIS), CIBER Epidemiologia y Salud Publica (CIBERESP), Ctra. Colmenar Km. 9,100, 28034 Madrid, Spain; Universidad Francisco de Vitoria, Ctra. Pozuelo-Majadahonda Km. 1,800, Madrid, Spain
| | - A Bramesfeld
- European Commission, Directorate General Joint Research Centre, Directorate F - Health, Consumers and Reference Materials, Unit F1 "Health in Society", Via E. Fermi 2749, TP 127, I-21027 Ispra, VA, Italy
| | - Z Saz-Parkinson
- European Commission, Directorate General Joint Research Centre, Directorate F - Health, Consumers and Reference Materials, Unit F1 "Health in Society", Via E. Fermi 2749, TP 127, I-21027 Ispra, VA, Italy
| | - A Ulutürk
- European Commission, Directorate General Joint Research Centre, Directorate F - Health, Consumers and Reference Materials, Unit F1 "Health in Society", Via E. Fermi 2749, TP 127, I-21027 Ispra, VA, Italy
| | - D Lerda
- European Commission, Directorate General Joint Research Centre, Directorate F - Health, Consumers and Reference Materials, Unit F1 "Health in Society", Via E. Fermi 2749, TP 127, I-21027 Ispra, VA, Italy
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Fioretti C, Mazzocco K, Riva S, Oliveri S, Masiero M, Pravettoni G. Research studies on patients' illness experience using the Narrative Medicine approach: a systematic review. BMJ Open 2016; 6:e011220. [PMID: 27417197 PMCID: PMC4947803 DOI: 10.1136/bmjopen-2016-011220] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Since its birth about 30 years ago, Narrative Medicine approach has increased in popularity in the medical context as well as in other disciplines. This paper aims to review Narrative Medicine research studies on patients' and their caregivers' illness experience. SETTING AND PARTICIPANTS MEDLINE, Psycinfo, EBSCO Psychological and Behavioural Science, The Cochrane Library and CINAHL databases were searched to identify all the research studies which focused on the Narrative Medicine approach reported in the title, in the abstract and in the keywords the words 'Narrative Medicine' or 'Narrative-based Medicine'. PRIMARY AND SECONDARY OUTCOME MEASURES number of participants, type of disease, race and age of participants, type of study, dependent variables, intervention methods, assessment. RESULTS Of the 325 titles screened, we identified 10 research articles fitting the inclusion criteria. Our systematic review showed that research on Narrative Medicine has no common specific methodology: narrative in Medicine is used as an intervention protocol as well as an assessment tool. Patients' characteristics, types of disease and data analysis procedures differ among the screened studies. CONCLUSIONS Narrative Medicine research in medical practice needs to find clear and specific protocols to deepen the impact of narrative on medical practice and on patients' lives.
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Affiliation(s)
- Chiara Fioretti
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy
| | - Ketti Mazzocco
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milano, Lombardia, Italy
| | - Silvia Riva
- Department of Oncology and Hemato-Oncology, University of Milan, Milano, Lombardia, Italy
| | - Serena Oliveri
- Department of Oncology and Hemato-Oncology, University of Milan, Milano, Lombardia, Italy
| | - Marianna Masiero
- Department of Oncology and Hemato-Oncology, University of Milan, Milano, Lombardia, Italy
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milano, Lombardia, Italy
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Cardiac Arrest and Gastrointestinal Bleeding: A Case of Medical Heuristics. Case Rep Med 2016; 2016:9621390. [PMID: 27366152 PMCID: PMC4913064 DOI: 10.1155/2016/9621390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 05/17/2016] [Indexed: 11/17/2022] Open
Abstract
Insufficient clinical data from patients is a major cause of errors in medical diagnostics. In an attempt to make a diagnosis, initial clinical information provided to the physician may be overly relied on as the only information required in making diagnosis leading to anchoring. Failure to rely on differential diagnoses in spite of new signs and symptoms or rethinking of initial hypothesis may lead to fixation on a certain diagnosis, which may lead to significant morbidity and mortality. In the event that there is an anchoring heuristic, like in our patient, it is important to consider differential diagnoses; however, it is not wrong to rely on some form of anchor. We report a case of a 62-year-old male with a history of multiple medical conditions and a history of acetaminophen overdose who presented to the hospital with large amounts of coffee ground emesis. He was subsequently transferred to the liver transplant center on discovery that he was in fulminant hepatic failure and died two days later in spite of aggressive medical treatment.
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Roosan D, Del Fiol G, Butler J, Livnat Y, Mayer J, Samore M, Jones M, Weir C. Feasibility of Population Health Analytics and Data Visualization for Decision Support in the Infectious Diseases Domain: A pilot study. Appl Clin Inform 2016; 7:604-23. [PMID: 27437065 PMCID: PMC4941864 DOI: 10.4338/aci-2015-12-ra-0182] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 05/01/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Big data or population-based information has the potential to reduce uncertainty in medicine by informing clinicians about individual patient care. The objectives of this study were: 1) to explore the feasibility of extracting and displaying population-based information from an actual clinical population's database records, 2) to explore specific design features for improving population display, 3) to explore perceptions of population information displays, and 4) to explore the impact of population information display on cognitive outcomes. METHODS We used the Veteran's Affairs (VA) database to identify similar complex patients based on a similar complex patient case. Study outcomes measures were 1) preferences for population information display 2) time looking at the population display, 3) time to read the chart, and 4) appropriateness of plans with pre- and post-presentation of population data. Finally, we redesigned the population information display based on our findings from this study. RESULTS The qualitative data analysis for preferences of population information display resulted in four themes: 1) trusting the big/population data can be an issue, 2) embedded analytics is necessary to explore patient similarities, 3) need for tools to control the view (overview, zoom and filter), and 4) different presentations of the population display can be beneficial to improve the display. We found that appropriateness of plans was at 60% for both groups (t9=-1.9; p=0.08), and overall time looking at the population information display was 2.3 minutes versus 3.6 minutes with experts processing information faster than non-experts (t8= -2.3, p=0.04). CONCLUSION A population database has great potential for reducing complexity and uncertainty in medicine to improve clinical care. The preferences identified for the population information display will guide future health information technology system designers for better and more intuitive display.
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Affiliation(s)
- Don Roosan
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Salt Lake City, UT 84108, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Salt Lake City, UT 84108, USA
- IDEAS Center for Innovation, VA Salt Lake City Health System, 500 Foothill Drive, Salt Lake City, UT 84108, USA
| | - Jorie Butler
- IDEAS Center for Innovation, VA Salt Lake City Health System, 500 Foothill Drive, Salt Lake City, UT 84108, USA
| | - Yarden Livnat
- Scientific Computing and Imaging Institute, Department of Computer Sciences, University of Utah, 72 S Central Campus Dr, Salt Lake City, UT 84112, USA
| | - Jeanmarie Mayer
- IDEAS Center for Innovation, VA Salt Lake City Health System, 500 Foothill Drive, Salt Lake City, UT 84108, USA
| | - Matthew Samore
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Salt Lake City, UT 84108, USA
- IDEAS Center for Innovation, VA Salt Lake City Health System, 500 Foothill Drive, Salt Lake City, UT 84108, USA
| | - Makoto Jones
- IDEAS Center for Innovation, VA Salt Lake City Health System, 500 Foothill Drive, Salt Lake City, UT 84108, USA
| | - Charlene Weir
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Salt Lake City, UT 84108, USA
- IDEAS Center for Innovation, VA Salt Lake City Health System, 500 Foothill Drive, Salt Lake City, UT 84108, USA
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Riva S, Pravettoni G. Value-Based Model: A New Perspective in Medical Decision-making. Front Public Health 2016; 4:118. [PMID: 27379224 PMCID: PMC4904028 DOI: 10.3389/fpubh.2016.00118] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 05/23/2016] [Indexed: 11/21/2022] Open
Affiliation(s)
- Silvia Riva
- Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy; Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (IEO), Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy; Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology (IEO), Milan, Italy
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Frederick PD, Nelson HD, Carney PA, Brunyé TT, Allison KH, Weaver DL, Elmore JG. The Influence of Disease Severity of Preceding Clinical Cases on Pathologists' Medical Decision Making. Med Decis Making 2016; 37:91-100. [PMID: 27037007 DOI: 10.1177/0272989x16638326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 01/30/2016] [Indexed: 01/29/2023]
Abstract
BACKGROUND Medical decision making may be influenced by contextual factors. We evaluated whether pathologists are influenced by disease severity of recently observed cases. METHODS Pathologists independently interpreted 60 breast biopsy specimens (one slide per case; 240 total cases in the study) in a prospective randomized observational study. Pathologists interpreted the same cases in 2 phases, separated by a washout period of >6 months. Participants were not informed that the cases were identical in each phase, and the sequence was reordered randomly for each pathologist and between phases. A consensus reference diagnosis was established for each case by 3 experienced breast pathologists. Ordered logit models examined the effect the pathologists' diagnoses on the preceding case or the 5 preceding cases had on their diagnosis for the subsequent index case. RESULTS Among 152 pathologists, 49 provided interpretive data in both phases I and II, 66 from only phase I, and 37 from phase II only. In phase I, pathologists were more likely to indicate a more severe diagnosis than the reference diagnosis when the preceding case was diagnosed as ductal carcinoma in situ (DCIS) or invasive cancer (proportional odds ratio [POR], 1.28; 95% confidence interval [CI], 1.15-1.42). Results were similar when considering the preceding 5 cases and for the pathologists in phase II who interpreted the same cases in a different order compared with phase I (POR, 1.17; 95% CI, 1.05-1.31). CONCLUSION Physicians appear to be influenced by the severity of previously interpreted test cases. Understanding types and sources of diagnostic bias may lead to improved assessment of accuracy and better patient care.
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Affiliation(s)
- Paul D Frederick
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA (PDF, JGE)
| | - Heidi D Nelson
- Providence Cancer Center, Providence Health and Services Oregon, and Departments of Medical Informatics and Clinical Epidemiology and Medicine, Oregon Health & Science University, Portland, OR, USA (HDN)
| | - Patricia A Carney
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA (PAC)
| | - Tad T Brunyé
- Center for Applied Brain & Cognitive Sciences, Tufts University, Medford, MA, USA (TTB)
| | - Kimberly H Allison
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA (KHA)
| | - Donald L Weaver
- Department of Pathology, University of Vermont and UVM Cancer Center, Burlington, VT, USA (DLW)
| | - Joann G Elmore
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA (PDF, JGE)
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Islam R, Mayer J, Clutter J. Supporting novice clinicians cognitive strategies: System design perspective. ... IEEE-EMBS INTERNATIONAL CONFERENCE ON BIOMEDICAL AND HEALTH INFORMATICS. IEEE-EMBS INTERNATIONAL CONFERENCE ON BIOMEDICAL AND HEALTH INFORMATICS 2016; 2016:509-512. [PMID: 27275020 DOI: 10.1109/bhi.2016.7455946] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Infections occur among all clinical domains. The changing nature of microbes, viruses and infections poses a great threat to the overall well-being in medicine. Clinicians in the infectious disease (ID) domain deal with diagnostic as well as treatment uncertainty in their everyday practice. Our current health information technology (HIT) systems do not consider the level of clinician expertise into the system design process. Thus, information is presented to both novice and expert ID clinicians in identical ways. The purpose of this study was to identify the cognitive strategies novice ID clinicians use in managing complex cases to make better recommendations for system design. In the process, we interviewed 14 ID experts and asked them to give us a detailed description of how novice clinicians would have dealt with complex cases. From the interview transcripts, we identified four major themes that expert clinicians suggested about novices' cognitive strategies including: A) dealing with uncertainty, B) lack of higher macrocognition, C) oversimplification of problems through heuristics and D) dealing with peer pressure. Current and future innovative decision support tools embedded in the electronic health record that can match these cognitive strategies may hold the key to cognitively supporting novice clinicians. The results of this study may open up avenues for future research and suggest design directions for better healthcare systems.
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Affiliation(s)
| | - Jeanmarie Mayer
- University of Utah with the Division of Epidemiology, Salt Lake City, UT, USA
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Islam R, Weir CR, Jones M, Del Fiol G, Samore MH. Understanding complex clinical reasoning in infectious diseases for improving clinical decision support design. BMC Med Inform Decis Mak 2015; 15:101. [PMID: 26620881 PMCID: PMC4665869 DOI: 10.1186/s12911-015-0221-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 11/24/2015] [Indexed: 11/10/2022] Open
Abstract
Background Clinical experts’ cognitive mechanisms for managing complexity have implications for the design of future innovative healthcare systems. The purpose of the study is to examine the constituents of decision complexity and explore the cognitive strategies clinicians use to control and adapt to their information environment. Methods We used Cognitive Task Analysis (CTA) methods to interview 10 Infectious Disease (ID) experts at the University of Utah and Salt Lake City Veterans Administration Medical Center. Participants were asked to recall a complex, critical and vivid antibiotic-prescribing incident using the Critical Decision Method (CDM), a type of Cognitive Task Analysis (CTA). Using the four iterations of the Critical Decision Method, questions were posed to fully explore the incident, focusing in depth on the clinical components underlying the complexity. Probes were included to assess cognitive and decision strategies used by participants. Results The following three themes emerged as the constituents of decision complexity experienced by the Infectious Diseases experts: 1) the overall clinical picture does not match the pattern, 2) a lack of comprehension of the situation and 3) dealing with social and emotional pressures such as fear and anxiety. All these factors contribute to decision complexity. These factors almost always occurred together, creating unexpected events and uncertainty in clinical reasoning. Five themes emerged in the analyses of how experts deal with the complexity. Expert clinicians frequently used 1) watchful waiting instead of over- prescribing antibiotics, engaged in 2) theory of mind to project and simulate other practitioners’ perspectives, reduced very complex cases into simple 3) heuristics, employed 4) anticipatory thinking to plan and re-plan events and consulted with peers to share knowledge, solicit opinions and 5) seek help on patient cases. Conclusion The cognitive strategies to deal with decision complexity found in this study have important implications for design future decision support systems for the management of complex patients. Electronic supplementary material The online version of this article (doi:10.1186/s12911-015-0221-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Roosan Islam
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Ste 140, Salt Lake City, UT, 84108, USA. .,IDEAS Center for Innovation, VA Salt Lake City Health System, 500 Foothill Drive, Salt Lake City, UT, 84108, USA.
| | - Charlene R Weir
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Ste 140, Salt Lake City, UT, 84108, USA.,IDEAS Center for Innovation, VA Salt Lake City Health System, 500 Foothill Drive, Salt Lake City, UT, 84108, USA
| | - Makoto Jones
- IDEAS Center for Innovation, VA Salt Lake City Health System, 500 Foothill Drive, Salt Lake City, UT, 84108, USA
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Ste 140, Salt Lake City, UT, 84108, USA.,IDEAS Center for Innovation, VA Salt Lake City Health System, 500 Foothill Drive, Salt Lake City, UT, 84108, USA
| | - Matthew H Samore
- Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Ste 140, Salt Lake City, UT, 84108, USA.,IDEAS Center for Innovation, VA Salt Lake City Health System, 500 Foothill Drive, Salt Lake City, UT, 84108, USA
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Translation, cross-cultural adaptation, and reliability, of the Italian version of the Passive Risk Taking (PRT) Scale. JUDGMENT AND DECISION MAKING 2015. [DOI: 10.1017/s193029750000704x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AbstractThe concept of “passive risk taking”, which refers to the risk brought on or magnified by inaction, has recently appeared in the literature on risk taking. Keinan and Bereby-Meyer (2012) have developed a scale to measure the personal tendency for passive risk taking (PRT); the scale has criterion validity and high test-retest reliability; it correlates with reported passive risk taking in everyday life and with the DOSPERT scale. Furthermore, it presents divergent validity from classic risk-taking constructs such as sensation seeking, and convergent validity with procrastination and avoidance. In this paper we propose a validation of the PRT scale in Italian. We performed the linguistic adaptation to Italian via the five steps suggested by Guillemin and colleagues (1993) and Beaton and colleagues (2000); we then submitted the derived questionnaire to a 297-adult sample. Results show that two out of three factors from the original scale were confirmed. However the third factor, originally composed of 6 items, was not consistent. We present the scale derived from such results, and discuss the differences with the original scale.
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ICU physician-based determinants of life-sustaining therapy during nights and weekends: French multicenter study from the Outcomerea Research Group. Crit Care Med 2014; 42:2393-400. [PMID: 25126878 DOI: 10.1097/ccm.0000000000000523] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Patient- and organization-related factors are the most common influences affecting the ICU decision-making process. Few studies have investigated ICU physician-related factors and life-sustaining treatment use during nights and weekends, when staffing ratios are low. Here, we described patients admitted during nights/weekends and looked for physician-related determinants of life-sustaining treatment use in these patients after adjustment for patient- and center-related factors. DESIGN Multicenter observational cohort study of admission procedures during nights/weekends shifts. SUBJECTS ICU physicians working nights/weekends in 6 French ICUs. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Patient characteristics and intensity of care were extracted from the prospective Outcomerea database. Physician characteristics were age, gender, religion and religiosity, ICU experience, specialty, being a permanent ICU staff member, degree in ethics, and degree in intensive care. We used hierarchical mixed models to adjust on center, physician random effects, and admission patient characteristics. Of 156 physicians contacted, 119 (77%) participated. Patients admitted during nights/weekends were younger and had fewer comorbidities and lower treatment intensity during the shift. ICU physicians who are younger than 35 years used more renal replacement therapy (odds ratio, 1.04; 95% CI, 1-1.07; p = 0.04), invasive mechanical ventilation (odds ratio, 1.09; 95% CI, 1.1-1.19; p = 0.04), and vasopressors (odds ratio, 1.16; 95% CI, 1.09-1.23; p < 0.0001). Internal or emergency medicine as the primary specialty was associated with invasive mechanical ventilation (odds ratio, 1.14; 95% CI, 1.04-1.24; p = 0.004) and vasopressor use (odds ratio, 1.09; 95% CI, 1.02-1.17; p = 0.01). Noninvasive ventilation was used less often by physicians with more than 10 years of night/weekend shifts and more often by those with religious beliefs (odds ratio, 1.05; 95% CI, 1.01-1.08; p = 0.008). CONCLUSIONS Patients admitted during nights/weekends were younger and had fewer comorbidities. Age, specialty, ICU experience, and religious beliefs of the physicians were significantly associated life-sustaining treatments used.
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Sun CS, Cantor SB, Reece GP, Fingeret MC, Crosby MA, Markey MK. Helping patients make choices about breast reconstruction: a decision analysis approach. Plast Reconstr Surg 2014; 134:597-608. [PMID: 25357022 PMCID: PMC4217136 DOI: 10.1097/prs.0000000000000514] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Decision analysis can help breast reconstruction patients and their surgeons to methodically evaluate clinical alternatives and make hard decisions. The purpose of this article is to help plastic surgeons guide patients in making decisions though a case study in breast reconstruction. By making good decisions, patient outcomes may be improved. This article aims to illustrate decision analysis techniques from the patient perspective, with an emphasis on her values and preferences. The authors introduce normative decision-making through a fictional breast reconstruction patient and systematically build the decision basis to help her make a good decision. The authors broadly identify alternatives of breast reconstruction, propose types of outcomes that the patient should consider, discuss sources of probabilistic information and outcome values, and demonstrate how to make a good decision. The concepts presented here may be extended to other shared decision-making problems in plastic and reconstructive surgery. In addition, the authors discuss how sensitivity analysis may test the robustness of the decision and how to evaluate the quality of decisions. The authors also present tools to help implement these concepts in practice. Finally, the authors examine limitations that hamper adoption of patient decision analysis in reconstructive surgery and health care in general. In particular, the authors emphasize the need for routine collection of quality-of-life information, out-of-pocket expense, and recovery time.
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Affiliation(s)
- Clement S. Sun
- Department of Biomedical Engineering, The University of Texas at Austin
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center
| | - Scott B. Cantor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center
| | - Gregory P. Reece
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center
| | - Michelle C. Fingeret
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center
| | - Melissa A. Crosby
- Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center
| | - Mia K. Markey
- Department of Biomedical Engineering, The University of Texas at Austin
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center
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Ali MT, Hui X, Hashmi ZG, Dhiman N, Scott VK, Efron DT, Schneider EB, Haider AH. Socioeconomic disparity in inpatient mortality after traumatic injury in adults. Surgery 2013; 154:461-7. [PMID: 23972652 DOI: 10.1016/j.surg.2013.05.036] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 05/28/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prior studies have demonstrated that race and insurance status predict inpatient trauma mortality, but have been limited by their inability to adjust for direct measures of socioeconomic status (SES) and comorbidities. Our study aimed to identify whether a relationship exists between SES and inpatient trauma mortality after adjusting for known confounders. METHODS Trauma patients aged 18-65 years with an Injury Severity Scores (ISS) of ≥9 were identified using the 2003-2009 Nationwide Inpatient Sample. Median household income (MHI) by zip code, available by quartiles, was used to measure SES. Multiple logistic regression analyses were performed to determine odds of inpatient mortality by MHI quartile, adjusting for ISS, type of injury, comorbidities, and patient demographics. RESULTS In all, 267,621 patients met inclusion criteria. Patients in lower wealth quartiles had significantly greater unadjusted inpatient mortality compared with the wealthiest quartile. Adjusted odds of death were also higher compared with the wealthiest quartile for Q1 (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.06-1.20), Q2 (OR, 1.09; 95% CI, 1.02-1.17), and Q3 (OR, 1.11; 95% CI, 1.04-1.19). CONCLUSION MHI predicts inpatient mortality after adult trauma, even after adjusting for race, insurance status, and comorbidities. Efforts to mitigate trauma disparities should address SES as an independent predictor of outcomes.
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Affiliation(s)
- Mays T Ali
- Center for Surgical Trials and Outcomes Research, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
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Elia F, Panero F, Molino P, Ferrari G, Aprà F. Ultrasound to reduce cognitive errors in the ED. Am J Emerg Med 2012; 30:2030-3. [PMID: 22795417 DOI: 10.1016/j.ajem.2012.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 04/04/2012] [Accepted: 04/04/2012] [Indexed: 12/16/2022] Open
Abstract
Emergency medicine setting is intrinsically prone to a greater risk of medical errors than other specialties. Cognitive errors are particularly frequent when the clinical decision-making process heavily relies on heuristics. These could be defined as "mental shortcuts," which enable physicians to rapidly overcome both time and efforts required by the normative reasoning. Our article demonstrates how emergency physicians' thinking may be affected by failed heuristics, through the description of 3 real clinical cases. We aimed to show how the proper use of a widespread and easy-learning technology, such as goal-directed, focused ultrasonography, may both counteract cognitive errors and favor the right interpretation of other examinations.
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Affiliation(s)
- Fabrizio Elia
- High Dependency Unit, San Giovanni Bosco Hospital, Piazza Donatore del Sangue 3, 10154 Torino, Italy.
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