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Iglesia EGA, Fleischer DM, Abrams EM. Health Promotion of Early and Sustained Allergenic Food Introduction for the Prevention of Food Allergy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1670-1683.e9. [PMID: 38796104 DOI: 10.1016/j.jaip.2024.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/20/2024] [Accepted: 05/20/2024] [Indexed: 05/28/2024]
Abstract
Observational studies and landmark randomized control trials support early and sustained allergenic food introduction in infancy as an effective preventive strategy against food allergy development. Despite a consensus regarding the intended goals of early and sustained allergenic food introduction, there have been myriad policy recommendations among health authorities in how to achieve both individual and population-level health outcomes for food allergy prevention. This clinical management review provides an overview on the data that informs early and sustained allergenic food introduction strategies, suggestions on how to advise allergenic food introduction, principles of prevention programs as they relate to food allergy prevention, and health promotion and systems-level challenges that impede achievement of food allergy prevention goals.
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Affiliation(s)
- Edward G A Iglesia
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tenn
| | - David M Fleischer
- Section of Allergy and Immunology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colo
| | - Elissa M Abrams
- Section of Allergy and Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
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2
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Ross R, Prater LC, Cole A, Mustafa A, Pham K, Gallagher A, Rowhani-Rahbar A, Phelan EA. Provider Perspectives on Addressing Firearm Safety with Older Adults in Primary Care. Clin Gerontol 2024; 47:555-570. [PMID: 37791738 PMCID: PMC10991080 DOI: 10.1080/07317115.2023.2264291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
OBJECTIVES Chronic conditions, including mild cognitive impairment and depression, place older adults at high risk of firearm suicide. Approximately 40% of older adults have access to a firearm, and many do not store their firearms safely. However, firearm counseling occurs infrequently in clinical settings. Using by the Ottawa Decision Support Framework (ODSF) to conceptualize the decisional support needed by patients and their providers to facilitate firearm counseling, we explore provider perspectives on desired resources for addressing firearm safety with older adult patients. METHODS From March - August 2022, we conducted 21 semi-structured interviews with primary care providers caring for older adults. We report deductive concepts as well as emergent themes. RESULTS Major themes were identified from the three components of the ODSF; decisional needs, decision support and decisional outcomes. Themes included: provider self-efficacy to conduct firearm counseling, clinical workflow considerations, stories for change, patient diagnosis implications, and caregiver involvement. CONCLUSIONS There is a need for decision aids in the clinical setting that facilitate firearm counseling and promotes shared decision-making about firearm storage. CLINICAL IMPLICATIONS Implementing a decision aid in the clinical setting can improve provider self-efficacy to conduct firearm counseling and help reduce risk factors associated with firearm-related harm among older adults.
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Affiliation(s)
- Rachel Ross
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Firearm Injury & Policy Research Program, University of Washington, Seattle, WA, USA
| | - Laura C. Prater
- Firearm Injury & Policy Research Program, University of Washington, Seattle, WA, USA
- Department of Psychiatry & Behavorial Sciences, University of Washington, Seattle, WA, USA
| | - Allison Cole
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Ayah Mustafa
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Firearm Injury & Policy Research Program, University of Washington, Seattle, WA, USA
| | - Kiet Pham
- School of Psychology, University of Washington, Seattle, WA, USA
| | - Amy Gallagher
- Department of Pediatrics, University of Washington, Seattle, WA, USA
- Firearm Injury & Policy Research Program, University of Washington, Seattle, WA, USA
| | - Ali Rowhani-Rahbar
- Firearm Injury & Policy Research Program, University of Washington, Seattle, WA, USA
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Elizabeth A. Phelan
- School of Medicine, Division of Gerontology and Geriatric Medicine, School of Public Health, Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
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3
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Martínez N, Barberia I, Rodríguez-Ferreiro J. Proneness to false memory generation predicts pseudoscientific belief endorsement. Cogn Res Princ Implic 2024; 9:39. [PMID: 38902418 PMCID: PMC11190135 DOI: 10.1186/s41235-024-00568-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 06/11/2024] [Indexed: 06/22/2024] Open
Abstract
Among cognitive factors that can influence the endorsement of pseudoscientific beliefs, our study focuses on proneness to false memory generation. In this preregistered study, we presented 170 fluent English speakers residing in the USA with a misinformation task aimed at generating false memories. In this task, they first completed an event encoding stage, in which two events were narrated through sequentially presented pictures. One day later, they read a series of sentences relating the same events but which included several inaccurate descriptions aimed at producing a misinformation effect. Finally, we measured the influence of the misinformation manipulation over false memory generation. After completing the misinformation task, participants responded to a questionnaire measuring pseudoscientific beliefs. Our results showed a positive correlation between pseudoscience endorsement and false memory rates, which indicates that the latter might be a key factor influencing susceptibility to pseudoscience. To our knowledge, this is the first study showing a link between the tendency to believe in pseudoscience and variability regarding proneness to develop false memories. Practical implications for the design of new interventions to effectively reduce pseudoscientific beliefs and their negative impact on our society are discussed.
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Affiliation(s)
- Naroa Martínez
- Grup de Recerca en Cognició i Llenguatge (GRECIL), Departament de Cognició, Desenvolupament i Psicologia de la Educació, Secció de Processos Cognitius, Institut de Neurociències (INUB), Facultat de Psicologia, Universitat de Barcelona (UB), Passeig de La Vall d'Hebron, 171, 08035, Barcelona, Spain
| | - Itxaso Barberia
- Grup de Recerca en Cognició i Llenguatge (GRECIL), Departament de Cognició, Desenvolupament i Psicologia de la Educació, Secció de Processos Cognitius, Institut de Neurociències (INUB), Facultat de Psicologia, Universitat de Barcelona (UB), Passeig de La Vall d'Hebron, 171, 08035, Barcelona, Spain
| | - Javier Rodríguez-Ferreiro
- Grup de Recerca en Cognició i Llenguatge (GRECIL), Departament de Cognició, Desenvolupament i Psicologia de la Educació, Secció de Processos Cognitius, Institut de Neurociències (INUB), Facultat de Psicologia, Universitat de Barcelona (UB), Passeig de La Vall d'Hebron, 171, 08035, Barcelona, Spain.
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4
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Langdon JA, Helgason BA, Qiu J, Effron DA. "It's Not Literally True, But You Get the Gist:" How nuanced understandings of truth encourage people to condone and spread misinformation. Curr Opin Psychol 2024; 57:101788. [PMID: 38306926 DOI: 10.1016/j.copsyc.2024.101788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/10/2024] [Accepted: 01/10/2024] [Indexed: 02/04/2024]
Abstract
People have a more-nuanced view of misinformation than the binary distinction between "fake news" and "real news" implies. We distinguish between the truth of a statement's verbatim details (i.e., the specific, literal information) and its gist (i.e., the general, overarching meaning), and suggest that people tolerate and intentionally spread misinformation in part because they believe its gist. That is, even when they recognize a claim as literally false, they may judge it as morally acceptable to spread because they believe it is true "in spirit." Prior knowledge, partisanship, and imagination increase belief in the gist. We argue that partisan conflict about the morality of spreading misinformation hinges on disagreements not only about facts but also about gists.
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Affiliation(s)
- Julia A Langdon
- Organisational Behaviour Subject Area, London Business School, Regent's Park, UK.
| | - Beth Anne Helgason
- Organisational Behaviour Subject Area, London Business School, Regent's Park, UK
| | - Judy Qiu
- Organisational Behaviour Subject Area, London Business School, Regent's Park, UK
| | - Daniel A Effron
- Organisational Behaviour Subject Area, London Business School, Regent's Park, UK
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Harrell AH, Kueppers GC, Vanderpool RC, Dean D, Rohde JA. Perceptions of HPV-Linked Oropharyngeal Cancer Risk Messages Among a Sample of Young Adult Men in the US: A Pilot Study. Am J Mens Health 2024; 18:15579883241252524. [PMID: 38767052 PMCID: PMC11107372 DOI: 10.1177/15579883241252524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 04/10/2024] [Accepted: 04/16/2024] [Indexed: 05/22/2024] Open
Abstract
Awareness of risk for oropharyngeal cancer from oral human papillomavirus (HPV) infection is low among men in the United States. This pilot study tested messages communicating oral HPV and oropharyngeal cancer risk among a sample of U.S. young adult men (aged 18-26). Six oral HPV and cancer risk messages were tested in an online survey. Participants (N = 68) were randomly assigned to one of two message sets, each containing three unique text-based messages. Participants evaluated messages separately based on various measures (e.g., perceived message effectiveness [PME], novelty). One-way repeated measures ANOVAs were used to assess evaluation differences within message sets. Participants provided open-ended feedback about each message, which were synthesized into overarching themes. Participants were receptive to the risk messages, rating them high on PME (mean range = 3.72-4.25 out of 5) and other measures. Analyses identified three high-performing messages. For example, participants rated a message about HPV-linked oropharyngeal cancer risk rates in men versus women higher on attention and novelty than two other messages in the same set (both ps < .05). Participants were shown three messages (instead of all six) in each message set to minimize survey fatigue. Common themes from open-ended feedback were that participants liked the short-form structure of the messages and that the messages used gender-tailored language. In conclusion, oral HPV and oropharyngeal cancer risk messages may be useful for increasing risk awareness among men in the U.S. Further work should test such messages in rigorous experimental contexts to assess their efficacy in modifying other health outcomes, such as HPV vaccination behaviors.
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Affiliation(s)
- Alyssa H. Harrell
- Office of the Associate Director, Behavioral Research Program, National Cancer Institute, Bethesda, MD, USA
| | - George C. Kueppers
- Health Communication and Informatics Research Branch, Behavioral Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Robin C. Vanderpool
- Health Communication and Informatics Research Branch, Behavioral Research Program, National Cancer Institute, Bethesda, MD, USA
| | - David Dean
- Health Behaviors Research Branch, Behavioral Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Jacob A. Rohde
- Cancer Prevention Fellowship Program, Health Communication and Informatics Research Branch, Behavioral Research Program, National Cancer Institute, Bethesda, MD, USA
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6
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Hwang Y, Jeong SH. Gist Knowledge and Misinformation Acceptance: An Application of Fuzzy Trace Theory. HEALTH COMMUNICATION 2024; 39:937-944. [PMID: 37038244 DOI: 10.1080/10410236.2023.2197306] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Applying fuzzy trace theory to misinformation related to COVID-19, the present study (a) examines the roles of gist knowledge in predicting misinformation acceptance, and (b) further examines whether a gist cue in fact checking scales affects the level of gist knowledge. Study 1 (a survey) showed that categorical gist knowledge was negatively related to misinformation acceptance, whereas ordinal gist knowledge was not, when both types of knowledge were included in the model. In addition, Study 2 (an experiment) showed that fact checking scales containing a categorical gist cue resulted in greater categorical gist knowledge.
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Affiliation(s)
- Yoori Hwang
- Department of Digital Media, Myongji University
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Hayes BB, Reyna VF, Edelson SM. Making decisions one drink at a time and the "just one drink" effect: A fuzzy-trace theory model of harmful drinking. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:889-902. [PMID: 38642331 DOI: 10.1111/acer.15291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/19/2024] [Accepted: 02/19/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Understanding the decision factors that drive harmful alcohol use among young adults is of practical and theoretical importance. We apply fuzzy-trace theory (FTT) to investigate a potential danger that may arise from the arguably correct notion that a single drink carries no meaningful risk. Decisions that are mentally represented as one drink at a time could contribute to excessive drinking. METHODS College students (N = 351) made a series of decisions to take or decline eight hypothetical drinks presented one at a time. Outcome measures included each decision, recent alcohol consumption (weekly drinks, peak blood alcohol content, and binges), and alcohol-related harms (scores on the Brief Young Adult Alcohol Consequences Questionnaire and Alcohol Use Disorders Identification Test). Linear regression models predicted each outcome from sex, perceived risk of a single drink, perceived risk of heavy drinking, perceived consequences of drinking, and general health-related risk sensitivity. RESULTS Consistent with FTT, decisions to have a first drink and up to four additional drinks in short succession were each associated with lower perceived risk of one drink-a "just-one drink" effect-independent of perceived risks of heavy drinking, perceived consequences of drinking, and general risk sensitivity. Similarly, all measures of recent alcohol consumption and consequent harms were associated with perceived risk of one drink. Participants reporting "zero risk" of a single drink had worse outcomes on all measures than those reporting at least "low risk." CONCLUSIONS Results are consistent with the theoretically informed premise that consumption decisions are typically made one drink at a time rather than by deciding the total number of drinks to be consumed in a sitting. When decisions about alcohol use proceed one drink at a time, a perception of zero risk in a single drink may contribute to heavy drinking.
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Affiliation(s)
- Bridget B Hayes
- Department of Human Development, Cornell University, Ithaca, New York, USA
| | - Valerie F Reyna
- Department of Human Development, Cornell University, Ithaca, New York, USA
| | - Sarah M Edelson
- Department of Human Development, Cornell University, Ithaca, New York, USA
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IJzerman RVH, van der Vaart R, Breeman LD, van den Broek I, Keesman M, Kraaijenhagen RA, Reijnders T, Weerts M, Evers AWM, Scholte Op Reimer WJM, Janssen VR. Brief lifestyle advice in cardiac care: an experimental study on message source and framing. Neth Heart J 2024; 32:38-44. [PMID: 37945935 PMCID: PMC10781907 DOI: 10.1007/s12471-023-01827-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE Communicating risk information and offering lifestyle advice are important goals in cardiac rehabilitation. However, the most effective way and the most effective source to communicate this information are not yet known. Therefore, we examined the effect of source (cardiologist, physiotherapist) and framing (gain, loss) of brief lifestyle advice on patients' intention-to-change-lifestyle. METHODS In an online experimental study, 636 cardiac patients (40% female, 67 (10) yrs.) were randomly assigned to one of four textual vignettes. Effect of source and framing on intention-to-change-lifestyle (assessed using a 5-point Likert scale) was analysed using analysis of covariance (ANCOVA). RESULTS Patients expressed positive intention-to-change-lifestyle after receiving advice from the cardiologist (M = 4.1) and physiotherapist (M = 3.9). However, patients showed significantly higher intention-to-change-lifestyle after receiving advice from the cardiologist (0.58 [0.54-0.61]) when compared with the physiotherapist (0.52 [0.48-0.56]), (F[1,609] = 7.06, P = 0.01). Gain-framed and loss-framed advice appeared equally effective. However, communicating risks (loss) was remembered by only 9% of patients, whereas 89% remembered benefits (gain). CONCLUSIONS Our study shows the value of cardiologists and physiotherapists communicating brief lifestyle advice, as cardiac patients expressed positive intention for lifestyle change after receiving advice, irrespective of framing. Lifestyle advice should include benefits due to better recall.
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Affiliation(s)
- Renée V H IJzerman
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands.
- Department of Cardiology, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands.
| | - Rosalie van der Vaart
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
| | - Linda D Breeman
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
| | | | - Mike Keesman
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
| | | | - Thomas Reijnders
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
| | | | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Medical Delta, Healthy Society, Leiden University, Technical University Delft, Erasmus University, Leiden, Delft, Rotterdam, The Netherlands
| | - Wilma J M Scholte Op Reimer
- Department of Cardiology, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
- Research Group Chronic Diseases, HU University of Applied Sciences, Utrecht, The Netherlands
| | - Veronica R Janssen
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
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Keene T, Newman E, Pammer K. Can degrading information about patient symptoms in vignettes alter clinical reasoning in paramedics and paramedic students? An experimental application of fuzzy trace theory. Australas Emerg Care 2023; 26:279-283. [PMID: 36792390 DOI: 10.1016/j.auec.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/05/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Research has shown paramedics form rapid intuitive impressions on first, meeting a patient and these impressions subsequently affected their clinical reasoning. We report an experiment where theory-based interventions are developed with the goal of reducing reliance on intuitive reasoning by paramedics and paramedic students in simulated patients. METHOD Australian paramedics (n = 213; 49% female) and paramedicine students (n = 83; 55% female) attending paramedic conferences completed a 2 × 2 fully between participants experiment. They saw a written clinical vignette designed to be representative of Acute Coronary Syndrome (ACS) in which key clinical information was precise or degraded (stimulus), they then either chose the single most likely diagnosis from a list, or ranked competing diagnoses (response). Outcome variables were diagnostic rate and response time. RESULTS There were no differences in the proportion of participants choosing ACS across the four stimulus-response conditions (0.75 [0.65, 0.84] vs 0.79 [0.68, 0.87] vs, 0.78 [0.65, 0.87] vs 0.72 [0.59, 0.82], p = 0.42) CONCLUSION: This is the first study attempting to experimentally examine clinical reasoning in paramedics using a theory-based intervention. Neither of the interventions tested succeeded in altering measures of clinical reasoning. Similar to previous research on physicians, paramedic reasoning appears robust to manipulation.
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Affiliation(s)
- Toby Keene
- The Australian National University, Australia.
| | - Eryn Newman
- The Australian National University, Australia
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Richter R, Jansen J, Bongaerts I, Damman O, Rademakers J, van der Weijden T. Communication of benefits and harms in shared decision making with patients with limited health literacy: A systematic review of risk communication strategies. PATIENT EDUCATION AND COUNSELING 2023; 116:107944. [PMID: 37619376 DOI: 10.1016/j.pec.2023.107944] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/17/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVES Risk communication (RC), as part of shared decision making, is challenging with people with limited health literacy (LHL). We aim to provide an overview of strategies to communicate benefits and harms of diagnostic and treatment options to this group. METHODS We systematically searched PubMed, Embase, Cinahl and PsycInfo. We included 28 studies on RC in informed/shared decision making without restriction to a health setting or condition and using a broad conceptualization of health literacy. Two researchers independently selected studies and one researcher performed data extraction. We descriptively compared findings for people with LHL towards recommendations for RC. RESULTS Health literacy levels varied in the included studies. Most studies used experimental designs, primarily on visual RC. Findings show verbal RC alone should be avoided. Framing of risk information influences risk perception (less risky when positively framed, riskier when negatively framed). Most studies recommended the use of icon arrays. Graph literacy should be considered when using visual RC. CONCLUSIONS The limited available evidence suggests that recommended RC strategies seem mainly to be valid for people with LHL, but more research is required. PRACTICE IMPLICATIONS More qualitative research involving people with LHL is needed to gain further in-depth insights into optimal RC strategies. PROTOCOL REGISTRATION PROSPERO ID 275022.
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Affiliation(s)
- Romy Richter
- Department of Family Medicine, CAPHRI, Maastricht University, Maastricht, the Netherlands.
| | - Jesse Jansen
- Department of Family Medicine, CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Iris Bongaerts
- Department of Family Medicine, CAPHRI, Maastricht University, Maastricht, the Netherlands
| | - Olga Damman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Free University of Amsterdam, Amsterdam, the Netherlands
| | - Jany Rademakers
- Department of Family Medicine, CAPHRI, Maastricht University, Maastricht, the Netherlands; Netherlands Institute for Health Services Research (Nivel), Utrecht, the Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, CAPHRI, Maastricht University, Maastricht, the Netherlands
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Di Spirito F, Giordano F, Di Palo MP, Cannatà D, Orio M, Coppola N, Santoro R. Reliability and Accuracy of YouTube Peri-Implantitis Videos as an Educational Source for Patients in Population-Based Prevention Strategies. Healthcare (Basel) 2023; 11:2094. [PMID: 37510535 PMCID: PMC10378864 DOI: 10.3390/healthcare11142094] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023] Open
Abstract
Considering the need to improve patient knowledge, awareness, and compliance for peri-implantitis prevention, and patients' demand for better, quick, and convenient access to medical information, the present study primarily assessed the reliability and accuracy of YouTube videos on peri-implantitis and secondarily evaluated their educational value for the patients, and the related suitability, as part of population-based preventive strategies, to deliver valid information, potentially capable of improving patient knowledge and educational skills. This study's protocol was developed in advance, and computer history and cookies were cleared to avoid limitations based on preferred user histories. The search term "peri-implantitis" was defined using the Google Trends website, and videos were searched on YouTube on 5 December 2022. Video inclusion and data collection were conducted by independent pre-calibrated investigators. Descriptive statistics were performed on the videos' characteristics, source, category, target audience, popularity, source reliability, video information and quality (VIQI), content, and educational value. Pearson's correlation between educational value and all parameters was calculated. Videos with very low/low and medium/good/excellent educational value were compared using the Mann-Whitney U test. A total of 44 videos with medium values for popularity, VIQI, content, and educational value were analyzed. Most videos covered peri-implantitis treatment rather than etiology and prevention, about half were uploaded by dentists/specialists, and only 10% specifically targeted patients. Only 2% of YouTube videos about peri-implantitis had excellent educational value, and 5% had good educational value. Video educational value was correlated with VIQI and content beyond video length and source reliability. When comparing the very low/low and medium/good/excellent educational value YouTube videos on peri-implantitis, a significant difference was found in the Video Information and Quality Index, VIQI, and video content.
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Affiliation(s)
- Federica Di Spirito
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Francesco Giordano
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Maria Pia Di Palo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Davide Cannatà
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Marco Orio
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Nicoletta Coppola
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Rossella Santoro
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialities, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
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12
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Ferguson M, Shapiro GD, McDonald SD. Understanding and preferences regarding risk communication during pregnancy: a survey to facilitate provider communication with patients. Am J Obstet Gynecol MFM 2023; 5:100929. [PMID: 36931434 DOI: 10.1016/j.ajogmf.2023.100929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/02/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Clear communication of medical risk helps to ensure proper patient understanding of healthcare options and supports informed decision-making. Communication involving visual and written risk typically conveys risk more effectively than conversations alone between a patient and a clinician. However, perception of risk is context-dependent, and the efficacy of and preferences for commonly-used risk communication formats are not well-understood during pregnancy, which is a time of complex decision-making. We sought to address this knowledge gap. OBJECTIVE This study aimed to assess pregnant and recently pregnant people's understanding and preferences for different risk communication formats. STUDY DESIGN We conducted an open online REDCap survey of pregnant and recently pregnant people over a 1-month period in 2022. Study participants were aged 16 to 49 years, pregnant or recently pregnant, and able to provide informed consent in English. Data collected included demographics, measurements of accuracy of understanding including both gist accuracy (general understanding) and verbatim accuracy (numeric quantification), and preferences for risk communication formats including icon arrays, pie charts, bar graphs, and text. Descriptive analyses of the proportion of correctly answered questions were calculated. RESULTS A total of 247 participants completed ≥1 item on accuracy and risk communication preferences, and 230 provided complete responses. Gist (general) understanding was accurate between 74% and 89% of the time for most graphical formats. Verbatim understanding (exact numeric quantification) was approximately 90% accurate for most formats. Respondents preferred that figures be used over circles to display risk in icon arrays, both for themselves and for infants, although figures generated more worry. However, participants substantially preferred pie charts over bar graphs (59%-70% vs 19%-25%). Respondents preferred risk to be expressed with a lower denominator of 200 rather than a higher denominator of 1000 (79% vs 13%, although the lower denominator generated more worry), and in terms of chance of survival rather than chance of death (50% vs 33%). CONCLUSION In a survey of pregnant and recently pregnant people, most respondents preferred pie charts over other graph formats, and lower rather than higher denominators in text. Presentations of survival rather than death estimates were also preferred. Approximately 75% to 90% of respondents accurately understood risk presented with visual and written communication. For the remaining participants, for whom accurate understanding was challenging, new strategies need to be developed.
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Affiliation(s)
- Margot Ferguson
- Faculty of Science, McMaster University, Hamilton, Canada (Ms Ferguson)
| | - Gabriel D Shapiro
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada (Dr Shapiro)
| | - Sarah D McDonald
- Division of Maternal-Fetal Medicine, Departments of Obstetrics and Gynecology, Radiology, and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada (Dr McDonald).
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13
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Spires B, Brewton A, Maples JM, Ehrlich SF, Fortner KB. Vaccine Hesitancy in Women's Health. Obstet Gynecol Clin North Am 2023; 50:401-419. [PMID: 37149319 DOI: 10.1016/j.ogc.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The development of vaccines is considered one of the greatest breakthroughs of modern medicine, saving millions of lives around the world each year. Despite vaccines' proven success, vaccine hesitancy remains a major issue affecting vaccine uptake. Common themes exist in patients' apprehension to receive vaccines. Women's health providers possess an important role in addressing these concerns and dispelling common misconceptions that may increase vaccine hesitancy thereby reduce vaccine uptake. This review aims to explore many of these topics as they are related to women's health and provide strategies for providers to implement which may reduce vaccine hesitancy among our patients.
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Affiliation(s)
- Benjamin Spires
- Department of Ob/Gyn, Uniformed Services University of the Health Sciences, 307 Boatner Road, Eglin Air Force Base, FL 32542, USA
| | - Annabeth Brewton
- Department of Ob/Gyn, University of Tennessee Graduate School of Medicine, 1924 Alcoa Highway, Box U-27, Knoxville, TN 37920, USA
| | - Jill M Maples
- Department of Ob/Gyn, University of Tennessee Graduate School of Medicine, 1924 Alcoa Highway, Box U-27, Knoxville, TN 37920, USA
| | - Samantha F Ehrlich
- Department of Public Health, University of Tennessee, 369 HPER, 1914 Andy Holt Avenue, Knoxville, TN 37996, USA
| | - Kimberly B Fortner
- Department of Ob/Gyn, University of Tennessee Graduate School of Medicine, 1924 Alcoa Highway, Box U-27, Knoxville, TN 37920, USA.
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14
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Reyna VF, Brainerd CJ. Numeracy, gist, literal thinking and the value of nothing in decision making. NATURE REVIEWS PSYCHOLOGY 2023; 2:1-19. [PMID: 37361389 PMCID: PMC10196318 DOI: 10.1038/s44159-023-00188-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 06/28/2023]
Abstract
The onus on the average person is greater than ever before to make sense of large amounts of readily accessible quantitative information, but the ability and confidence to do so are frequently lacking. Many people lack practical mathematical skills that are essential for evaluating risks, probabilities and numerical outcomes such as survival rates for medical treatments, income from retirement savings plans or monetary damages in civil trials. In this Review, we integrate research on objective and subjective numeracy, focusing on cognitive and metacognitive factors that distort human perceptions and foment systematic biases in judgement and decision making. Paradoxically, an important implication of this research is that a literal focus on objective numbers and mechanical number crunching is misguided. Numbers can be a matter of life and death but a person who uses rote strategies (verbatim representations) cannot take advantage of the information contained in the numbers because 'rote' strategies are, by definition, processing without meaning. Verbatim representations (verbatim is only surface form, not meaning) treat numbers as data as opposed to information. We highlight a contrasting approach of gist extraction: organizing numbers meaningfully, interpreting them qualitatively and making meaningful inferences about them. Efforts to improve numerical cognition and its practical applications can benefit from emphasizing the qualitative meaning of numbers in context - the gist - building on the strengths of humans as intuitive mathematicians. Thus, we conclude by reviewing evidence that gist training facilitates transfer to new contexts and, because it is more durable, longer-lasting improvements in decision making.
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Affiliation(s)
- Valerie F. Reyna
- Cornell University, Department of Psychology, Human Neuroscience Institute, Ithaca, NY USA
| | - Charles J. Brainerd
- Cornell University, Department of Psychology, Human Neuroscience Institute, Ithaca, NY USA
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15
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Wolfe CR, Eylem AA, Dandignac M, Lowe SR, Weber ML, Scudiere L, Reyna VF. Understanding the landscape of web-based medical misinformation about vaccination. Behav Res Methods 2023; 55:348-363. [PMID: 35380412 PMCID: PMC8981888 DOI: 10.3758/s13428-022-01840-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 11/16/2022]
Abstract
Given the high rates of vaccine hesitancy, web-based medical misinformation about vaccination is a serious issue. We sought to understand the nature of Google searches leading to medical misinformation about vaccination, and guided by fuzzy-trace theory, the characteristics of misinformation pages related to comprehension, inference-making, and medical decision-making. We collected data from web pages presenting vaccination information. We assessed whether web pages presented medical misinformation, had an overarching gist, used narrative, and employed emotional appeals. We used Search Engine Optimization tools to determine the number of backlinks from other web pages, monthly Google traffic, and Google Keywords. We used Coh-Metrix to measure readability and Gist Inference Scores (GIS). For medical misinformation web pages, Google traffic and backlinks were heavily skewed with means of 138.8 visitors/month and 805 backlinks per page. Medical misinformation pages were significantly more likely than other vaccine pages to have backlinks from other pages, and significantly less likely to receive at least one visitor from Google searches per month. The top Google searches leading to medical misinformation were "the truth about vaccinations," "dangers of vaccination," and "pro con vaccines." Most frequently, pages challenged vaccine safety, with 32.7% having an overarching gist, 7.7% presenting narratives, and 17.3% making emotional appeals. Emotional appeals were significantly more common with medical misinformation than other high-traffic vaccination pages. Misinformation pages had a mean readability grade level of 11.5, and a mean GIS of - 0.234. Low GIS scores are a likely barrier to understanding gist, and are the "Achilles' heel" of misinformation pages.
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Affiliation(s)
| | - Andrew A Eylem
- Department of Psychology, Miami University, Oxford, OH, 45056, USA
| | | | - Savannah R Lowe
- Department of Psychology, Miami University, Oxford, OH, 45056, USA
| | - Margo L Weber
- Department of Psychology, Miami University, Oxford, OH, 45056, USA
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16
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Schacter DL. Memory Sins in Applied Settings: What Kind of Progress? JOURNAL OF APPLIED RESEARCH IN MEMORY AND COGNITION 2022; 11:445-460. [PMID: 37035272 PMCID: PMC10077946 DOI: 10.1037/mac0000078] [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] [Indexed: 12/24/2022]
Abstract
Over two decades ago, I proposed that memory errors could be classified into seven basic categories or sins (Schacter, 1999, 2001), comprising three sins of omission (transience, absentmindedness, and blocking) and four sins of commission (misattribution, suggestibility, bias, and persistence). In the past two decades, much has been learned about the nature and basis of the memory sins. Here, I assess the extent of progress that has been made during that time regarding applied implications of five of the sins: transience, absentmindedness, misattribution, suggestibility, and persistence. The manifestations of these sins have been examined in a variety of applied settings, including educational, clinical, legal, and technological domains. I argue that considerable progress has been made in characterizing the impact of memory sins in each domain, identify gaps in and limitations of our current knowledge, and briefly consider how these developments bear on broad questions regarding the reliability of human memory.
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Voepel-Lewis T, Boyd CJ, Tait AR, McCabe SE, Zikmund-Fisher BJ. A Risk Education Program Decreases Leftover Prescription Opioid Retention: An RCT. Am J Prev Med 2022; 63:564-573. [PMID: 35909029 PMCID: PMC10866200 DOI: 10.1016/j.amepre.2022.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/14/2022] [Accepted: 04/22/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Retaining leftover prescription opioids poses the risks of diversion, misuse, overdose, and death for youth and other family members. This study examined whether a new educational program would enhance risk perceptions and disposal intentions among parents and decrease their retention of leftover prescription opioids. STUDY DESIGN This study is an RCT (NCT03287622). SETTING/PARTICIPANTS A total of 648 parents whose children were prescribed opioid analgesics were recruited from a Midwestern, academic pediatric hospital between 2017 and 2019. Parents were randomized to receive routine information (control) with or without Scenario-Tailored Opioid Messaging Program intervention. INTERVENTION The intervention provided opioid risk and mitigation advice using interactive decisional feedback. MAIN OUTCOME MEASURES The main outcome measures were parents' perceptions of the riskiness of keeping/sharing opioids and child misuse measured at baseline, Days 3 and 14, their intention to dispose of leftover opioids, and their final retention decisions after the child's use (at or around Day 14). RESULTS Perceived riskiness of child misuse and keeping/sharing opioids increased from baseline through Day 14 only for parents in the intervention group (p≤0.006). However, there were no significant differences in risk perceptions between groups and no intervention effect on disposal intentions at either follow-up. Despite these findings, the intervention reduced the likelihood of parents' opioid retention when adjusted for important parent and child covariates (AOR=0.48; 95% CI=0.25, 0.93; p=0.028). Parents who reported past opioid misuse also showed higher retention behavior (AOR=4.78; 95% CI=2.05, 11.10; p<0.001). CONCLUSIONS A scenario-specific educational intervention emphasizing the potential risks that leftover opioids pose to children and that provided risk mitigation advice decreased parents' retention of their child's leftover opioid medication. Removing leftover prescription drugs from homes with children may be an important step to reducing diversion, accidental poisoning, and misuse among youth. TRIAL REGISTRATION This study is registered at www. CLINICALTRIALS gov NCT03287622.
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Affiliation(s)
- Terri Voepel-Lewis
- School of Nursing, University of Michigan, Ann Arbor, Michigan; Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan; Center for the Study of Drugs, Alcohol, Smoking and Health (DASH Center), University of Michigan, Ann Arbor, Michigan.
| | - Carol J Boyd
- School of Nursing, University of Michigan, Ann Arbor, Michigan; Center for the Study of Drugs, Alcohol, Smoking and Health (DASH Center), University of Michigan, Ann Arbor, Michigan
| | - Alan R Tait
- Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan; Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan
| | - Sean Esteban McCabe
- School of Nursing, University of Michigan, Ann Arbor, Michigan; Center for the Study of Drugs, Alcohol, Smoking and Health (DASH Center), University of Michigan, Ann Arbor, Michigan; Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Brian J Zikmund-Fisher
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan; Department of Health Behavior Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan; Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
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Hurtado-de-Mendoza A, Reyna VF, Wolfe CR, Gómez-Trillos S, Sutton AL, Brennan A, Sheppard VB. Adapting a Theoretically-Based intervention for underserved clinical populations at increased risk for hereditary Cancer: Lessons learned from the BRCA-Gist experience. Prev Med Rep 2022; 28:101887. [PMID: 35855922 PMCID: PMC9287635 DOI: 10.1016/j.pmedr.2022.101887] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 06/04/2022] [Accepted: 07/01/2022] [Indexed: 11/15/2022] Open
Abstract
The use of GCT in underserved diverse populations is suboptimal. Translational genomics research has been conducted with mostly NHW. Adapting EBIs can enhance the reach of EBI to underserved diverse populations. This paper describes the adaptation BRCA Gist, for at-risk Blacks and Latinas. Findings illustrate the need to integrate fidelity and adaptation considerations.
Background Minorities at increased risk for Hereditary Breast and Ovarian Cancer (HBOC) frequently have low awareness and use of genetic counseling and testing (GCT). Making sure that evidence-based interventions (EBIs) reach minorities is key to reduce disparities. BRCA-Gist is a theory-informed EBI that has been proven to be efficacious in mostly non-Hispanic White non-clinical populations. We conducted formative work to inform adaptations of BRCA-Gist for use in clinical settings with at-risk diverse women. Methods Genetic counselors (n = 20) were recruited nationally; at-risk Latinas and Blacks (n = 21) were recruited in Washington DC and Virginia. They completed the BRCA-Gist EBI between April 2018 – September 2019. Participants completed an acceptability scale and an interview to provide suggestions about implementation adaptations. T-tests for independent samples compared acceptability between at-risk women and genetic counselors. The Consensual Qualitative Research Framework was used to code adaptation suggestions. Suggested adaptations were discussed by a multidisciplinary team to integrate fidelity and adaptation considerations. Results At-risk women had a significantly higher acceptability (M = 4.17, SD = 0.47 vs. M = 3.24, SD = 0.64; p = 0.000; scale 1–5) and satisfaction scores (M = 8.3, SD = 1.3 vs. M = 4.2, SD = 2.0; p = 0.000; scale 1–10) than genetic counselors. Genetic counselors and at-risk women suggested contextual (e.g. format) and content (e.g. shortening) adaptations to enhance the fit of BRCA-Gist for diverse clinical populations. Conclusions Findings illustrate the process of integrating fidelity and adaptation considerations to ensure that EBIs retain their core components while enhancing the fit to minoritized clinical populations. Future studies will test the efficacy of the adapted BRCA-Gist in a Randomized Controlled Trial.
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Affiliation(s)
- Alejandra Hurtado-de-Mendoza
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
| | - Valerie F Reyna
- Human Neuroscience Institute, Cornell University, Ithaca, NY, USA
| | | | - Sara Gómez-Trillos
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
| | - Arnethea L Sutton
- Department of Health Behavior Policy, Virginia Commonwealth University, VA, USA
| | - Ashleigh Brennan
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA
| | - Vanessa B Sheppard
- Department of Health Behavior Policy, Virginia Commonwealth University, VA, USA
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Reyna VF, Edelson S, Hayes B, Garavito D. Supporting Health and Medical Decision Making: Findings and Insights from Fuzzy-Trace Theory. Med Decis Making 2022; 42:741-754. [PMID: 35735225 PMCID: PMC9283268 DOI: 10.1177/0272989x221105473] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
HIGHLIGHTS Fuzzy-trace theory (FTT) supports practical approaches to improving health and medicine.FTT differs in important respects from other theories of decision making, which has implications for how to help patients, providers, and health communicators.Gist mental representations emphasize categorical distinctions, reflect understanding in context, and help cue values relevant to health and patient care.Understanding the science behind theory is crucial for evidence-based medicine.
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Affiliation(s)
- Valerie F Reyna
- Human Neuroscience Institute and Center for Behavioral Economics and Decision Research, Cornell University, Ithaca, NY, USA
| | - Sarah Edelson
- Human Neuroscience Institute and Center for Behavioral Economics and Decision Research, Cornell University, Ithaca, NY, USA
| | - Bridget Hayes
- Human Neuroscience Institute and Center for Behavioral Economics and Decision Research, Cornell University, Ithaca, NY, USA
| | - David Garavito
- Human Neuroscience Institute and Center for Behavioral Economics and Decision Research, Cornell University, Ithaca, NY, USA
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20
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Tomsho KS, Polka E, Chacker S, Queeley D, Alvarez M, Scammell MK, Emmons KM, Rudd RE, Adamkiewicz G. A process for creating data report-back tools to improve equity in environmental health. Environ Health 2022; 21:67. [PMID: 35821055 PMCID: PMC9277935 DOI: 10.1186/s12940-022-00880-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/27/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Although there is increasing interest in reporting results of environmental research efforts back to participants, evidence-based tools have not yet been applied to developed materials to ensure their accessibility in terms of literacy, numeracy, and data visualization demand. Additionally, there is not yet guidance as to how to formally assess the created materials to assure a match with the intended audience. METHODS Relying on formative qualitative research with participants of an indoor air quality study in Dorchester, Massachusetts, we identified means of enhancing accessibility of indoor air quality data report-back materials for participants. Participants (n = 20) engaged in semi-structured interviews in which they described challenges they encountered with scientific and medical materials and outlined written and verbal communication techniques that would help facilitate engagement with and accessibility of environmental health report-back materials. We coupled these insights from participants with best practice guidelines for written materials by operationalizing health literacy tools to produce accessible audience-informed data report-back materials. RESULTS The resulting data report-back materials had a 7th -grade reading level, and between a 4th -8th grade level of overall document complexity. The numeracy skills required to engage with the material were of the lowest demand, and we incorporated best practices for risk communication and facilitating understanding and actionability of the materials. Use of a rigorous assessment tool provides evidence of accessibility and appropriateness of the material for the audience. CONCLUSIONS We outline a process for developing and evaluating environmental health data reports that are tailored to inspire risk-reduction actions, and are demonstrably accessible in terms of their literacy, numeracy, and data visualization demand. Adapting health literacy tools to create and evaluate environmental data report-back materials is a novel and evidence-based means of ensuring their accessibility.
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Affiliation(s)
- Kathryn S. Tomsho
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 02215 Boston, MA USA
| | - Erin Polka
- Department of Environmental Health, Boston University School of Public Health, 02118 Boston, MA USA
| | | | - David Queeley
- Mystic River Watershed Association, 02476 Arlington, MA USA
| | - Marty Alvarez
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 02215 Boston, MA USA
| | - Madeleine K. Scammell
- Department of Environmental Health, Boston University School of Public Health, 02118 Boston, MA USA
| | - Karen M. Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 02115 Boston, MA USA
| | - Rima E. Rudd
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 02115 Boston, MA USA
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 02215 Boston, MA USA
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21
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Marti D, Hamdy RF, Broniatowski DA. Gist Representations and Decision-Making Processes Affecting Antibiotic Prescribing for Children with Acute Otitis Media. MDM Policy Pract 2022; 7:23814683221115416. [PMID: 35911174 PMCID: PMC9335473 DOI: 10.1177/23814683221115416] [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: 08/16/2021] [Accepted: 07/01/2022] [Indexed: 11/25/2022] Open
Abstract
Objective. To test the predictions of fuzzy-trace theory regarding pediatric clinicians’ decision-making processes and risk perceptions about antibiotics for children with acute otitis media (AOM). Methods. We conducted an online survey experiment administered to a sample of 260 pediatric clinicians. We measured their risk perceptions and prescribing decisions across 3 hypothetical AOM treatment scenarios. Participants were asked to choose among the following options: prescribe antibiotics immediately, watchful waiting (“hedging”), or not prescribing antibiotics. Results. We identified 4 gists based on prior literature: 1) “why not take a risk?” 2) “antibiotics might not help but can hurt,” 3) “antibiotics do not have harmful side effects,” and 4) “antibiotics might have harmful side effects.” All 4 gists predicted risky choice (P < 0.001), and gist endorsements varied significantly between scenarios when antibiotics were indicated, F(2, 255) = 8.53, P < 0.001; F(2, 255) = 5.14, P < .01; and F(2, 255) = 3.56, P < 0.05 for the first 3 factors, respectively. In a logistic regression, more experienced clinicians were less likely to hedge (B = −0.05; P < 0.01). Conclusion. As predicted by fuzzy-trace theory, pediatric clinicians’ prescription decisions are associated with gist representations, which are distinct from verbatim risk estimates. Implications. Antibiotic stewardship programs can benefit by communicating the appropriate gists to clinicians who prescribe antibiotics for pediatric patients.
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Affiliation(s)
| | - Rana F. Hamdy
- Department of Pediatrics, Children’s National Health System, Washington DC, USA
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22
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Voepel-Lewis T, Veliz P, Heinze J, Boyd CJ, Zikmund-Fisher B, Lenko R, Grant J, Bromberg H, Kelly A, Tait AR. Enhancing risk perception may be insufficient to curtail prescription opioid use and misuse among youth after surgery: A randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2022; 105:2217-2224. [PMID: 35216854 PMCID: PMC9203921 DOI: 10.1016/j.pec.2022.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This randomized controlled trial examined whether an interactive, risk-focused educational program was associated with higher risk perceptions and decreased prescription opioid use/misuse among emerging adults. METHODS 503 participants aged 15-24 years scheduled for ambulatory surgery were randomized to routine prescription education with or without our Scenario-Tailored Opioid Messaging Program (STOMP) provided prior to receipt of a prescribed opioid. Surveys were completed preoperatively, and at days 7&14, months 1&3 postoperatively. Outcomes included analgesic risk perceptions, opioid use, and misuse intentions/behavior. RESULTS Compared to Controls, STOMP was associated with stable but higher risk perceptions on day 14 (β = 1.76 [95% CI 0.53, 2.99], p = .005) and month 3 (β = 2.13 [95% CI 0.86, 3.40], p = .001). There was no effect of STOMP or analgesic misuse risk perceptions on days of opioid use or subsequent misuse intentions/behavior. The degree to which participants valued pain relief over analgesic risk (trade-off preference) was, however, associated with prolonged postoperative opioid use and later misuse. CONCLUSION Education emphasizing the risks of opioids was insufficient in reducing opioid use and misuse in youth who were prescribed these analgesics for acute pain relief. PRACTICE IMPLICATIONS Education may need to better address analgesic expectations to shorten opioid use and mitigate misuse.
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Affiliation(s)
- Terri Voepel-Lewis
- Department of Health Behavior and Biological Science at the School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA; Department of Pediatric Anesthesiology at Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA.
| | - Phillip Veliz
- Department of Pediatric Anesthesiology at Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Justin Heinze
- Department of Health Behavior and Health Education at the School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Carol J Boyd
- Department of Health Behavior and Biological Science at the School of Nursing, University of Michigan, Ann Arbor, MI 48109, USA
| | - Brian Zikmund-Fisher
- Department of Health Behavior and Health Education at the School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
| | - Rachel Lenko
- Department of Pediatric Anesthesiology at Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - John Grant
- Department of Orthopedic Surgery at Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Harrison Bromberg
- Department of Pediatric Anesthesiology at Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Alyssa Kelly
- Department of Pediatric Anesthesiology at Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Alan R Tait
- Department of Pediatric Anesthesiology at Michigan Medicine, University of Michigan, Ann Arbor, MI 48109, USA
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23
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Weir C. Through the Narrative Looking Glass: Commentary on “Impact of Electronic Health Records on Information Practices in Mental Health Contexts: A Scoping Review” (Preprint). J Med Internet Res 2022; 24:e38513. [PMID: 35507399 PMCID: PMC9118087 DOI: 10.2196/38513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 11/13/2022] Open
Abstract
The authors of “Impact of Electronic Health Records on Information Practices in Mental Health Contexts: Scoping Review” have effectively brought to our attention the failure of the electronic health record (EHR) to represent the human context. Because mental health or behavioral disorders (and functional status in general) emerge from an interaction between the individual’s characteristics and the social context, it is essentially a failure to represent the human context. The assessment and treatment of these disorders must reflect how the person lives, their degree of social connectedness, their personal motivation, and their cultural background. This type of information is best communicated both through narrative and in collaboration with other providers and the patient—largely because human social memory is organized around situation models and natural episodes. Neither functionality is currently available in most EHRs. Narrative communication is effective for several reasons: (1) it supports the communication of goals between providers; (2) it allows the author to express their belief in others’ perspectives (theory of mind), for example, those who will be reading these notes; and (3) it supports the incorporation of the patient’s personal perspective. The failure of the EHR to support mental health information data and information practices is, therefore, essentially a failure to support the basic communication functions necessary for the narrative. The authors have rightly noted the problems of the EHR in this domain, but perhaps they did not completely link the problems to the lack of functionality to support narrative communication. Suggestions for adding design elements are discussed.
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Affiliation(s)
- Charlene Weir
- Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
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Allen RJ, Saeed F. Dialysis Organization Online Information on Kidney Failure Treatments: A Content Analysis Using Corpus Linguistics. Kidney Med 2022; 4:100462. [PMID: 35620083 PMCID: PMC9127690 DOI: 10.1016/j.xkme.2022.100462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Rationale & Objective Dialysis organizations’ websites may influence patient decision making, but the websites have received almost no consideration. We investigated how/whether these websites present all kidney replacement therapy options and how the quality of life of these options is portrayed. Study Design Content analysis using corpus linguistics (computer-assisted language analysis). Setting Website content aimed at patients from the 2 major dialysis organizations’ websites, totaling 226,968 words. The analysis took place from November 12, 2020, to March 30, 2021. Analytical Approach We used linguistic software (AntConc) to document the frequencies of words needed to present treatment options and quality of life information. Results Over both sites, dialysis mentions outstripped transplantation mentions. Organization A did not appear to reference conservative kidney management. Organization B mentioned dialysis more often than conservative management, at a ratio of 34:1. Organization A did not attribute symptoms to dialysis, whereas organization B had 12 mentions of dialysis-induced symptoms out of 87 total symptom references. Both organizations framed life on dialysis optimistically, suggesting that patients can continue to engage in “work,” “sex,” or “travel”; organization A referenced sex, work, and/or travel 123 times and organization B referenced these 262 times. Limitations We used quantitative analysis and linked ideas with certain keywords. We did not conduct a detailed qualitative inquiry. Conclusions The websites emphasized dialysis as a treatment for kidney failure, and the quality of life on dialysis was framed very optimistically. Qualitative studies of treatment modalities and the quality of life on dialysis in the patient-targeted material of dialysis organizations are needed.
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Keene T, Pammer K, Lord B, Shipp C. Fluency and confidence predict paramedic diagnostic intuition: An experimental study of applied dual-process theory. Int Emerg Nurs 2022; 61:101126. [DOI: 10.1016/j.ienj.2021.101126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 11/25/2021] [Accepted: 12/10/2021] [Indexed: 11/05/2022]
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Kaye DK. Navigating ethical challenges of conducting randomized clinical trials on COVID-19. Philos Ethics Humanit Med 2022; 17:2. [PMID: 35086524 PMCID: PMC8794733 DOI: 10.1186/s13010-022-00115-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 01/10/2022] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND The contemporary frameworks for clinical research require informed consent for research participation that includes disclosure of material information, comprehension of disclosed information and voluntary consent to research participation. There is thus an urgent need to test, and an ethical imperative, to test, modify or refine medications or healthcare plans that could reduce patient morbidity, lower healthcare costs or strengthen healthcare systems. METHODS Conceptual review. DISCUSSION Although some allocation principles seem better than others, no single moral principle allocates interventions justly, necessitating combining the moral principles into multiprinciple allocation systems. The urgency notwithstanding, navigating ethical challenges related to conducting corona virus disease (COVID-19) clinical trials is mandatory, in order to safeguard the safety and welfare of research participants, ensure autonomy of participants, reduce possibilities for exploitation and ensure opportunities for research participation. The ethical challenges to can be categorized as challenges in allocation of resources for research; challenges of clinical equipoise in relation to the research questions; challenges of understanding disclosed information in potential participants; and challenges in obtaining informed consent. CONCLUSION To navigate these challenges, stakeholders need a delicate balance of moral principles during allocation of resources for research. Investigators need to apply information processing theories to aid decision-making about research participation or employ acceptable modifications to improve the informed consent process. Research and ethics committees should strengthen research review and oversight to ensure rigor, responsiveness and transparency.
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Affiliation(s)
- Dan Kabonge Kaye
- College of Health Sciences, Department of Obstetrics and Gynecology, Makerere University, P.O. Box 7072, Kampala, Uganda.
- Johns Hopkins Berman Institute of Bioethics, Deering Hall, 1809 Ashland Avenue, Baltimore, MD, 21205, USA.
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Wolfe CR. Fuzzy-Trace Theory and the Battle for the Gist in the Public Mind. JOURNAL OF APPLIED RESEARCH IN MEMORY AND COGNITION 2021; 10:527-531. [PMID: 34926137 PMCID: PMC8668039 DOI: 10.1016/j.jarmac.2021.10.004] [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: 10/05/2021] [Accepted: 10/13/2021] [Indexed: 11/22/2022]
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Edelson S, Reyna V. How Fuzzy-trace Theory Predicts Development of Risky Decision Making, with Novel Extensions to Culture and Reward Sensitivity. DEVELOPMENTAL REVIEW 2021; 62:100986. [PMID: 34776580 PMCID: PMC8589284 DOI: 10.1016/j.dr.2021.100986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Comprehensive meta-analyses of risky decision making in children, adolescents, and adults have revealed that age trends in disambiguated laboratory tasks confirmed fuzzy-trace theory's prediction that preference for risk decreases monotonically from childhood to adulthood. These findings are contrary to predictions of dual systems or neurobiological imbalance models. Assumptions about increasing developmental reliance on mental representations of the gist of risky options are essential to account for this developmental trend. However, dual systems theory appropriately emphasizes how cultural context changes behavioral manifestation of risk preferences across age and neurobiological imbalance models appropriately emphasize developmental changes in reward sensitivity. All of the major theories include the assumption of increasing behavioral inhibition. Here, we integrate these theoretical constructs-representation, cultural context, reward sensitivity, and behavioral inhibition-to provide a novel framework for understanding and improving risky decision making in youth. We also discuss the roles of critical tests, scientific falsification, disambiguating assessments of psychological and neurological processes, and the misuse of such concepts as ecological validity and reverse inference. We illustrate these concepts by extending fuzzy-trace theory to explain why youth are a major conduit of viral infections, including the virus that causes COVID-19. We conclude by encouraging behavioral scientists to embrace new ways of thinking about risky decision making that go beyond traditional stereotypes about adolescents and that go beyond conceptualizing ideal decision making as trading off degrees of risk and reward.
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Reyna VF, Broniatowski DA, Edelson SM. Viruses, Vaccines, and COVID-19: Explaining and Improving Risky Decision-making. JOURNAL OF APPLIED RESEARCH IN MEMORY AND COGNITION 2021; 10:491-509. [PMID: 34926135 PMCID: PMC8668030 DOI: 10.1016/j.jarmac.2021.08.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/15/2021] [Accepted: 08/20/2021] [Indexed: 12/24/2022]
Abstract
Risky decision-making lies at the center of the COVID-19 pandemic and will determine future viral outbreaks. Therefore, a critical evaluation of major explanations of such decision-making is of acute practical importance. We review the underlying mechanisms and predictions offered by expectancy-value and dual-process theories. We then highlight how fuzzy-trace theory builds on these approaches and provides further insight into how knowledge, emotions, values, and metacognitive inhibition influence risky decision-making through its unique mental representational architecture (i.e., parallel verbatim and gist representations of information). We discuss how social values relate to decision-making according to fuzzy-trace theory, including how categorical gist representations cue core values. Although gist often supports health-promoting behaviors such as vaccination, social distancing, and mask-wearing, why this is not always the case as with status-quo gist is explained, and suggestions are offered for how to overcome the "battle for the gist" as it plays out in social media.
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Affiliation(s)
- Valerie F Reyna
- Human Neuroscience Institute, Center for Behavioral Economics and Decision Research, Cornell University, USA
| | - David A Broniatowski
- Department of Engineering Management and Systems Engineering, Institute for Data, Democracy, and Politics, George Washington University, USA
| | - Sarah M Edelson
- Human Neuroscience Institute, Center for Behavioral Economics and Decision Research, Cornell University, USA
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Reyna VF, Edelson SM, Broniatowski DA. Misconceptions, Misinformation, and Moving Forward in Theories of COVID-19 Risky Behaviors. JOURNAL OF APPLIED RESEARCH IN MEMORY AND COGNITION 2021. [DOI: 10.1016/j.jarmac.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Influência da percepção de risco sobre a covid-19 no sofrimento psicológico dos profissionais de saúde. PSICO 2021. [DOI: 10.15448/1980-8623.2021.3.41408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
A saúde mental dos profissionais de saúde da linha de frente durante a pandemia da Doença Coronavírus-2019 (COVID-19) está relacionada a uma percepção qualitativa de risco sobre a doença, segundo a Teoria do Traço Difuso. Uma pesquisa de levantamento foi realizada com 134 profissionais de saúde da linha de frente em um município da região metropolitana do Rio Grande do Sul. Os participantes responderam a um questionário online sobre percepção de risco e a Clinical Outcome Routine Evaluation - Outcome Measure. Análises de regressão linear corroboraram a literatura, indicando que a percepção qualitativa do risco estava relacionada a menor sofrimento psicológico e uma avaliação quantitativa, a maior sofrimento. Os resultados demonstraram a importância da Teoria do Traço Difuso para compreensão dos riscos associados ao sofrimento mental (potencialmente clínico) de profissionais de saúde durante a pandemia.
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Saeed F, Shah AY, Allen RJ, Epstein RM, Fiscella KA. Communication principles and practices for making shared decisions about renal replacement therapy: a review of the literature. Curr Opin Nephrol Hypertens 2021; 30:507-515. [PMID: 34148978 PMCID: PMC8373782 DOI: 10.1097/mnh.0000000000000731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW To provide an overview of the skill set required for communication and person-centered decision making for renal replacement therapy (RRT) choices, especially conservative kidney management (CKM). RECENT FINDINGS Research on communication and decision-making skills for shared RRT decision making is still in infancy. We adapt literature from other fields such as primary care and oncology for effective RRT decision making. SUMMARY We review seven key skills: (1) Announcing the need for decision making (2) Agenda Setting (3) Educating patients about RRT options (4) Discussing prognoses (5) Eliciting patient preferences (6) Responding to emotions and showing empathy, and (7) Investing in the end. We also provide example sentences to frame the conversations around RRT choices including CKM.
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Affiliation(s)
- Fahad Saeed
- Departments of Medicine and Public Health, Division of Nephrology
- Division of Palliative Care
- University of Rochester School of Medicine, National University of Medical Sciences
| | - Amna Yousaf Shah
- Rawalpindi, Pakistan; CITE Center, Department of Behavioral and Natural Sciences
| | | | - Ronald M Epstein
- Division of Palliative Care
- Department of Family Medicine and Center for Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Kevin A Fiscella
- Department of Family Medicine and Center for Center for Communication and Disparities Research, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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Raittio E, Raittio L. Verbal communication of effect-sizes, possible comparators, and uncertainty of evidence in the Finnish clinical practice guidelines: Omitting effect-sizes and comparators without expressing much uncertainty. J Eval Clin Pract 2021; 27:759-766. [PMID: 33084201 DOI: 10.1111/jep.13499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 11/27/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Our aim was to investigate verbal representations of intervention effect-size, uncertainty of evidence, and possible intervention comparators in statements concerning effects of interventions in Finnish clinical practice guidelines. METHOD We selected 10 clinical practice guidelines on common diseases and risk factors published by The Finnish Medical Society Duodecim. All the statements that considered beneficial effects of interventions and that were graded with a level of evidence (levels A, high, to D, very low) were included in analyses. We assessed whether the statements verbally represented intervention effect-size, uncertainty of evidence or a possible comparator, and the reported outcome. RESULTS Of 385 statements, verbal representation of beneficial effect-sizes occurred in 25 (6%) statements. Most (72%) statements indicated that intervention had a beneficial effect, but did not specify effect-size. Less than half (42%) of the statements represented uncertainty verbally. Comparisons to placebo or no-treatment were rare (3%) and 18% of the statements compared interventions to other treatments. Against instructions, a considerable part (35%) of statements with B-level evidence did not represent uncertainty. CONCLUSION Communicating beneficial intervention effects, effect-sizes, possible comparators, and uncertainty of evidence require much broader attention in the clinical practice guideline context.
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Affiliation(s)
- Eero Raittio
- Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.,Oral Health Care, City of Tampere, Tampere, Finland
| | - Lauri Raittio
- The Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Schwartz PH, O’Doherty KC, Bentley C, Schmidt KK, Burgess MM. Layperson Views about the Design and Evaluation of Decision Aids: A Public Deliberation. Med Decis Making 2021; 41:527-539. [PMID: 33813928 PMCID: PMC8191156 DOI: 10.1177/0272989x21998980] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 01/28/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE We carried out the first public deliberation to elicit lay input regarding guidelines for the design and evaluation of decision aids, focusing on the example of colorectal ("colon") cancer screening. METHODS A random, demographically stratified sample of 28 laypeople convened for 4 days, during which they were informed about key issues regarding colon cancer, screening tests, risk communication, and decision aids. Participants then deliberated in small and large group sessions about the following: 1) What information should be included in all decision aids for colon screening? 2) What risk information should be in a decision aid and how should risk information be presented? 3) What makes a screening decision a good one (reasonable or legitimate)? 4) What makes a decision aid and the advice it provides trustworthy? With the help of a trained facilitator, the deliberants formulated recommendations, and a vote was held on each to identify support and alternative views. RESULTS Twenty-one recommendations ("deliberative conclusions") were strongly supported. Some conclusions matched current recommendations, such as that decision aids should be available for use with and without providers present (conclusions 1-4) and should support informed choice (conclusion 9). Some conclusions differed from current recommendations, at least in emphasis-for example, that decision aids should disclose cost of screening (conclusion 11) and should be kept simple and understandable (conclusion 14). Deliberants recommended that decision aids should disclose the baseline risk of getting colon cancer (conclusions 15, 17). LIMITATIONS Single location and medical decision. CONCLUSIONS Guidelines for design of decision aids should consider putting a greater focus on disclosing cost and keeping decision aids simple, and they possibly should recommend disclosing less extensive amounts of quantitative information than currently recommended.
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Affiliation(s)
- Peter H. Schwartz
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Center for Bioethics, Indianapolis, IN, USA
- Philosophy Department, Indiana University School of Liberal Arts, Indianapolis, IN, USA
- Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | | | - Colene Bentley
- British Columbia Cancer Research Institute, Vancouver, BC, Canada
| | - Karen K. Schmidt
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
- Indiana University Center for Bioethics, Indianapolis, IN, USA
| | - Michael M. Burgess
- W. Maurice Young Centre for Applied Ethics, School of Population and Public Health, Medical Genetics, University of British Columbia, Vancouver, BC, Canada
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Monje A, Pérez A, Vera-Rodriguez M, Nart J, Catena A, Petrova D. Comprehension and recall of information about factors associated with peri-implantitis: A randomized controlled trial. J Periodontol 2021; 93:89-99. [PMID: 33949680 DOI: 10.1002/jper.21-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/17/2021] [Accepted: 04/23/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND To evaluate the effect of different communication strategies on comprehension and recall of information about factors associated to peri-implantitis. MATERIALS A prospective, randomized controlled trial was conducted in consecutive patients diagnosed with peri-implantitis. The sample was divided into three groups according to the communication strategy used: Test group 1-Written communication via leaflet with visual aids (L-VA); Test group 2-Written communication via leaflet with no visual aids (L-NVA); and control group-only verbal communication with no leaflet (NL). A questionnaire assessing comprehension at baseline (T0) and recall at 3 months (T1) and 6 months (T2) was administered following the fuzzy trace theory with a combination of 11 "gist" and seven "verbatim" items. The "health belief model" dimensions were further examined to test the influence of the communication strategy upon perceived severity, susceptibility, benefits, barriers, self-efficacy, and behavioral intentions. RESULTS Ninety-nine patients that fulfilled the eligibility criteria were included. Gist and verbatim comprehension of the control, risk factors, and preventive measures for peri-implantitis overall was significantly greater in the test groups, in particular in L-VA at T0 (n = 99). Nevertheless, recall was not influenced by the communication strategy at T1 (n = 85) or T2 (n = 78). No significant differences were noted between groups or as a function of time for any of the "health belief model" constructs with the sole exception of perceived barriers (P = 0.045), which proved lower in the test groups. CONCLUSION The comprehension of information about factors associated to peri-implantitis can be efficiently improved by using written communicative strategies, in particular when supplemented with visual aids. Nevertheless, this approach failed to show effectiveness in modulating recall or in changing behavioral intentions over follow-up (NCT04543604).
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Affiliation(s)
- Alberto Monje
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain.,Department of Periodontology, School of Dental Medicine, University of Michigan, Ann Arbor, USA.,Private practice, CICOM, Badajoz, Spain
| | | | - Maria Vera-Rodriguez
- Department of Periodontology, School of Dental Medicine, University of Michigan, Ann Arbor, USA
| | - José Nart
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Andrés Catena
- Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, Granada, Spain
| | - Dafina Petrova
- CIBER of Epidemiology and Public Health (CIBERSP), Madrid, Spain.,Escuela Andaluza de Salud Pública (EASP), Granada, Spain.,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
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Davis KW, Roter DL, Schmidlen T, Scheinfeldt LB, Klein WMP. Testing a best practices risk result format to communicate genetic risks. PATIENT EDUCATION AND COUNSELING 2021; 104:936-943. [PMID: 33131927 PMCID: PMC8053732 DOI: 10.1016/j.pec.2020.10.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 08/09/2020] [Accepted: 10/15/2020] [Indexed: 05/09/2023]
Abstract
OBJECTIVE To investigate the effect of a genetic report format using risk communication "best-practices" on risk perceptions, in part to reduce risk overestimates. METHODS Adults (N = 470) from the Coriell Personalized Medicine Collaborative (CPMC) were randomized to a 2 × 2 experimental design to receive a hypothetical "personalized" genetic risk result for leukemia (relative risk = 1.5 or 2.5) through either the standard CPMC report (N = 232) or an enriched report informed by best practices (N = 238). A one-time, online survey assessed numeracy and risk perceptions including "feelings of risk" and a numerical estimate. RESULTS Regardless of numeracy, participants who received the enriched report had fewer overestimates of their lifetime risk estimate (LRE; odds ratio = 0.19, p < .001) and lower feelings of risk on two of three measures (p < .001). Participants with higher numeracy scores had fewer overestimates of LRE (OR = 0.66, p < .001) and lower feelings of risk on two out of three measures (p ≤ .01); the interaction between numeracy and report format was non-significant. CONCLUSION The enriched report produced more accurate LRE and lower risk perceptions regardless of numeracy level, suggesting the enriched format was helpful to individuals irrespective of numeracy ability. PRACTICE IMPLICATIONS Best practice elements in risk reports may help individuals form more accurate risk perceptions.
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Affiliation(s)
- Kyle W Davis
- Lineagen, Inc., Salt Lake City, UT, USA; Social and Behavioral Research Branch, National Human Genome Research Institute, NIH, Bethesda, USA.
| | - Debra L Roter
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Tara Schmidlen
- Geisinger, Genomic Medicine Institute, Danville, USA; Coriell Institute for Medical Research, Camden, USA
| | | | - William M P Klein
- Social and Behavioral Research Branch, National Human Genome Research Institute, NIH, Bethesda, USA; Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA; Behavioral Research Program, National Cancer Institute, NIH, Bethesda, USA
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Reyna VF. A scientific theory of gist communication and misinformation resistance, with implications for health, education, and policy. Proc Natl Acad Sci U S A 2021; 118:e1912441117. [PMID: 32312815 PMCID: PMC8054009 DOI: 10.1073/pnas.1912441117] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
A framework is presented for understanding how misinformation shapes decision-making, which has cognitive representations of gist at its core. I discuss how the framework goes beyond prior work, and how it can be implemented so that valid scientific messages are more likely to be effective, remembered, and shared through social media, while misinformation is resisted. The distinction between mental representations of the rote facts of a message-its verbatim representation-and its gist explains several paradoxes, including the frequent disconnect between knowing facts and, yet, making decisions that seem contrary to those facts. Decision makers can falsely remember the gist as seen or heard even when they remember verbatim facts. Indeed, misinformation can be more compelling than information when it provides an interpretation of reality that makes better sense than the facts. Consequently, for many issues, scientific information and misinformation are in a battle for the gist. A fuzzy-processing preference for simple gist explains expectations for antibiotics, the spread of misinformation about vaccination, and responses to messages about global warming, nuclear proliferation, and natural disasters. The gist, which reflects knowledge and experience, induces emotions and brings to mind social values. However, changing mental representations is not sufficient by itself; gist representations must be connected to values. The policy choice is not simply between constraining behavior or persuasion-there is another option. Science communication needs to shift from an emphasis on disseminating rote facts to achieving insight, retaining its integrity but without shying away from emotions and values.
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Affiliation(s)
- Valerie F Reyna
- Human Neuroscience Institute, Cornell University, Ithaca, NY 14853
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Risky choice framing with various problem descriptions: A replication and extension study. JUDGMENT AND DECISION MAKING 2021. [DOI: 10.1017/s1930297500008615] [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
AbstractIn “Risky choice framing: Task versions and a comparison of prospect theory and fuzzy-trace theory”, Kühberger and Tanner (2010) examined the impacts of removing stated zero/non-zero complements of risky options on the gain/loss framing effect. They also tested two rival theoretical explanations for this effect: prospect theory and fuzzy-trace theory. The present study aimed to examine the reliability and robustness of the evidence provided by Kühberger and Tanner by precise replication in Study 1. The original findings were reported for conditions in which the probability of the risky option was fixed, and the expected value of the two alternatives was approximately equivalent. The present study also aimed to examine the generality of their findings under additional conditions in which large, medium and small probabilities of the risky option were assigned, and the expected value of the certain or risky options differed. The main findings of Kühberger and Tanner (2010) were successfully replicated and confirmed under the original and additional conditions. The implications of these findings are discussed.
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Ajayi PT, Garavito DM, Reyna VF. Socioeconomic status and concussion reporting: The distinct and mediating roles of gist processing, knowledge, and attitudes. JOURNAL OF BEHAVIORAL DECISION MAKING 2021. [DOI: 10.1002/bdm.2235] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Peter T. Ajayi
- Department of Human Development, Human Neuroscience Institute Cornell University Ithaca New York USA
| | - David M.N. Garavito
- Department of Human Development, Human Neuroscience Institute Cornell University Ithaca New York USA
| | - Valerie F. Reyna
- Department of Human Development, Human Neuroscience Institute Cornell University Ithaca New York USA
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van Weert JCM, Alblas MC, van Dijk L, Jansen J. Preference for and understanding of graphs presenting health risk information. The role of age, health literacy, numeracy and graph literacy. PATIENT EDUCATION AND COUNSELING 2021; 104:109-117. [PMID: 32727670 DOI: 10.1016/j.pec.2020.06.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/27/2020] [Accepted: 06/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To investigate 1) younger (< 65) and older (> 65) adults' preference for and understanding of graph formats presenting risk information, and 2) the contribution of age, health literacy, numeracy and graph literacy in understanding information. MATERIALS AND METHODS To assess preferences, participants (n = 219 < 65 and n = 227>65) were exposed to a storyboard presenting six types of graphs. Understanding (verbatim and gist knowledge) was assessed in an experiment using a 6 (graphs: clock, bar, sparkplug, table, pie vs pictograph) by 2 (age: younger [<65] vs older [>65]) between-subjects design. RESULTS Most participants preferred clock, pie or bar chart. Pie was not well understood by both younger and older people, and clock not by older people. Bar was fairly well understood in both groups. Table yielded high knowledge scores, particularly in the older group. Lower age, higher numeracy and higher graph literacy contributed to higher verbatim knowledge scores. Higher health literacy and graph literacy were associated with higher gist knowledge. DISCUSSION AND CONCLUSION Although not the preferred format, tables are best understood by older adults. PRACTICE IMPLICATIONS Graph literacy skills are essential for both verbatim and gist understanding, and are important to take into account when developing risk information.
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Affiliation(s)
- Julia C M van Weert
- Amsterdam School of Communication Research / ASCoR, Department of Communication Science, University of Amsterdam, Amsterdam, the Netherlands.
| | - Monique C Alblas
- Amsterdam School of Communication Research / ASCoR, Department of Communication Science, University of Amsterdam, Amsterdam, the Netherlands.
| | - Liset van Dijk
- Nivel, Netherlands Institute of Health Services Research, Utrecht, the Netherlands; Dept. of PharmacoTherapy, Epidemiology & -Economics (PTEE), Groningen Research Institute of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Groningen, Groningen, the Netherlands.
| | - Jesse Jansen
- Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, University of Sydney, 2006, Australia; Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, Maastricht, the Netherlands.
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Aronson PL, Politi MC, Schaeffer P, Fleischer E, Shapiro ED, Niccolai LM, Alpern ER, Bernstein SL, Fraenkel L. Development of an App to Facilitate Communication and Shared Decision-making With Parents of Febrile Infants ≤ 60 Days Old. Acad Emerg Med 2021; 28:46-59. [PMID: 32648270 DOI: 10.1111/acem.14082] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/21/2020] [Accepted: 07/07/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVES We aimed to develop and test a tool to engage parents of febrile infants ≤ 60 days of age evaluated in the emergency department (ED). The tool was designed to improve communication for all parents and to support shared decision-making (SDM) about whether to perform a lumbar puncture (LP) for infants 29 to 60 days of age. METHODS We conducted a multiphase development and testing process: 1) individual, semistructured interviews with parents and clinicians (pediatric and general emergency medicine [EM] physicians and pediatric EM nurses) to learn their preferences for a communication and SDM tool; 2) design of a "storyboard" of the tool with design impression testing; 3) development of a software application (i.e., app) prototype, called e-Care; and 4) usability testing of e-Care, using qualitative assessment and the system usability scale (SUS). RESULTS We interviewed 27 parents and 23 clinicians. Interviews revealed several themes, including that a communication tool should augment but not replace verbal communication; a Web-based format was preferred; and information about infections and testing, including the rationales for specific tests, would be valuable. We then developed separate versions of e-Care for infants ≤ 28 days and 29 to 60 days of age, in both English and Spanish. The e-Care app includes four sections: 1) homepage; 2) why testing is done; 3) what tests are done; and 4) what happens after testing, including a table for parents of infants 29 to 60 days of age to compare the risks/benefits of LP in preparation for an SDM conversation. Parents and clinicians reported that e-Care was understandable and helpful. The mean SUS score was 90.3 (95% confidence interval = 84 to 96.6), representing "excellent" usability. CONCLUSIONS The e-Care app is a useable and understandable tool to support communication and SDM with parents of febrile infants ≤ 60 days of age in the ED.
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Affiliation(s)
- Paul L. Aronson
- From the Department of PediatricsYale School of Medicine New HavenCTUSA
- the Department of Emergency Medicine Yale School of Medicine New Haven CTUSA
| | - Mary C. Politi
- the Department of Surgery Division of Public Health Sciences School of Medicine Washington University St. Louis MOUSA
| | - Paula Schaeffer
- From the Department of PediatricsYale School of Medicine New HavenCTUSA
| | - Eduardo Fleischer
- From the Department of PediatricsYale School of Medicine New HavenCTUSA
| | - Eugene D. Shapiro
- From the Department of PediatricsYale School of Medicine New HavenCTUSA
- the Department of Epidemiology of Microbial Diseases Yale School of Public Health Yale School of Public Health New Haven CTUSA
| | - Linda M. Niccolai
- the Department of Epidemiology of Microbial Diseases Yale School of Public Health Yale School of Public Health New Haven CTUSA
| | - Elizabeth R. Alpern
- the Department of Pediatrics, Division of Emergency Medicine Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine Chicago ILUSA
| | - Steven L. Bernstein
- the Department of Emergency Medicine Yale School of Medicine New Haven CTUSA
- and the Yale Center for Implementation Science Yale School of Medicine New Haven CTUSA
| | - Liana Fraenkel
- and the Department of Internal Medicine Yale School of Medicine New Haven CTUSA
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Sauceda JA, Dubé K, Brown B, Pérez AE, Rivas CE, Evans D, Fisher CB. Framing a Consent Form to Improve Consent Understanding and Determine How This Affects Willingness to Participate in HIV Cure Research: An Experimental Survey Study. J Empir Res Hum Res Ethics 2020; 16:78-87. [PMID: 33307932 DOI: 10.1177/1556264620981205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
HIV cure research carries serious risks and negligible benefits. We investigated how participants understand these risks and what influences their willingness to participate. Through internet-based and in-person convenience sampling, 86 HIV+ participants completed an experimental survey. Participants were randomized to read a standard consent form describing a hypothetical HIV cure study or one adapted using Fuzzy Trace Theory-a decision-making model to facilitate complex information processing. We measured consent understanding and cognitive (e.g., safe/harmful) and affective (e.g., concerning, satisfying) evaluations of HIV cure research. Participants who read the adapted consent form had improved consent understanding, but only positive affective evaluations were associated with a willingness to participate. Consent processes can use decision-making theories to facilitate comprehension of study information.
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Affiliation(s)
| | - Karine Dubé
- 2331University of North Carolina Chapel Hill, USA
| | | | | | | | - David Evans
- 455669Delaney AIDS Research Enterprise Martin Delaney Collaboratory Community Advisory Board, San Francisco, CA, USA
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McElroy T, Dickinson DL, Levin IP. Thinking about decisions: An integrative approach of person and task factors. JOURNAL OF BEHAVIORAL DECISION MAKING 2020. [DOI: 10.1002/bdm.2175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Todd McElroy
- Department of Psychology Florida Gulf Coast University Fort Myers FL USA
| | - David L. Dickinson
- Economics Department, CERPA (Center for Economic Research and Policy Analysis) Appalachian State University Boone NC USA
- IZA (Institute for the Study of Labor) Bonn Germany
- ESI (Economic Science Institute) Chapman University Orange CA USA
| | - Irwin P. Levin
- Department of Psychology University of Iowa Iowa City IA USA
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Garavito DMN, Reyna VF, DeTello JE, Landow BR, Tarpinian LM. Intentions to report concussion symptoms in nonprofessional athletes: A fuzzy‐trace theory approach. APPLIED COGNITIVE PSYCHOLOGY 2020. [DOI: 10.1002/acp.3734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
| | - Valerie F. Reyna
- Department of Human Development Cornell University Ithaca New York USA
| | - Joseph E. DeTello
- Department of Human Development Cornell University Ithaca New York USA
| | - Bailey R. Landow
- Department of Human Development Cornell University Ithaca New York USA
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Tucker Edmonds B, Hoffman SM, Laitano T, Bhamidipalli SS, Jeffries E, Fadel W, Kavanaugh K. Values clarification: Eliciting the values that inform and influence parents' treatment decisions for periviable birth. Paediatr Perinat Epidemiol 2020; 34:556-564. [PMID: 31637742 DOI: 10.1111/ppe.12590] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 08/22/2019] [Accepted: 08/23/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Values clarification can assist families facing the threat of periviable delivery in navigating the complexity of competing values related to death, disability, and quality of life (QOL). OBJECTIVE We piloted values clarification exercises to inform resuscitation decision making and qualitatively assess perceptions of QOL. METHODS We conducted a mixed-method study of women with threatened periviable delivery (22 0/7-24 6/7 weeks) and their important others (IOs). Participants engaged in three values clarification activities as part of a semi-structured interview-(a) Card sorting nine conditions as an acceptable/unacceptable QOL for a child; (b) Rating/ranking seven common concerns in periviable decision making (scale 0-10, not at all to extremely important); and (c) "Agreed/disagreed" with six statements regarding end-of-life treatment, disability, and QOL. Participants were also asked to define "QOL" and describe their perceptions of a good and poor QOL for their child. Analysis was conducted using SAS version 9.4 and NVivo 12. RESULTS All mild disabilities were an acceptable QOL, while two-thirds of participants considered long-term mechanical ventilation unacceptable. Although pregnant women rated "Impact on Your Physical/Mental Health" (average 5.6) and IOs rated "Financial Concerns" the highest (average 6.6), both groups ranked "Financial Concerns" as the most important concern (median 5.0 and 6.0, respectively). Most participants agreed that "Any amount of life is better than no life at all" (pregnant women 62.1%; IOs 75.0%) and disagreed that resuscitation would cause "Too much suffering" for their child (pregnant women 71.4%; IOs 80.0%). Half were familiar with the phrase "QOL". Although the majority described a good QOL in terms of emotional well-being (eg "loved", "happy", "supported"), a poor QOL was described in terms of functionality (eg "dependent" and "confined"). Additionally, financial stability emerged as a distinctive theme when IOs discussed poor QOL. CONCLUSION The study offers important insights on parental perspectives in periviable decision making and potential values clarification tools for decision support.
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Affiliation(s)
- Brownsyne Tucker Edmonds
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Shelley M Hoffman
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Tatiana Laitano
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Surya Sruthi Bhamidipalli
- Department of Biostatistics, Indiana University School of Medicine & Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Erin Jeffries
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - William Fadel
- Department of Biostatistics, Indiana University School of Medicine & Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Karen Kavanaugh
- Children's Hospital of Wisconsin, Milwaukee, WI, USA.,College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
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46
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Reyna VF, Brust‐Renck PG. How representations of number and numeracy predict decision paradoxes: A fuzzy‐trace theory approach. JOURNAL OF BEHAVIORAL DECISION MAKING 2020. [DOI: 10.1002/bdm.2179] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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47
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Tiede KE, Ripke F, Degen N, Gaissmaier W. When Does the Incremental Risk Format Aid Informed Medical Decisions? The Role of Learning, Feedback, and Number of Treatment Options. Med Decis Making 2020; 40:212-221. [PMID: 32036764 PMCID: PMC7174829 DOI: 10.1177/0272989x20904357] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Informed medical decisions require understanding the
benefits and risks of treatments. This entails comparing treatment outcomes to a
control group. The incremental risk format has been recommended
as it directly visualizes the differences between treatment and control group in
1 graph, whereas they have to be calculated from 2 separate graphs in the
total risk format. We investigated when the incremental
risk format aids understanding. Methods. In 2 experiments,
participants received information about medical treatments, either as
incremental or total risk format. We assessed verbatim
knowledge (precise quantitative knowledge), gist
knowledge (knowledge of essential meaning), and evaluations of the
formats. Study 1 (N = 99) consisted of only 1 trial with
medical information and also assessed recall. Study 2 (N = 222)
assessed learning across multiple trials and also varied the presence of
feedback and the number of treatment options. Results. In study 1,
the incremental risk format (v. total risk format) led to worse knowledge,
recall, and evaluations. In study 2, participants learned to understand the
incremental risk format over time, resulting in comparable verbatim knowledge
and evaluations as in the total risk format, as well as in even better gist
knowledge. Feedback and number of treatment options did not moderate the effect
of risk format. Limitations. The studies were conducted with
nonpatient samples, and study 2 employed hypothetical treatments.
Conclusions. The incremental risk format was initially less
understandable than the total risk format. After a short learning period,
however, the incremental risk format resulted in better gist knowledge and was
comparable otherwise, which suggests that participants had to get used to that
format. This has important implications for the study of new formats.
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Affiliation(s)
- Kevin E Tiede
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Graduate School of Decision Sciences, University of Konstanz, Konstanz, Germany
| | - Felicia Ripke
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Nicole Degen
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Wolfgang Gaissmaier
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Centre for the Advanced Study of Collective Behaviour, University of Konstanz, Konstanz, Germany
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Middlemiss W, Brownstein NC, Nelson SP, Manchiraju S, Leddy M, Steliotes N, Grzywacz JG. Crafting effective messages to enhance safe infant sleep. J Am Assoc Nurse Pract 2020; 33:441-450. [PMID: 32039958 DOI: 10.1097/jxx.0000000000000365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 11/01/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Health care professionals are continually challenged by the need to provide health information in a way that successfully changes health practices. Research has documented this as a concern in relation to safe infant sleep health campaigns. Often, caregivers' knowledge of recommended practices is not associated with a change in infant sleep choices. PURPOSE Health campaigns, including most safe infant sleep efforts, often share specific risk factors and steps for avoiding risk, that is, in a verbatim format. Research has shown that caregivers' behavior may be more likely to change when presented with messages based on their general understanding of risk, that is, gist-based format. This research examines caregivers' responses as related to verbatim- and gist-based safe sleep information. METHODS Five hundred forty-one caregivers of infants were shown 12 images depicting infants in safe or unsafe sleep spaces. Images varied across three commercially available spaces, infant race, and presence/absence of one policy-based risk factor. RESULTS Differences in caregivers' discernment of safe and unsafe sleep images paralleled reported differences in knowledge of safe sleep recommendations. Discernment of safe/unsafe images was greater for White than Black caregivers, as well as for females in comparison with male caregivers. Gist-based considerations, such as familiarity with the sleeper depicted or infant race, were also associated with caregivers' discernment of safe/unsafe images. IMPLICATIONS FOR PRACTICE Attending to both gist- and verbatim-based knowledge regarding safe infant sleep campaign information may help to effectively facilitate caregivers' ability to always create safe sleep spaces for their infants.
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Affiliation(s)
- Wendy Middlemiss
- Department of Educational Psychology, University of North Texas, Denton, Texas
| | - Naomi C Brownstein
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, Florida
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, Florida
| | - Scott P Nelson
- College of Medicine, Florida State University, Tallahassee, Florida
| | - Srikant Manchiraju
- The Jim Moran School of Entrepreneurship, Florida State University, Tallahassee, Florida
| | - Miranda Leddy
- Department of Educational Psychology, University of North Texas, Denton, Texas
| | - Nicole Steliotes
- Department of Nutrition, Food, and Exercise Science, Florida State University, Tallahassee, Florida
| | - Joseph G Grzywacz
- Department of Family and Child Sciences, Florida State University, Tallahassee, Florida
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Sepucha KR, Langford AT, Belkora JK, Chang Y, Moy B, Partridge AH, Lee CN. Impact of Timing on Measurement of Decision Quality and Shared Decision Making: Longitudinal Cohort Study of Breast Cancer Patients. Med Decis Making 2019; 39:642-650. [PMID: 31354095 PMCID: PMC7240785 DOI: 10.1177/0272989x19862545] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose.The objective of this study was to examine whether scores of shared decision-making measures differ when collected shortly after (1 month) or long after (1 year) breast cancer surgical treatment decisions. Methods. Longitudinal, multisite survey of breast cancer (BC) patients, with measurements at 1 month and 1 year after surgery at 4 cancer centers. Patients completed the BC Surgery Decision Quality Instrument (used to generate a knowledge score, ratings of goals, and concordance with treatment preferences) and Shared Decision Making (SDM) Process survey at both time points. We tested several hypotheses related to the scores over time, including whether the scores discriminated between sites that did and did not offer formal decision support services. Exploratory analyses examined factors associated with large increases and decreases in scores over time. Results. Across the 4 sites, 229 patients completed both assessments. The mean total knowledge scores (69.2% [SD 16.6%] at 1 month and 69.4% [SD 17.7%] at 1 year, P = 0.86), SDM Process scores (2.7 [SD 1.1] 1 month v. 2.7 [SD 1.2] 1 year, P = 0.68), and the percentage of patients receiving their preferred treatment (92% at 1 month and 92% at 1 year, P = 1.0) were not significantly different over time. The site using formal decision support had significantly higher knowledge and SDM Process scores at 1 month, and only the SDM Process scores remained significantly higher at 1 year. A significant percentage of patients had large changes in their individual knowledge and SDM Process scores, with increases balancing out decreases. Conclusion. For population-level assessments, it is reasonable to survey BC patients up to a year after the decision, greatly increasing feasibility of measurement. For those evaluating decision support interventions, shorter follow-up is more likely to detect an impact on knowledge scores.
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Affiliation(s)
- Karen R Sepucha
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Aisha T Langford
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, NYU School of Medicine, New York, NY, USA
| | | | - Yuchiao Chang
- Division of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Beverly Moy
- Division of Hematology/Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Clara N Lee
- The Ohio State University, Columbus, OH, USA
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Reyna VF, Helm RK, Weldon RB, Shah PD, Turpin AG, Govindgari S. Brain activation covaries with reported criminal behaviors when making risky choices: A fuzzy-trace theory approach. J Exp Psychol Gen 2019; 147:1094-1109. [PMID: 29975093 DOI: 10.1037/xge0000434] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Criminal behavior has been associated with abnormal neural activity when people experience risks and rewards or exercise inhibition. However, neural substrates of mental representations that underlie criminal and noncriminal risk-taking in adulthood have received scant attention. We take a new approach, applying fuzzy-trace theory, to examine neural substrates of risk preferences and criminality. We extend ideas about gist (simple meaning) and verbatim (precise risk-reward tradeoffs) representations used to explain adolescent risk-taking to uncover neural correlates of developmentally inappropriate adult risk-taking. We tested predictions using a risky-choice framing task completed in the MRI scanner, and examined neural covariation with self-reported criminal and noncriminal risk-taking. As predicted, risk-taking was correlated with a behavioral pattern of risk preferences called "reverse framing" (preferring sure losses over a risky option and a risky option over sure gains, the opposite of typical framing biases) that has been linked to risky behavior in adolescents and is rarely observed in nondisordered adults. Experimental manipulations confirmed processing interpretations of typical framing (gist-based) and reverse-framing (verbatim-based) risk preferences. In the brain, covariation with criminal and noncriminal risk-taking was observed predominantly when subjects made reverse-framing choices. Noncriminal risk-taking behavior was associated with emotional reactivity (amygdala) and reward motivation (striatal) areas, whereas criminal behavior was associated with greater activation in temporal and parietal cortices, their junction, and insula. When subjects made more developmentally typical framing choices, reflecting nonpreferred gist processing, activation in dorsolateral prefrontal cortex covaried with criminal risk-taking, which may reflect cognitive effort to process gist while inhibiting preferred verbatim processing. (PsycINFO Database Record
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