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Gwilym BL, Twine CP, Bosanquet DC. Information Provision to Facilitate Vascular Surgery Shared Decision Making in the Face of Uncertainty. Eur J Vasc Endovasc Surg 2024; 68:427-429. [PMID: 38810718 DOI: 10.1016/j.ejvs.2024.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 05/02/2024] [Accepted: 05/22/2024] [Indexed: 05/31/2024]
Affiliation(s)
- Brenig Llwyd Gwilym
- South East Wales Vascular Network, University Hospital of Wales, Cardiff, UK.
| | - Christopher P Twine
- Bristol Centre for Surgical Research, Bristol Medical School, University of Bristol, Bristol, UK; North Bristol NHS Trust, Bristol, UK
| | - David C Bosanquet
- South East Wales Vascular Network, University Hospital of Wales, Cardiff, UK
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2
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Tang YT, Chooi WT. A systematic review of the effects of positive versus negative framing on cancer treatment decision making. Psychol Health 2023; 38:1148-1173. [PMID: 34856837 DOI: 10.1080/08870446.2021.2006197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/21/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Presenting treatment outcomes positively or negatively may differently influence treatment preferences and lead to sub-optimal decision in a medical context. This review systematically organised how positive versus negative framing of treatment outcomes influenced cancer treatment decisions of cancer patients and individuals without a cancer diagnosis. DESIGN Three databases (PubMed, PsycInfo and Scopus) were searched for studies reporting the effects of positive versus negative framing on cancer treatment decision-making from 1981 to December 2020. MAIN OUTCOME MEASURE The effects of positive versus negative framing on cancer treatment preferences and the elimination of framing effect were evaluated. RESULTS A total of 12 studies that met inclusion criteria were reviewed. Framing effect was consistently observed in individuals without a cancer diagnosis. There was not enough evidence to suggest a robust framing effect in cancer patients. Surgery was preferred in positive framing, whereas adjuvant therapy was preferred in negative framing. Justification intervention significantly eliminated framing effect. Mixed framing failed to eliminate framing effect. CONCLUSION Current recommendations for presenting treatment options are based on research in cancer-screening decision-making. Knowledge of how positive versus negative framing affect cancer patients' treatment decisions is still limited. Our review highlighted the need for continued research in this area.
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Affiliation(s)
- Yi-Ting Tang
- School of Social Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia
| | - Weng-Tink Chooi
- School of Social Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia
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Abukmail E, Bakhit M, Jones M, Del Mar C, Hoffmann T. Effect of different visual presentations on the public's comprehension of prognostic information using acute and chronic condition scenarios: two online randomised controlled trials. BMJ Open 2023; 13:e067624. [PMID: 37316324 DOI: 10.1136/bmjopen-2022-067624] [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] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES To assess the effectiveness of bar graph, pictograph and line graph compared with text-only, and to each other, for communicating prognosis to the public. DESIGN Two online four-arm parallel-group randomised controlled trials. Statistical significance was set at p<0.016 to allow for three-primary comparisons. PARTICIPANTS AND SETTING Two Australian samples were recruited from members registered at Dynata online survey company. In trial A: 470 participants were randomised to one of the four arms, 417 were included in the analysis. In trial B: 499 were randomised and 433 were analysed. INTERVENTIONS In each trial four visual presentations were tested: bar graph, pictograph, line graph and text-only. Trial A communicated prognostic information about an acute condition (acute otitis media) and trial B about a chronic condition (lateral epicondylitis). Both conditions are typically managed in primary care where 'wait and see' is a legitimate option. MAIN OUTCOME Comprehension of information (scored 0-6). SECONDARY OUTCOMES Decision intention, presentation satisfaction and preferences. RESULTS In both trials, the mean comprehension score was 3.7 for the text-only group. None of the visual presentations were superior to text-only. In trial A, the adjusted mean difference (MD) compared with text-only was: 0.19 (95% CI -0.16 to 0.55) for bar graph, 0.4 (0.04 to 0.76) for pictograph and 0.06 (-0.32 to 0.44) for line graph. In trial B, the adjusted MD was: 0.1 (-0.27 to 0.47) for bar graph), 0.38 (0.01 to 0.74) for pictograph and 0.1 (-0.27 to 0.48) for line graph. Pairwise comparisons between the three graphs showed all were clinically equivalent (95% CIs between -1.0 and 1.0). In both trials, bar graph was the most preferred presentation (chosen by 32.9% of trial A participants and 35.6% in trial B). CONCLUSIONS Any of the four visual presentations tested may be suitable to use when discussing quantitative prognostic information. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12621001305819).
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Affiliation(s)
- Eman Abukmail
- Institute for Evidence-Based Healthcare (IEBH), Faculty of Health Sciences and Medicine (HSM), Bond University, Robina, Queensland, Australia
| | - Mina Bakhit
- Institute for Evidence-Based Healthcare (IEBH), Faculty of Health Sciences and Medicine (HSM), Bond University, Robina, Queensland, Australia
| | - Mark Jones
- Institute for Evidence-Based Healthcare (IEBH), Faculty of Health Sciences and Medicine (HSM), Bond University, Robina, Queensland, Australia
| | - Chris Del Mar
- Institute for Evidence-Based Healthcare (IEBH), Faculty of Health Sciences and Medicine (HSM), Bond University, Robina, Queensland, Australia
| | - Tammy Hoffmann
- Institute for Evidence-Based Healthcare (IEBH), Faculty of Health Sciences and Medicine (HSM), Bond University, Robina, Queensland, Australia
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Scorziello C, Durante C, Biffoni M, Borcea MC, Consorti F, Laca A, Melcarne R, Ventrone L, Giacomelli L. The Size of a Thyroid Nodule with ACR TI-RADS Does Not Provide a Better Prediction of the Nature of the Nodule: A Single-Center Retrospective Real-Life Observational Study. Healthcare (Basel) 2023; 11:1673. [PMID: 37372791 DOI: 10.3390/healthcare11121673] [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: 04/07/2023] [Revised: 05/30/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
We investigated if thyroid nodule size has a predictive value of malignancy on a par with composition, echogenicity, shape, margin, and echogenic foci, and what would be the consequence of observing the rule of the American College of Radiology (ACR) to perform a fine-needle aspiration biopsy (FNAB). We conducted a retrospective real-life observational study on 86 patients who underwent surgery after a standardized diagnostic protocol. We divided the TR3, TR4, and TR5 classes into sub-classes according to the size threshold indicating FNAB (a: up to the threshold for no FNAB; b: over the threshold for FNAB suggested). We computed sensitivity, specificity, and positive (PPV) and negative predictive value (NPV) for the different sub-classes and Youden's index (Y) for the different possible cutoffs. Each sub-class showed the following PPV (0.67, 0.68, 0.70, 0.78, 0.72), NPV (0.56, 0.54, 0.51, 0.52, 0.59), and Y (0.20, 0.20, 0.22, 0.31, 0.30). In this real-life series, we did not find a significant difference in prediction of malignancy between the sub-categories according to the size threshold. All nodules have a pre-evaluation likelihood of being malignant, and the impact and utility of size thresholds may be less clear than suggested by the ACR TIRADS guidelines in patients undergoing standardized thyroid work up.
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Affiliation(s)
- Chiara Scorziello
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy
| | - Marco Biffoni
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy
| | - Maria Carola Borcea
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy
| | - Fabrizio Consorti
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy
| | - Angelo Laca
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy
| | - Rossella Melcarne
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy
| | - Luca Ventrone
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy
| | - Laura Giacomelli
- Department of Surgical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, I-00161 Rome, Italy
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Jee WF, Hyun M. "10,000 Available" or "10% Remaining": The Impact of Scarcity Framing on Ticket Availability Perceptions in the Secondary Ticket Market. Behav Sci (Basel) 2023; 13:bs13040338. [PMID: 37102852 PMCID: PMC10135727 DOI: 10.3390/bs13040338] [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: 03/09/2023] [Revised: 04/13/2023] [Accepted: 04/15/2023] [Indexed: 04/28/2023] Open
Abstract
The aim of this study was to investigate the effect of numeracy framing and demand on participants' perceived ticket availability and likelihood of finding a lower-priced deal in the secondary ticket market for National Football League (NFL) games. A total of 640 participants were recruited via Qualtrics where participants were solicited electronically via 10 date-specific email blasts prior to a New York Giants Sunday Night Football home game. Participants were randomly assigned to one of five treatment conditions (control, percentage frame × low demand, percentage frame × high demand, frequency frame × low demand, frequency frame × high demand) to complete an online survey. Multivariate analysis of variance (MANOVA) was performed to discern overall differences in the mean likelihood scores of the dependent variable between groups. The results showed that participants presented with the "percentage" frame perceived tickets as less available than those presented with the "frequency scarcity" frame, and the effect was greater for high-demand games. Additionally, game demand moderated the effect of scarcity framing on participants' perceived ticket availability and expected lower rate. Several manipulation checks were applied to ensure the study's validity. The findings of this study have practical implications for ticket marketers in the sport industry to effectively frame scarcity information and facilitate transactions for online buyers and sellers.
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Affiliation(s)
- Wonsok Frank Jee
- School of Marketing, Entrepreneurship, Sport Management, Hospitality, and Tourism Management, Western Carolina University, Cullowhee, NC 28723, USA
| | - Moonsup Hyun
- Department of Business and Economics, Utica University, Utica, NY 13502, USA
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6
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Hasannejadasl H, Roumen C, Smit Y, Dekker A, Fijten R. Health Literacy and eHealth: Challenges and Strategies. JCO Clin Cancer Inform 2022; 6:e2200005. [DOI: 10.1200/cci.22.00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Given the impact of health literacy (HL) on patients' outcomes, limited health literacy is a major barrier to improve cancer care globally. HL refers to the degree in which an individual is able to acquire, process, and comprehend information in a way to be actively involved in their health decisions. Previous research found that almost half of the population in developed countries have difficulties in understanding health-related information. With the gradual shift toward the shared decision making process and digital transformation in oncology, the need for addressing low HL issues is crucial. Decision making in oncology is often accompanied by considerable consequences on patients' lives, which requires patients to understand complex information and be able to compare treatment methods by considering their own values. How health information is perceived by patients is influenced by various factors including patients' characteristics and the way information is presented to patients. Currently, identifying patients with low HL and simple data visualizations are the best practice to help patients and clinicians in dealing with limited health literacy. Furthermore, using eHealth, as well as involving HL mediators, supports patients to make sense of complex information.
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Affiliation(s)
- Hajar Hasannejadasl
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Cheryl Roumen
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Yolba Smit
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Andre Dekker
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Rianne Fijten
- Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands
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Smith IP, Ancillotti M, de Bekker-Grob EW, Veldwijk J. Does It Matter How You Ask? Assessing the Impact of Failure or Effectiveness Framing on Preferences for Antibiotic Treatments in a Discrete Choice Experiment. Patient Prefer Adherence 2022; 16:2921-2936. [PMID: 36324822 PMCID: PMC9621030 DOI: 10.2147/ppa.s365624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/01/2022] [Indexed: 11/05/2022] Open
Abstract
PURPOSE Studies assessing framing effects in discrete choice experiments (DCE) primarily focused on attributes related to mortality/survival information. Little is known about framing effects for other attributes in health-related DCEs. This study aimed to investigate how framing treatment outcome as effective, failure, or a combined frame impacts respondent choices and DCE outcomes. PATIENTS AND METHODS Three Bayesian D-efficient designed DCE surveys measuring preferences for antibiotic treatments were randomly distributed to a representative sample of the Swedish population aged 18-65 years (n=1119). Antibiotic treatments were described using five attributes. Four attributes were static: Contribution to Antibiotic Resistance, Treatment Duration, Likelihood of Side-Effects, and Costs. A fifth treatment attribute was framed in three ways: Effectiveness, Failure Rate, or both. Mixed logit models were used to analyze attribute level estimates, importance value, and choice predictions. RESULTS Significant differences between the frames were found for the parameter estimates of the attributes of Treatment Duration and Likelihood of Side-Effects, but not Treatment Outcome which was the alternatively framed attribute. Contribution to Antibiotic Resistance and Costs were the most important attributes for all participants regardless of framing. Choice predictions for the "best option" antibiotic only slightly differed between the groups based on the frame seen (95.2-92.4%). CONCLUSION Our study showed that attribute framing can impact preferences regardless of the attribute's importance value in alternative valuation. However, the practical implication of this effect may be limited. A theoretical discussion is needed to identify how researchers should accommodate and report any potential framing effect in their studies.
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Affiliation(s)
- Ian P Smith
- Julius Center for Health and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Correspondence: Ian P Smith, Julius Center for Health and Primary Care, University Medical Center Utrecht, Str. 6.131, P.O. Box 85500 3508 GA, Utrecht, the Netherlands, Tel +31 88 75 69 616, Fax +31 88 75 554 84, Email
| | - Mirko Ancillotti
- Centre for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Esther W de Bekker-Grob
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Jorien Veldwijk
- Centre for Research Ethics and Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Erasmus Choice Modelling Centre, Erasmus University Rotterdam, Rotterdam, the Netherlands
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
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8
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Effect of different visual presentations on the comprehension of prognostic information: a systematic review. BMC Med Inform Decis Mak 2021; 21:249. [PMID: 34433455 PMCID: PMC8390199 DOI: 10.1186/s12911-021-01612-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 08/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background Understanding prognostic information can help patients know what may happen to their health over time and make informed decisions. However, communicating prognostic information well can be challenging. Purpose To conduct a systematic review to identify and synthesize research that has evaluated visual presentations that communicate quantitative prognostic information to patients or the public. Data sources MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC and the Cochrane Central Register of Controlled Trials (CENTRAL) (from inception to December 2020), and forward and backward citation search. Study selection Two authors independently screened search results and assessed eligibility. To be eligible, studies required a quantitative design and comparison of at least one visual presentation with another presentation of quantitative prognostic information. The primary outcome was comprehension of the presented information. Secondary outcomes were preferences for or satisfaction with the presentations viewed, and behavioral intentions. Data extraction Two authors independently assessed risk of bias and extracted data. Data synthesis Eleven studies (all randomized trials) were identified. We grouped studies according to the presentation type evaluated. Bar graph versus pictograph (3 studies): no difference in comprehension between the groups. Survival vs mortality curves (2 studies): no difference in one study; higher comprehension in survival curve group in another study. Tabular format versus pictograph (4 studies): 2 studies reported similar comprehension between groups; 2 found higher comprehension in pictograph groups. Tabular versus free text (3 studies): 2 studies found no difference between groups; 1 found higher comprehension in a tabular group. Limitations Heterogeneity in the visual presentations and outcome measures, precluding meta-analysis. Conclusions No visual presentation appears to be consistently superior to communicate quantitative prognostic information. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01612-9.
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Kalke K, Studd H, Scherr CL. The communication of uncertainty in health: A scoping review. PATIENT EDUCATION AND COUNSELING 2021; 104:1945-1961. [PMID: 33593644 DOI: 10.1016/j.pec.2021.01.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 12/22/2020] [Accepted: 01/28/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To conduct a scoping review of existing studies that examine communication strategies that address uncertainty in health and categorize them using the taxonomy of uncertainty. METHODS Relevant articles retrieved from ten databases were categorized according to the dimensions of the taxonomy of uncertainty, and study characteristics were extracted from each article. RESULTS All articles (n = 63) explored uncertainty in the context of probabilistic risk and related to scientific issues (n = 63; 100%). The majority focused on complexity (n = 24; 38.1%) and uncertainty experienced by patients (n = 52; 82.5%). Most utilized quantitative methods (n = 46; 73.0%), hypothetical scenarios (n = 49; 77.8%), and focused on cancer (n = 20; 31.7%). Theory guided messages and study design in fewer than half (n = 27; 42.9%). CONCLUSIONS Heterogeneity in terminology used to refer to different types of uncertainties preclude a unified research agenda on uncertainty communication. Research predominately focuses on probability as the source of uncertainty, uncertainties related to scientific issues, and uncertainty experienced by patients. PRACTICE IMPLICATIONS Additional efforts are needed to understand providers' experience of uncertainty, and to identify strategies to address ambiguity. Future studies should use consistent terminology to allow for coherence and advancement of uncertainty communication scholarship. Continued efforts to refine the existing taxonomy should be undertaken.
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Affiliation(s)
- Kerstin Kalke
- Department of Communication Studies, Northwestern University, Chicago, IL, USA.
| | - Hannah Studd
- Department of Communication Studies, Northwestern University, Chicago, IL, USA
| | - Courtney L Scherr
- Department of Communication Studies, Northwestern University, Chicago, IL, USA
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10
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Ho-Sam-Sooi N, Pieters W, Kroesen M. Investigating the effect of security and privacy on IoT device purchase behaviour. Comput Secur 2021. [DOI: 10.1016/j.cose.2020.102132] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Maleyeff J, Chen D. Consumer health informatics approach for personalized cancer screening decisions using utility functions. Health Informatics J 2020; 26:2877-2891. [PMID: 33317380 DOI: 10.1177/1460458220949484] [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: 11/16/2022]
Abstract
A consumer health informatics approach is used to investigate the development of a patient-centered decision support system (DSS) with individualized utility functions. It supports medical decisions that have uncertain benefits and potential harms. Its use for accepting or declining cancer screening is illustrated. The system's underlying optimization model incorporates two user-specific utility functions-one that quantifies life-saving benefits and one that quantifies harms, such as unnecessary follow-up tests, surgeries, or treatments. The system requires sound decision making. Therefore, the decision making process was studied using a decision aid in the form of a color-coded matrix with the potential outcomes randomly placed in proportion to their likelihoods. Data were collected from 48 study participants, based on a central composite experimental design. The results show that the DSS can be effective, but health consumers may not be rational decision makers.
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Affiliation(s)
| | - Danrong Chen
- College of Arts & Sciences, Boston University, USA
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12
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Shapey IM, Malik HZ, de Liguori Carino N. Data driven decision-making for older patients with hepatocellular carcinoma. Eur J Surg Oncol 2020; 47:576-582. [PMID: 32600896 DOI: 10.1016/j.ejso.2020.05.023] [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: 05/22/2020] [Accepted: 05/28/2020] [Indexed: 10/24/2022] Open
Abstract
Older age is a risk factor for the development of HCC. However, the treatment options available for older patients with HCC, their safety, efficacy and utility, are poorly understood resulting in challenging decision-making. In this review, we aim to report the best available evidence to facilitate optimal decision making for older patients with HCC. We report that surgical resection for HCC is equally safe (90-day mortality ~3%) and effective (five-year disease free survival ~40%) for older patients as it is for younger patients. Five-year survival after ablation therapy for HCC is in excess of 50% in older patients, whilst morbidity rates are in the region of 3%. Survival rates of 30% after chemoembolisation reflects its role as a non-curative treatment. Transplantation is an option that may be helpful for a minority of patients, but the high risks of in-hospital mortality and lower likelihood of receiving a transplant should be duly considered before committing to this approach. We therefore advocate an individualised assessment for older patients based on these risk profiles and probabilities of optimal outcomes. In patients with a projected life-span ≥ 3 years, and who have sufficient physiological and functional reserve, surgical resection should be the treatment of choice. Patients with a projected life-span < 3 years are better served with loco-regional therapies, and tumour size, at a threshold of 3 cm, should guide the choice between ablation and chemoembolisation therapies.
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Affiliation(s)
- Iestyn M Shapey
- Regional Hepato-Pancreatico-Biliary Unit, Manchester Royal Infirmary, Manchester University, NHS Foundation Trust, Manchester, M13 9WL, UK; Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology Medicine and Health, University of Manchester, Manchester, M13 9PL, UK
| | - Hassan Z Malik
- Hepatobiliary Unit, University Hospital Aintree, Liverpool, UK
| | - Nicola de Liguori Carino
- Regional Hepato-Pancreatico-Biliary Unit, Manchester Royal Infirmary, Manchester University, NHS Foundation Trust, Manchester, M13 9WL, UK.
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13
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Lai C, Sceats LA, Qiu W, Park KT, Morris AM, Kin C. Patient decision-making in severe inflammatory bowel disease: the need for improved communication of treatment options and preferences. Colorectal Dis 2019; 21:1406-1414. [PMID: 31295766 DOI: 10.1111/codi.14759] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/27/2019] [Indexed: 01/09/2023]
Abstract
AIM Patients with inflammatory bowel disease and their physicians must navigate ever-increasing options for treatment. The aim of this study was to elucidate the key drivers of treatment decision-making in inflammatory bowel disease. METHODS We conducted qualitative semi-structured in-person interviews of 20 adult patients undergoing treatment for inflammatory bowel disease at an academic medical centre who either recently initiated biologic therapy or underwent an operation or surgical evaluation. Interviews were audio-recorded, transcribed verbatim, iteratively coded, and discussed to consensus by five researchers. We used thematic analysis to explore factors influencing decision-making. RESULTS Four major themes emerged as key drivers of treatment decision-making: perceived clinical state and disease severity, the patient-physician relationship, knowledge, attitudes and beliefs about treatment options, and social isolation and stigma. Patients described experiencing a clinical turning point as the impetus for proceeding with a previously undesired treatment such as infusion medication or surgery. Patients reported delays in care or diagnosis, inadequate communication with their physicians, and lack of control over their disease management. Patients often stated that they considered surgery to be the treatment of last resort, which further compounded the complexity of making treatment decisions. CONCLUSION Patients described multiple barriers to making informed and collaborative decisions about treatment, especially when considering surgical options. Our study reveals a need for more comprehensive communication between the patient and their physician about the range of medical and surgical treatment options. We recommend a patient-centred approach toward the decision-making process that accounts for patient decision-making preferences, causes of social stress, and clinical status.
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Affiliation(s)
- C Lai
- Stanford University School of Medicine, Stanford, California, USA
| | - L A Sceats
- Department of Surgery, S-SPIRE Center, Stanford University School of Medicine, Stanford, California, USA
| | - W Qiu
- Stanford University School of Medicine, Stanford, California, USA
| | - K T Park
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - A M Morris
- Department of Surgery, S-SPIRE Center, Stanford University School of Medicine, Stanford, California, USA
| | - C Kin
- Department of Surgery, S-SPIRE Center, Stanford University School of Medicine, Stanford, California, USA
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14
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Marshall AC, Gentsch A, Blum AL, Broering C, Schütz-Bosbach S. I feel what I do: Relating interoceptive processes and reward-related behavior. Neuroimage 2019; 191:315-324. [PMID: 30776528 DOI: 10.1016/j.neuroimage.2019.02.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/01/2019] [Accepted: 02/13/2019] [Indexed: 11/24/2022] Open
Abstract
Interoceptive signalling has been shown to contribute to action regulation and action experience. Here, we assess whether motor behaviour can be influenced by anticipated homeostatic feeling states induced through different predictable contexts. Participants performed a reward incentive paradigm in which accurate responses increased (gain) or avoided the depletion (averted loss) of a credit score. Across two types of blocks, we varied the predictability of the outcome state. In predictable blocks, a cue signaled a gain, loss or control trial (motor response did not affect the credit score). This allowed participants to anticipate the interoceptive feeling state associated with the outcome. In unpredictable blocks, the cue had no relation to the type of outcome. Thus, participants were unable to anticipate the feeling state it produced. Via EEG, we measured the Heartbeat Evoked Potential (HEP) and the Contingent Negative Variation (CNV) as indices of interoceptive and motor processing respectively. In addition, we measured feedback P3 amplitude following outcome presentation and accuracy and reaction times of the required motor response. We observed higher HEP and CNV amplitudes as well as faster and more accurate motor responses in predictable compared to unpredictable outcome blocks. Similarly, feedback-related P3 amplitudes were significantly lower for predictable relative to unpredictable outcomes. Crucially, HEP amplitudes measured prior to feedback predicted feedback-related P3 amplitudes for anticipated outcome events. Results suggest that accurate anticipation of homeostatic feeling states associated with gain, loss or control outcomes facilitates motor execution and outcome evaluation. Findings are hereby the first to empirically assess the link between interoceptive and motor domains and provide primary evidence for a joint processing structure.
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Affiliation(s)
- Amanda C Marshall
- Department of Psychology, General and Experimental Psychology Unit, Ludwig-Maximilians University, D-80802, Munich, Germany.
| | - Antje Gentsch
- Department of Psychology, General and Experimental Psychology Unit, Ludwig-Maximilians University, D-80802, Munich, Germany
| | - Anna-Lucia Blum
- Department of Psychology, General and Experimental Psychology Unit, Ludwig-Maximilians University, D-80802, Munich, Germany
| | - Christina Broering
- Department of Affective Neuroscience and Psychophysiology, Institute of Psychology, University of Goettingen, Goettingen, Germany
| | - Simone Schütz-Bosbach
- Department of Psychology, General and Experimental Psychology Unit, Ludwig-Maximilians University, D-80802, Munich, Germany
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Life After Surgery: Surgeon Assessments of Quality of Life Among Patients With Familial Adenomatous Polyposis. Dis Colon Rectum 2018; 61:1217-1222. [PMID: 30192330 DOI: 10.1097/dcr.0000000000001146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Without prophylactic surgery, patients with familial adenomatous polyposis are at high risk for colorectal cancer development. Various surgical options for prophylaxis are available. Patient decision-making for preventative treatments is often influenced by the preferences of healthcare providers. OBJECTIVE We determined surgeon preferences for the surgical options available to patients with familial adenomatous polyposis. DESIGN We obtained preference estimates for postoperative health states from colorectal surgeons who had treated ≥10 patients with familial adenomatous polyposis. SETTINGS Assessments were made at an annual meeting of the American Society of Colon and Rectal Surgeons. MAIN OUTCOME MEASURES Utilities were measured through the time trade-off method. We determined utilities for 3 procedures used for prophylaxis, including total proctocolectomy with permanent ileostomy, colectomy with ileorectal anastomosis, and total proctocolectomy with IPAA. We also assessed utilities for 2 short-term health states: 90 days with a temporary ileostomy and 2 years with a poorly functioning ileoanal pouch. RESULTS Twenty-seven surgeons who had cared for >1700 patients with familial adenomatous polyposis participated in this study. The highest utility scores were provided for colectomy with ileorectal anastomosis (0.98). Lower utility scores were provided for total proctocolectomy with permanent ileostomy (0.87) and IPAA (0.89). The number of patients with familial adenomatous polyposis who were treated by participating surgeons did not influence these estimates; however, more-experienced surgeons gave lower utility scores for a poorly functioning ileoanal pouch than less-experienced surgeons (0.15, 0.50, and 0.25 for high-, medium-, and low-volume surgeons; p = 0.02). LIMITATIONS This study was limited by the sample size. CONCLUSIONS For patients with familial adenomatous polyposis and relative rectal sparing, surgeon preferences are greatest for colectomy with ileorectal anastomosis. Utility estimates provided by this study are important for understanding surgical decision-making and suggest a role for ileorectal anastomosis in appropriately selected patients. See Video Abstract at http://links.lww.com/DCR/A656.
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Abstract
Background:
Clinical decision support (CDS) systems can improve safety and facilitate evidence-based practice. However, clinical decisions are often affected by the cognitive biases and heuristics of clinicians, which is increasing the interest in behavioral and cognitive science approaches in the medical field.
Objectives:
This review aimed to identify decision biases that lead clinicians to exhibit irrational behaviors or responses, and to show how behavioral economics can be applied to interventions in order to promote and reveal the contributions of CDS to improving health care quality.
Methods:
We performed a systematic review of studies published in 2016 and 2017 and applied a snowball citationsearch method to identify topical publications related to studies forming part of the BEARI (Application of Behavioral Economics to Improve the Treatment of Acute Respiratory Infections) multisite, cluster-randomized controlled trial performed in the United States.
Results:
We found that 10 behavioral economics concepts with nine cognitive biases were addressed and investigated for clinician decision-making, and that the following five concepts, which were actively explored, had an impact in CDS applications: social norms, framing effect, status-quo bias, heuristics, and overconfidence bias.
Conclusions:
Our review revealed that the use of behavioral economics techniques is increasing in areas such as antibiotics prescribing and preventive care, and that additional tests of the concepts and heuristics described would be useful in other areas of CDS. An improved understanding of the benefits and limitations of behavioral economics techniques is also still needed. Future studies should focus on successful design strategies and how to combine them with CDS functions for motivating clinicians.
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Affiliation(s)
- Insook Cho
- Nursing Department, Inha University, Incheon, South Korea.,The Center for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA
| | - David W Bates
- The Center for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Partners Healthcare Systems, Inc., Wellesley, MA, USA
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Viberg Johansson J, Segerdahl P, Ugander UH, Hansson MG, Langenskiöld S. Making sense of genetic risk: A qualitative focus-group study of healthy participants in genomic research. PATIENT EDUCATION AND COUNSELING 2018; 101:422-427. [PMID: 28947362 DOI: 10.1016/j.pec.2017.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 09/13/2017] [Accepted: 09/14/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE It is well known that research participants want to receive genetic risk information that is about high risks, serious diseases and potential preventive measures. The aim of this study was to explore, by qualitative means, something less well known: how do healthy research participants themselves make sense of genetic risk information? METHOD A phenomenographic approach was chosen to explore research participants' understanding and assessment of genetic risk. We conducted four focus-group (N=16) interviews with participants in a research programme designed to identify biomarkers for cardiopulmonary disease. RESULTS Among the research participants, we found four ways of understanding genetic risk: as a binary concept, as an explanation, as revealing who I am (knowledge of oneself) and as affecting life ahead. CONCLUSION Research participants tend to understand genetic risk as a binary concept. This does not necessarily imply a misunderstanding of, or an irrational approach to, genetic risk. Rather, it may have a heuristic function in decision-making. PRACTICAL IMPLICATIONS Risk communication may be enhanced by tailoring the communication to the participants' own lay conceptions. For example, researchers and counselors should address risk in binary terms, maybe looking out for how individual participants search for threshold figures.
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Affiliation(s)
- Jennifer Viberg Johansson
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Box 564, Uppsala SE-751 22, Sweden.
| | - Pär Segerdahl
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Box 564, Uppsala SE-751 22, Sweden
| | | | - Mats G Hansson
- Centre for Research Ethics & Bioethics, Department of Public Health and Caring Sciences, Uppsala University, Box 564, Uppsala SE-751 22, Sweden
| | - Sophie Langenskiöld
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
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Buchbinder M. Aid-in-dying laws and the physician's duty to inform. JOURNAL OF MEDICAL ETHICS 2017; 43:666-669. [PMID: 28325745 DOI: 10.1136/medethics-2016-103936] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 02/09/2017] [Accepted: 03/03/2017] [Indexed: 06/06/2023]
Abstract
On 19 July 2016, three medical organisations filed a federal lawsuit against representatives from several Vermont agencies over the Patient Choice and Control at End of Life Act. The law is similar to aid-in-dying (AID) laws in four other US states, but the lawsuit hinges on a distinctive aspect of Vermont's law pertaining to patients' rights to information. The lawsuit raises questions about whether, and under what circumstances, there is an ethical obligation to inform terminally ill patients about AID as an end-of-life option. Much of the literature on clinical communication about AID addresses how physicians should respond to patient requests for assisted dying, but neglects the question of how physicians should approach patients who may not know enough about AID to request it. In this article, I examine the possibility of an affirmative duty to inform terminally ill patients about AID in light of ethical concerns about professional responsibilities to patients and the maintenance of the patient-provider relationship. I suggest that we should not take for granted that communication about AID ought to be patient-initiated, and that there may be circumstances in which physicians have good reasons to introduce the topic themselves. By identifying ethical considerations that ought to inform such discussions, I aim to set an agenda for future bioethical research that adopts a broader perspective on clinical communication about AID.
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Stevens J. The Promising Contributions of Behavioral Economics to Quality Improvement in Health Care. Pediatr Qual Saf 2017; 2:e023. [PMID: 30229161 PMCID: PMC6132457 DOI: 10.1097/pq9.0000000000000023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 03/31/2017] [Indexed: 12/21/2022] Open
Affiliation(s)
- Jack Stevens
- Research Institute at Nationwide Children's Hospital, Columbus, Ohio; and Department of Pediatrics, The Ohio State University, Columbus, Ohio
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Blumenthal-Barby JS. 'That's the doctor's job': Overcoming patient reluctance to be involved in medical decision making. PATIENT EDUCATION AND COUNSELING 2017; 100:14-17. [PMID: 27423179 DOI: 10.1016/j.pec.2016.07.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/02/2016] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To review the barriers to patient engagement and techniques to increase patients' engagement in their medical decision-making and care. DISCUSSION Barriers exist to patient involvement in their decision-making and care. Individual barriers include education, language, and culture/attitudes (e.g., deference to physicians). Contextual barriers include time (lack of) and timing (e.g., lag between test results being available and patient encounter). Clinicians should gauge patients' interest in being involved and their level of current knowledge about their condition and options. Framing information in multiple ways and modalities can enhance understanding, which can empower patients to become more engaged. Tools such as decision aids or audio recording of conversations can help patients remember important information, a requirement for meaningful engagement. Clinicians and researchers should work to create social norms and prompts around patients asking questions and expressing their values. Telehealth and electronic platforms are promising modalities for allowing patients to ask questions on in a non-intimidating atmosphere. CONCLUSION Researchers and clinicians should be motivated to find ways to engage patients on the ethical imperative that many patients prefer to be more engaged in some way, shape, or form; patients have better experiences when they are engaged, and engagement improves health outcomes.
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Affiliation(s)
- J S Blumenthal-Barby
- Baylor College of Medicine, Center for Medical Ethics & Health Policy, One Baylor Plaza, MS: BCM 420, Houston, TX, USA.
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21
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Cox LAT. Overcoming Learning Aversion in Evaluating and Managing Uncertain Risks. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2015; 35:1892-1910. [PMID: 26491992 DOI: 10.1111/risa.12511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Decision biases can distort cost-benefit evaluations of uncertain risks, leading to risk management policy decisions with predictably high retrospective regret. We argue that well-documented decision biases encourage learning aversion, or predictably suboptimal learning and premature decision making in the face of high uncertainty about the costs, risks, and benefits of proposed changes. Biases such as narrow framing, overconfidence, confirmation bias, optimism bias, ambiguity aversion, and hyperbolic discounting of the immediate costs and delayed benefits of learning, contribute to deficient individual and group learning, avoidance of information seeking, underestimation of the value of further information, and hence needlessly inaccurate risk-cost-benefit estimates and suboptimal risk management decisions. In practice, such biases can create predictable regret in selection of potential risk-reducing regulations. Low-regret learning strategies based on computational reinforcement learning models can potentially overcome some of these suboptimal decision processes by replacing aversion to uncertain probabilities with actions calculated to balance exploration (deliberate experimentation and uncertainty reduction) and exploitation (taking actions to maximize the sum of expected immediate reward, expected discounted future reward, and value of information). We discuss the proposed framework for understanding and overcoming learning aversion and for implementing low-regret learning strategies using regulation of air pollutants with uncertain health effects as an example.
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Lu A, Mohan D, Alexander SC, Mescher C, Barnato AE. The Language of End-of-Life Decision Making: A Simulation Study. J Palliat Med 2015; 18:740-6. [PMID: 26186668 DOI: 10.1089/jpm.2015.0089] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Framing is known to influence decision making. OBJECTIVE The study objective was to describe language used by physicians when discussing treatment options with a critically and terminally ill elder. METHODS High-fidelity simulation was used, involving an elder with end-stage cancer and life-threatening hypoxia, followed by a debriefing interview. Subjects were hospitalist, emergency medicine, and critical care physicians from three academic medical centers. Measures were observation of encounters in real time followed by content analysis of simulation and debriefing interview transcripts. During the simulation we identified the first mention ("broaching") of principal treatment options--intubation and mechanical ventilation (life-sustaining treatment [LST]) and palliation in anticipation of death (palliation)--and used constant comparative methods to identify language used. We identified physician opinions about the use of LST in this clinical context during the debriefing interviews, and compared language used with opinions. RESULTS Among 114 physician subjects, 106 discussed LST, 86 discussed palliation, and 84 discussed both. We identified five frames: will (decided), must (necessary), should (convention), could (option), and ask (elicitation of preferences). Physicians broached LST differently than palliation (p<0.01), most commonly framing LST as necessary (53%), while framing palliation as optional (49%). Among physicians who framed LST as imperative (will or must), 16 (30%) felt intubation would be inappropriate in this clinical situation. CONCLUSIONS In this high-fidelity simulation experiment involving a critically and terminally ill elder, the majority of physicians framed the available options in ways implying LST was the expected or preferred choice. Framing of treatment options could influence ultimate treatment decisions.
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Affiliation(s)
- Annie Lu
- 1 Department of Pediatrics and Communicable Diseases, University of Michigan , Ann Arbor, Michigan
| | - Deepika Mohan
- 2 Department of Critical Care Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania
| | - Stewart C Alexander
- 3 Department of Consumer Science, Purdue University , West Lafayette, Indiana
| | - Craig Mescher
- 4 Department of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota , Minneapolis, Minnesota
| | - Amber E Barnato
- 5 Section of Decision Sciences, Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine , Pittsburgh, Pennsylvania.,6 Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh , Pittsburgh, Pennsylvania
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Lin CS, Wu SY, Wu LT. Preferences for Analgesic Treatments Are Influenced by Probability of the Occurrence of Adverse Effects and the Time to Reach Maximal Therapeutic Effects. PLoS One 2015; 10:e0130214. [PMID: 26067778 PMCID: PMC4466564 DOI: 10.1371/journal.pone.0130214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 05/17/2015] [Indexed: 12/02/2022] Open
Abstract
Research on shared medical decision-making suggested that both the potency of a treatment and the probability of it being successful influence individual treatment preferences. Patients also need to consider the negative attributes of treatments, such as the occurrence of adverse effects or a slow start to the therapeutic effects. It remains unclear how these attributes influence individual treatment preferences. We investigated how the analgesic effect, the adverse effect, and the time-course effect influenced the preference of analgesic treatments. Forty-five healthy volunteers participated in three hypothetical analgesic decision-making tasks. They were instructed to imagine that they were experiencing pain and choose between two hypothetical analgesic treatments: the more potent radical treatment and the less potent conservative treatment. The potency of a treatment was countered by the following attributes: the probability of working successfully, the probability of inducing an adverse effect, and the time required for the treatment to reach its maximal effect. We found that (a) when the overall probability that a treatment would induce an adverse effect decreased, the participants changed their preference from a conservative treatment to a radical treatment; (b) when the time-course for a treatment to reach its maximal effect was shortened, the participants changed their preference from a conservative treatment to a radical treatment, and (c) individual differences in prior clinical pain and the degree of imagined pain relief were associated with preferences. The findings showed that the adverse effects and the time course of treatments guide the analgesic treatment preferences, highlighting the importance of sharing information about negative attributes of treatments in pain management. The findings imply that patients may over-emphasize the occurrence of adverse effect or a slow time-course of treatment effect. In terms of shared medical decision-making, clinicians should clarify these negative attributes related to treatment to patients.
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Affiliation(s)
- Chia-Shu Lin
- Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
| | - Shih-Yun Wu
- Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan
- Division of Family Dentistry, Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Long-Ting Wu
- Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan
- Division of Endodontics and Periodontology, Department of Stomatology, Taipei Veterans General Hospital, Taipei, Taiwan
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Haward MF, Janvier A. An introduction to behavioural decision-making theories for paediatricians. Acta Paediatr 2015; 104:340-5. [PMID: 25625319 DOI: 10.1111/apa.12948] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Revised: 12/02/2014] [Accepted: 01/21/2015] [Indexed: 11/29/2022]
Abstract
UNLABELLED Behavioural decision-making theories provide insights into how people make choices under conditions of uncertainty. However, few have been studied in paediatrics. This study introduces these theories, reviews current research and makes recommendations for their application within the context of shared decision-making. CONCLUSION As parents are expected to share decision-making in paediatrics, it is critical that the fields of behavioural economics, communication and decision sciences merge with paediatric clinical ethics to optimise decision-making.
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Affiliation(s)
- Marlyse F. Haward
- Department of Paediatrics; Albert Einstein College of Medicine; Children's Hospital at Montefiore; Bronx NY USA
- Division of Neonatology; The Valley Hospital; Ridgewood NJ USA
| | - Annie Janvier
- Department of Paediatrics and Clinical Ethics; Université de Montréal; Montreal QC Canada
- Neonatology and Clinical Ethics; Hôpital Sainte-Justine Montreal; Montreal QC Canada
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He F, Li D, Cao R, Zeng J, Guan H. The attitude-behavior discrepancy in medical decision making. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 16:e14612. [PMID: 25763230 PMCID: PMC4341323 DOI: 10.5812/ircmj.14612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 11/06/2013] [Accepted: 10/04/2014] [Indexed: 11/25/2022]
Abstract
Background: In medical practice, the dissatisfaction of patients about medical decisions made by doctors is often regarded as the fuse of doctor-patient conflict. However, a few studies have looked at why there are such dissatisfactions. Objectives: This experimental study aimed to explore the discrepancy between attitude and behavior within medical situations and its interaction with framing description. Patients and Methods: A total of 450 clinical undergraduates were randomly assigned to six groups and investigated using the classic medical decision making problem, which was described either in a positive or a negative frame (2) × decision making behavior\attitude to risky plan\attitude to conservative plan (3). Results: A discrepancy between attitude and behavior did exist in medical situations. Regarding medical dilemmas, if the mortality rate was described, subjects had a significant tendency to choose a conservative plan (t = 3.55, P < 0.01) yet if the survival rate was described, there was no such preference (t = -1.48, P > 0.05). However, regardless of the plan chosen by the doctor, the subjects had a significant opposing attitude (P < .05). Framing description had a significant impact on both decision making behavior and attitude (t behavior = -3.24, P < 0.01;t attitude to surgery = 4.08,P < 0.01;t attitude to radiation = -2.15,P < 0.05). Conclusions: A discrepancy of attitude-behavior does exist in medical situations. The framing of a description has an impact on medical decision-making.
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Affiliation(s)
- Fei He
- School of Public Management, Northwest University, Xian, China
- Corresponding Author: Fei He, School of Public Management, Northwest University, Xian, China. Tel: +86-2976397654, Fax: +86-2984664724, E-mail:
| | - Dongdong Li
- Brigade of Cadets, Fourth Military Medical University, Xian, China
| | - Rong Cao
- School of Public Management, Northwest University, Xian, China
| | - Juli Zeng
- Department of Psychology, Officer’s College of the Chinese People's Armed Police Force, Langfang, China
| | - Hao Guan
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Forth Military Medical University, Xian, China
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Vélez Ortiz D, Martinez RO, Espino DV. Framing Effects on End-of-Life Preferences Among Latino Elders. SOCIAL WORK IN HEALTH CARE 2015; 54:708-724. [PMID: 26399490 DOI: 10.1080/00981389.2015.1059398] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study compared how the presentation of end-of-life (EOL) choices influences responses by Latino and White older adults relative to resuscitation preferences. The authors apply prospect theory, which deals with decision making based on how choices are framed. Participants were presented with differently ordered questions framing a resuscitation scenario and asked to rate their preferences. Results show that Latino participants were significantly influenced by the framing order of treatment options with regard to resuscitation while Whites were not. Health professionals need to be aware that the ways they present EOL options are likely to affect the choices of Latino older adults. Further research is needed with Latino subgroups.
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Affiliation(s)
- Daniel Vélez Ortiz
- a Julian Samora Research Institute , Michigan State University , East Lansing , Michigan , USA
| | - Rubén O Martinez
- a Julian Samora Research Institute , Michigan State University , East Lansing , Michigan , USA
| | - David V Espino
- b Family & Community Medicine, School of Medicine , University of Texas Health Science Center , San Antonio , Texas , USA
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Gong J, Zhang Y, Wu B, Feng J, Zhang W, Wang S, Huang Y, Wu X. Factors influencing risky decision-making in patients with cerebral infarction. PSYCHOL HEALTH MED 2014; 20:410-8. [DOI: 10.1080/13548506.2014.958506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Blumenthal-Barby JS, Krieger H. Cognitive biases and heuristics in medical decision making: a critical review using a systematic search strategy. Med Decis Making 2014; 35:539-57. [PMID: 25145577 DOI: 10.1177/0272989x14547740] [Citation(s) in RCA: 290] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 07/26/2014] [Indexed: 12/23/2022]
Abstract
BACKGROUND The role of cognitive biases and heuristics in medical decision making is of growing interest. The purpose of this study was to determine whether studies on cognitive biases and heuristics in medical decision making are based on actual or hypothetical decisions and are conducted with populations that are representative of those who typically make the medical decision; to categorize the types of cognitive biases and heuristics found and whether they are found in patients or in medical personnel; and to critically review the studies based on standard methodological quality criteria. METHOD Data sources were original, peer-reviewed, empirical studies on cognitive biases and heuristics in medical decision making found in Ovid Medline, PsycINFO, and the CINAHL databases published in 1980-2013. Predefined exclusion criteria were used to identify 213 studies. During data extraction, information was collected on type of bias or heuristic studied, respondent population, decision type, study type (actual or hypothetical), study method, and study conclusion. RESULTS Of the 213 studies analyzed, 164 (77%) were based on hypothetical vignettes, and 175 (82%) were conducted with representative populations. Nineteen types of cognitive biases and heuristics were found. Only 34% of studies (n = 73) investigated medical personnel, and 68% (n = 145) confirmed the presence of a bias or heuristic. Each methodological quality criterion was satisfied by more than 50% of the studies, except for sample size and validated instruments/questions. Limitations are that existing terms were used to inform search terms, and study inclusion criteria focused strictly on decision making. CONCLUSIONS Most of the studies on biases and heuristics in medical decision making are based on hypothetical vignettes, raising concerns about applicability of these findings to actual decision making. Biases and heuristics have been underinvestigated in medical personnel compared with patients.
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Affiliation(s)
- J S Blumenthal-Barby
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX (JSBB)
| | - Heather Krieger
- Department of Social Psychology, University of Houston, Houston, TX (HK)
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Zhao X, Huang C, Li X, Zhao X, Peng J. Dispositional optimism, self-framing and medical decision-making. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2014; 50:121-7. [DOI: 10.1002/ijop.12079] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 04/22/2014] [Accepted: 04/23/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Xu Zhao
- School of Marxism; Liaoning Shihua University; Fushun China
| | - Chunlei Huang
- School of Marxism; Liaoning Shihua University; Fushun China
| | - Xuesong Li
- School of Marxism; Liaoning Shihua University; Fushun China
| | - Xin Zhao
- School of Marxism; Liaoning Shihua University; Fushun China
| | - Jiaxi Peng
- Department of Psychology; Fourth Military Medical University; Xi'an China
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O'Donoghue AC, Sullivan HW, Aikin KJ, Betts KR. Important Safety Information or Important Risk Information? A Question of Framing in Prescription Drug Advertisements. Ther Innov Regul Sci 2014; 48:305-307. [PMID: 30235532 DOI: 10.1177/2168479013510306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The summary of risks in a prescription drug print advertisement is typically headlined either "Important Safety Information" or "Important Risk Information." Research has shown that words used to frame information can influence interpretation of the information. We examined the impact of headline framing on risk perception among consumers viewing prescription drug ads. Participants (N = 2000) were randomly assigned to see the title "Important Safety Information" or "Important Risk Information" before reading a description of risks for a fictitious drug. Participants then answered questions about the perceived risk of the drug, attempted to recall the section heading, and reported demographic characteristics. Results revealed no differences between participants in the 2 conditions, suggesting that framing drug risk information in terms of its safety or risk does not differentially affect consumer risk perception.
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Affiliation(s)
| | | | | | - Kevin R Betts
- 1 US Food and Drug Administration, Silver Spring, MD, USA
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Abhyankar P, Summers BA, Velikova G, Bekker HL. Framing Options as Choice or Opportunity. Med Decis Making 2014; 34:567-82. [DOI: 10.1177/0272989x14529624] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 02/28/2014] [Indexed: 11/15/2022]
Abstract
Objective. Health professionals must enable patients to make informed decisions about health care choices through unbiased presentation of all options. This study examined whether presenting the decision as “opportunity” rather than “choice” biased individuals’ preferences in the context of trial participation for cancer treatment. Methods. Self-selecting healthy women ( N = 124) were randomly assigned to the following decision frames: opportunity to take part in the trial (opt-in), opportunity to be removed from the trial (opt-out), and choice to have standard treatment or take part in the trial (choice). The computer-based task required women to make a hypothetical choice about a real-world cancer treatment trial. The software presented the framed scenario, recorded initial preference, presented comprehensive and balanced information, traced participants’ use of information during decision making, and recorded final decision. A posttask paper questionnaire assessed perceived risk, attitudes, subjective norm, perceived behavioral control, and satisfaction with decision. Results. Framing influenced women’s immediate preferences. Opportunity frames, whether opt-in or opt-out, introduced a bias as they discouraged women from choosing standard treatment. Using the choice frame avoided this bias. The opt-out opportunity frame also affected women’s perceived social norm; women felt that others endorsed the trial option. The framing bias was not present once participants had had the opportunity to view detailed information on the options within a patient decision aid format. There were no group differences in information acquisition and final decisions. Sixteen percent changed their initial preference after receiving full information. Conclusions. A “choice” frame, where all treatment options are explicit, is less likely to bias preferences. Presentation of full information in parallel, option-by-attribute format is likely to “de-bias” the decision frame. Tailoring of information to initial preferences would be ill-advised as preferences may change following detailed information.
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Affiliation(s)
- Purva Abhyankar
- Leeds Institute of Health Sciences, University of Leeds, UK (PA)
- Centre for Decision Research, Leeds University Business School, UK (BAS)
- Leeds Institute for Molecular Medicine, St. James’s Institute of Oncology, University of Leeds, UK (GV)
- Leeds Institute of Health Sciences, University of Leeds, UK (HLB)
| | - Barbara A. Summers
- Leeds Institute of Health Sciences, University of Leeds, UK (PA)
- Centre for Decision Research, Leeds University Business School, UK (BAS)
- Leeds Institute for Molecular Medicine, St. James’s Institute of Oncology, University of Leeds, UK (GV)
- Leeds Institute of Health Sciences, University of Leeds, UK (HLB)
| | - Galina Velikova
- Leeds Institute of Health Sciences, University of Leeds, UK (PA)
- Centre for Decision Research, Leeds University Business School, UK (BAS)
- Leeds Institute for Molecular Medicine, St. James’s Institute of Oncology, University of Leeds, UK (GV)
- Leeds Institute of Health Sciences, University of Leeds, UK (HLB)
| | - Hilary L. Bekker
- Leeds Institute of Health Sciences, University of Leeds, UK (PA)
- Centre for Decision Research, Leeds University Business School, UK (BAS)
- Leeds Institute for Molecular Medicine, St. James’s Institute of Oncology, University of Leeds, UK (GV)
- Leeds Institute of Health Sciences, University of Leeds, UK (HLB)
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Lin PJ, Concannon TW, Greenberg D, Cohen JT, Rossi G, Hille J, Auerbach HR, Fang CH, Nadler ES, Neumann PJ. Does framing of cancer survival affect perceived value of care? A willingness-to-pay survey of US residents. Expert Rev Pharmacoecon Outcomes Res 2014; 13:513-22. [PMID: 23977977 DOI: 10.1586/14737167.2013.814948] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AIMS To investigate the relationship between the framing of survival gains and the perceived value of cancer care. METHODS Through a population-based survey of 2040 US adults, respondents were randomized to one of the two sets of hypothetical scenarios, each of which described the survival benefit for a new treatment as either an increase in median survival time (median survival), or an increase in the probability of survival for a given length of time (landmark survival). Each respondent was presented with two randomly selected scenarios with different prognosis and survival improvements, and asked about their willingness to pay (WTP) for the new treatments. RESULTS Predicted WTP increased with survival benefits and respondents' income, regardless of how survival benefits were described. Framing therapeutic benefits as improvements in landmark rather than median time survival increased the proportion of the population willing to pay for that gain by 11-35%, and the mean WTP amount by 42-72% in the scenarios we compared. CONCLUSION How survival benefits are described may influence the value people place on cancer care.
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Affiliation(s)
- Pei-Jung Lin
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA.
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Effects of induced moods on economic choices. JUDGMENT AND DECISION MAKING 2014. [DOI: 10.1017/s1930297500005532] [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
AbstractEmotions can shape decision processes by altering valuation signals, risk perception, and strategic orientation. Although multiple theories posit a role for affective processes in mediating the influence of frames on decision making, empirical studies have yet to demonstrate that manipulated affect modulates framing phenomena. The present study asked whether induced affective states alter gambling propensity and the influence of frames on decision making. In a between-subjects design, we induced mood (happy, sad, or neutral) in subjects (N=91) via films that were interleaved with the framing task. Happy mood induction increased gambling and apparently accentuated framing effects compared to sad mood induction, although the effect on framing could have resulted from the fact that the increased tendency to gamble made the framing measure more sensitive. Happy mood induction increased gambling, but not framing magnitude, compared to neutral mood induction. Subjects experiencing a sad mood induction did not exhibit behavioral differences from those experiencing a neutral mood. For those subjects who experienced the happy mood induction, both gambling propensity and framing magnitude were positively correlated with the magnitude of the change in their mood valence. We discuss the broader implications of mood effects on real-world economic decisions.
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Sumner W, Ding E, Fischer ID, Hagen MD. Methods for Performing Survival Curve Quality-of-Life Assessments. Med Decis Making 2014; 34:787-99. [PMID: 24449432 DOI: 10.1177/0272989x13514775] [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: 01/18/2013] [Accepted: 11/02/2013] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many medical decisions involve an implied choice between alternative survival curves, typically with differing quality of life. Common preference assessment methods neglect this structure, creating some risk of distortions. METHODS Survival curve quality-of-life assessments (SQLA) were developed from Gompertz survival curves fitting the general population's survival. An algorithm was developed to generate relative discount rate-utility (DRU) functions from a standard survival curve and health state and an equally attractive alternative curve and state. A least means squared distance algorithm was developed to describe how nearly 3 or more DRU functions intersect. These techniques were implemented in a program called X-Trade and tested. RESULTS SQLA scenarios can portray realistic treatment choices. A side effect scenario portrays one prototypical choice, to extend life while experiencing some loss, such as an amputation. A risky treatment scenario portrays procedures with an initial mortality risk. A time trade scenario mimics conventional time tradeoffs. Each SQLA scenario yields DRU functions with distinctive shapes, such as sigmoid curves or vertical lines. One SQLA can imply a discount rate or utility if the other value is known and both values are temporally stable. Two SQLA exercises imply a unique discount rate and utility if the inferred DRU functions intersect. Three or more SQLA results can quantify uncertainty or inconsistency in discount rate and utility estimates. Pilot studies suggested that many subjects could learn to interpret survival curves and do SQLA. LIMITATIONS SQLA confuse some people. Compared with SQLA, standard gambles quantify very low utilities more easily, and time tradeoffs are simpler for high utilities. When discount rates approach zero, time tradeoffs are as informative and easier to do than SQLA. CONCLUSIONS SQLA may complement conventional utility assessment methods.
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Affiliation(s)
- Walton Sumner
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA (WS, IDF)
| | - Eric Ding
- American Board of Family Medicine, Inc., Lexington, KY, USA (ED, MDH)
| | - Irene D Fischer
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA (WS, IDF)
| | - Michael D Hagen
- American Board of Family Medicine, Inc., Lexington, KY, USA (ED, MDH),Department of Family and Community Medicine, University of Kentucky College of Medicine, Lexington, KY, USA (MDH)
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Blumenthal-Barby JS, Cantor SB, Russell HV, Naik AD, Volk RJ. Decision aids: when 'nudging' patients to make a particular choice is more ethical than balanced, nondirective content. Health Aff (Millwood) 2013; 32:303-10. [PMID: 23381523 DOI: 10.1377/hlthaff.2012.0761] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Patient decision aids, such as instructional leaflets describing treatment options for prostate cancer, are designed to help educate patients so that they can share in decisions about their care. Developers of these decision aids strive for balance, aiming to be as neutral, unbiased, and nondirective as possible. We argue that balance should not always be a goal, and we identify three situations where it should not be. For example, men diagnosed with early-stage prostate cancer frequently are not advised by their physicians that active surveillance is a reasonable alternative to immediate surgery or radiation. It may be desirable to design decision aids that promote active surveillance as an option. We recognize that the arguments put forth in this article are controversial. But they are also justified. We challenge medical decision makers and decision aid developers to determine if and when patients should be "nudged" toward one option or another.
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Affiliation(s)
- J S Blumenthal-Barby
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA.
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Gong J, Zhang Y, Yang Z, Huang Y, Feng J, Zhang W. The framing effect in medical decision-making: a review of the literature. PSYCHOL HEALTH MED 2013; 18:645-53. [DOI: 10.1080/13548506.2013.766352] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Trevena LJ, Zikmund-Fisher BJ, Edwards A, Gaissmaier W, Galesic M, Han PKJ, King J, Lawson ML, Linder SK, Lipkus I, Ozanne E, Peters E, Timmermans D, Woloshin S. Presenting quantitative information about decision outcomes: a risk communication primer for patient decision aid developers. BMC Med Inform Decis Mak 2013; 13 Suppl 2:S7. [PMID: 24625237 PMCID: PMC4045391 DOI: 10.1186/1472-6947-13-s2-s7] [Citation(s) in RCA: 309] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Making evidence-based decisions often requires comparison of two or more options. Research-based evidence may exist which quantifies how likely the outcomes are for each option. Understanding these numeric estimates improves patients' risk perception and leads to better informed decision making. This paper summarises current "best practices" in communication of evidence-based numeric outcomes for developers of patient decision aids (PtDAs) and other health communication tools. METHOD An expert consensus group of fourteen researchers from North America, Europe, and Australasia identified eleven main issues in risk communication. Two experts for each issue wrote a "state of the art" summary of best evidence, drawing on the PtDA, health, psychological, and broader scientific literature. In addition, commonly used terms were defined and a set of guiding principles and key messages derived from the results. RESULTS The eleven key components of risk communication were: 1) Presenting the chance an event will occur; 2) Presenting changes in numeric outcomes; 3) Outcome estimates for test and screening decisions; 4) Numeric estimates in context and with evaluative labels; 5) Conveying uncertainty; 6) Visual formats; 7) Tailoring estimates; 8) Formats for understanding outcomes over time; 9) Narrative methods for conveying the chance of an event; 10) Important skills for understanding numerical estimates; and 11) Interactive web-based formats. Guiding principles from the evidence summaries advise that risk communication formats should reflect the task required of the user, should always define a relevant reference class (i.e., denominator) over time, should aim to use a consistent format throughout documents, should avoid "1 in x" formats and variable denominators, consider the magnitude of numbers used and the possibility of format bias, and should take into account the numeracy and graph literacy of the audience. CONCLUSION A substantial and rapidly expanding evidence base exists for risk communication. Developers of tools to facilitate evidence-based decision making should apply these principles to improve the quality of risk communication in practice.
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Affiliation(s)
- Lyndal J Trevena
- Primary Health Care, School of Public Health, Room 321b, Edward Ford Building (A27), University of Sydney, NSW 2006, Australia
| | - Brian J Zikmund-Fisher
- Department of Health Behavior & Health Education, School of Public Health, Department of Internal Medicine, School of Medicine, and Center for Bioethics and Social Sciences in Medicine, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - Adrian Edwards
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - Wolfgang Gaissmaier
- Harding Center for Risk Literacy, Max Planck Institute for Human Development, Lentzeallee 94, 14195 Berlin, Germany
| | - Mirta Galesic
- Center for Adaptive Behavior and Cognition, Max Planck Institute for Human Development, Lentzeallee 94, 14195 Berlin, Germany
| | - Paul KJ Han
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, 509 Forest Avenue, Portland, ME 04101, USA
| | - John King
- Department of Family Medicine, University of Vermont College of Medicine, 235 Rowell, 106 Carrigan Drive, University of Vermont, Burlington, Vermont 05405, USA
| | - Margaret L Lawson
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | - Suzanne K Linder
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Isaac Lipkus
- Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710, USA
| | - Elissa Ozanne
- Department of Surgery and Institute for Health Policy Studies, University of California, San Francisco, 3333 California St. Suite 265, San Francisco, CA 94143-0936, USA
| | - Ellen Peters
- Department of Psychology, Ohio State University, 235 Psychology Building, 1835 Neil Avenue, Columbus, OH 43210, USA
| | - Danielle Timmermans
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Steven Woloshin
- Departments of Medicine and of Community & Family Medicine and The Dartmouth Institute for Health Policy & Clinical Practice at the Geisel School of Medicine at Dartmouth and the VA Outcomes Group, VA Medical Center, 215 North Main Street, White River Junction, VT 05009-0001, USA
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Peng J, He F, Zhang Y, Liu Q, Miao D, Xiao W. Differences in simulated doctor and patient medical decision making: a construal level perspective. PLoS One 2013; 8:e79181. [PMID: 24244445 PMCID: PMC3828343 DOI: 10.1371/journal.pone.0079181] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 09/21/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Patients are often confronted with diverse medical decisions. Often lacking relevant medical knowledge, patients fail to independently make medical decisions and instead generally rely on the advice of doctors. OBJECTIVE This study investigated the characteristics of and differences in doctor-patient medical decision making on the basis of construal level theory. METHODS A total of 420 undergraduates majoring in clinical medicine were randomly assigned to six groups. Their decisions to opt for radiotherapy and surgery were investigated, with the choices described in a positive/neutral/negative frame × decision making for self/others. RESULTS Compared with participants giving medical advice to patients, participants deciding for themselves were more likely to select radiotherapy (F1, 404 = 13.92, p = 011). Participants from positive or neutral frames exhibited a higher tendency to choose surgery than did those from negative frames (F2, 404 = 22.53, p<.001). The effect of framing on independent decision making was nonsignificant (F2, 404 = 1.07, p = 35); however the effect of framing on the provision of advice to patients was significant (F2, 404 = 12.95, p<.001). The effect of construal level was significant in the positive frame (F1, 404 = 8.06, p = 005) and marginally significant in the neutral frame (F2, 404 = 3.31, p = 07) but nonsignificant in the negative frame (F2, 404 = .29, p = 59). CONCLUSION Both social distance and framing depiction significantly affected medical decision making and exhibited a significant interaction. Differences in medical decision making between doctors and patients need further investigation.
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Affiliation(s)
- Jiaxi Peng
- Department of Psychology, Fourth Military Medical University, Xi’an, China
| | - Fei He
- School of Public Management, Northwest University, Xi’an, China
| | - Yan Zhang
- Department of Psychology, Fourth Military Medical University, Xi’an, China
| | - Quanhui Liu
- Department of Psychology, Fourth Military Medical University, Xi’an, China
| | - Danmin Miao
- Department of Psychology, Fourth Military Medical University, Xi’an, China
| | - Wei Xiao
- Department of Psychology, Fourth Military Medical University, Xi’an, China
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Jung M. Cancer Control and the Communication Innovation in South Korea: Implications for Cancer Disparities. Asian Pac J Cancer Prev 2013; 14:3411-7. [DOI: 10.7314/apjcp.2013.14.6.3411] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Garcia-Retamero R, Dhami MK. On avoiding framing effects in experienced decision makers. Q J Exp Psychol (Hove) 2013; 66:829-42. [DOI: 10.1080/17470218.2012.727836] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The present study aimed to (a) demonstrate the effect of positive–negative framing on experienced criminal justice decision makers, (b) examine the debiasing effect of visually structured risk messages, and (c) investigate whether risk perceptions mediate the debiasing effect of visual aids on decision making. In two phases, 60 senior police officers estimated the accuracy of a counterterrorism technique in identifying whether a known terror suspect poses an imminent danger and decided whether they would recommend the technique to policy makers. Officers also rated their confidence in this recommendation. When information about the effectiveness of the counterterrorism technique was presented in a numerical format, officers' perceptions of accuracy and recommendation decisions were susceptible to the framing effect: The technique was perceived to be more accurate and was more likely to be recommended when its effectiveness was presented in a positive than in a negative frame. However, when the information was represented visually using icon arrays, there were no such framing effects. Finally, perceptions of accuracy mediated the debiasing effect of visual aids on recommendation decisions. We offer potential explanations for the debiasing effect of visual aids and implications for communicating risk to experienced, professional decision makers.
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Affiliation(s)
- Rocio Garcia-Retamero
- Department of Experimental Psychology, University of Granada, Granada, Spain
- Center for Adaptive Behavior and Cognition, Max Planck Institute for Human Development, Berlin, Germany
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West SL, Squiers LB, McCormack L, Southwell BG, Brouwer ES, Ashok M, Lux L, Boudewyns V, O'Donoghue A, Sullivan HW. Communicating quantitative risks and benefits in promotional prescription drug labeling or print advertising. Pharmacoepidemiol Drug Saf 2013; 22:447-58. [DOI: 10.1002/pds.3416] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Revised: 01/04/2013] [Accepted: 01/10/2013] [Indexed: 11/11/2022]
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Peng J, Li H, Miao D, Feng X, Xiao W. Five different types of framing effects in medical situation: a preliminary exploration. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:161-5. [PMID: 23682330 PMCID: PMC3652505 DOI: 10.5812/ircmj.8469] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 12/26/2012] [Accepted: 12/26/2012] [Indexed: 11/19/2022]
Abstract
Background Considerable reports concerned the framing effect in medical situations. But quite few of them noticed to explore the differences among the various kinds of framing effects. Objectives In the present study, five different types of framing effects were examined and the effect sizes of them were compared. Materials and Methods Medical decision making problems concerning medicine effect evaluation, patient's compliance, treatment and doctor options selection were established. All the problems were described in both positive and negative frames. 500 undergraduates as participants were randomly divided into ten groups. Participants from each group were asked to finish one decision making task. Results All the frames that were examined leaded to significant framing effects: When the Asia Disease Problem was described in a positive frame, the participants preferred the conservative frame than the risky one, while if in a negative frame, the preference reversed (P < 0.01). If the drug effect was described as “of 100 patients taking this kind of medicine, 70 patients became better”, people tended to make more positive evaluations, compared with described as “of 100 patients taking this kind of medicine, 30 patients didn’t become better” (P < 0.01). Doctors’ advices were respectively described in a baneful or beneficial frame and the former one resulted in a better compliance (P < 0.05). If treatment options were described with a survival rate, people tended to choose risky option, while if described with a mortality rate, people tended to choose conservative option (P < 0.05). The number sized framing effect was also tested to be significant (P < 0.01). The five types of framing effects were small to big in effect size. Conclusions Medical decision making can be affected by frame descriptions. Attentions should be paid on the standardization of description in medical practice.
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Affiliation(s)
- Jiaxi Peng
- Department of Psychology, Fourth Military Medical University, Xi'an, China
| | - Hongzheng Li
- Mental Health Center, 303 Hospital, Nanning, China
| | - Danmin Miao
- Department of Psychology, Fourth Military Medical University, Xi'an, China
- Corresponding authors: Danmin Miao, Department of Psychology, Fourth Military Medical University, 710032, Xi'an, China, Tel: +86-2984774816, Fax: +86-2984774816, E-mail: ; Wei Xiao, Department of Psychology, Fourth Military Medical University, 710032, Xi'an, China, Tel: +86-2984774816, Fax: +86-2984774816, E-mail:
| | - Xi Feng
- Department of Psychology, Fourth Military Medical University, Xi'an, China
| | - Wei Xiao
- Department of Psychology, Fourth Military Medical University, Xi'an, China
- Corresponding authors: Danmin Miao, Department of Psychology, Fourth Military Medical University, 710032, Xi'an, China, Tel: +86-2984774816, Fax: +86-2984774816, E-mail: ; Wei Xiao, Department of Psychology, Fourth Military Medical University, 710032, Xi'an, China, Tel: +86-2984774816, Fax: +86-2984774816, E-mail:
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Viswanath K, Nagler RH, Bigman-Galimore CA, McCauley MP, Jung M, Ramanadhan S. The communications revolution and health inequalities in the 21st century: implications for cancer control. Cancer Epidemiol Biomarkers Prev 2012; 21:1701-8. [PMID: 23045545 PMCID: PMC3468900 DOI: 10.1158/1055-9965.epi-12-0852] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The radical and transformative developments in information and communication technologies (ICT) offer unprecedented opportunities to promote cancer control and enhance population and individual health. However, the current context in which these technologies are being deployed--where cancer incidence and mortality and communication are characterized by inequalities among different racial/ethnic and socioeconomic status groups--raises important questions for cancer communication research, policy, and practice. Drawing on illustrative data, this essay characterizes the communications revolution and elucidates its implications for cancer control, with a particular focus on communication inequalities and cancer disparities.
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Affiliation(s)
- K Viswanath
- Harvard School of Public Health, 450 Brookline Ave. LW601, Boston, MA 02215, USA.
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Rakow T, Wright RJ, Bull C, Spiegelhalter DJ. Simple and multistate survival curves: can people learn to use them? Med Decis Making 2012; 32:792-804. [PMID: 22753419 DOI: 10.1177/0272989x12451057] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED OBJECTIVE AND SAMPLE: This investigation assessed the comprehension of survival curves in a community sample of 88 young and middle-aged adults when several aspects of good practice for graphical communication were implemented, and it compared comprehension for alternative presentation formats. DESIGN, METHOD, and MEASUREMENTS After reading worked examples of using survival curves that provided explanation and answers, participants answered questions on survival data for pairs of treatments. Study 1 compared presenting survival curves for both treatments on the same figure against presentation via 2 separate figures. Study 2 compared presenting data for 3 possible outcome states via a single "multistate" figure for each treatment against presenting each outcome on a separate figure (with both treatments on the same figure). Both studies compared alternative forms of questioning (e.g., "number alive" versus "number dead"). Numeracy levels (self-rated and objective measures) were also assessed. RESULTS Comprehension was generally good--exceeding 90% correct answers on half the questions--and was similar across alternative graphical formats. Lower accuracy was observed for questions requiring a calculation but was significantly lower only when the requirement for calculation was not explicit (13%-28% decrements in performance). In study 1, this effect was most acute for those with lower levels of numeracy. Subjective (self-rated) numeracy and objective (measured) numeracy were both moderate positive predictors of overall task accuracy (r ≈ 0.3). CONCLUSIONS A high degree of accuracy in extracting information from survival curves is possible, as long as any calculations that are required are made explicit (e.g., finding differences between 2 survival rates). Therefore, practitioners need not avoid using survival curves in discussions with patients, although clear and explicit explanations are important.
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Affiliation(s)
- Tim Rakow
- University of Essex, Colchester, United Kingdom (TR, RJW)
| | | | - Catherine Bull
- Hospital for Sick Children, Great Ormond Street, London, United Kingdom (KB)
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Harle CA, Downs JS, Padman R. Effectiveness of personalized and interactive health risk calculators: a randomized trial. Med Decis Making 2012; 32:594-605. [PMID: 22247421 DOI: 10.1177/0272989x11431736] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Risk calculators are popular websites that provide individualized disease risk assessments to the public. Little is known about their effect on risk perceptions and health behavior. OBJECTIVE This study sought to test whether risk calculator features-namely, personalized estimates of one's disease risk and feedback about the effects of risk-mitigating behaviors-improve risk perceptions and motivate healthy behavior. DESIGN A web-based experimental study using simple randomization was conducted to compare the effects of 3 prediabetes risk communication websites. Setting The study was conducted in the context of ongoing health promotion activities sponsored by a university's human resources office. Patients Participants were adult university employees. Intervention The control website presented nonindividualized risk information. The personalized noninteractive website presented individualized risk calculations. The personalized interactive website presented individualized risk calculations and feedback about the effects of hypothetical risk-mitigating behaviors. Measurements Pre- and postintervention risk perceptions were measured in absolute and relative terms. Health behavior was measured by assessing participant interest in follow-up preventive health services. RESULTS On average, risk perceptions decreased by 2%. There was no general effect of personalization or interactivity in aligning subjective risk perceptions with objective risk calculations or in increasing healthy behaviors. However, participants who previously overestimated their risk reduced their perceptions by 16%. This was a significantly larger change than the 2% increase by participants who underestimated their risk. Limitations Results may not generalize to different populations, different diseases, or longer-term outcomes. CONCLUSIONS Compared to nonpersonalized information, individualized risk calculators had little positive effect on prediabetes risk perception accuracy or health behavior. Risk perception accuracy was improved in people who receive relatively "good news" about risk rather than "bad news."
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Affiliation(s)
- Christopher A Harle
- H. John Heinz III College, Carnegie Mellon University, Pittsburgh, Pennsylvania (CAH, RP)
| | - Julie S Downs
- Social and Decision Sciences, Carnegie Mellon University, Pittsburgh, Pennsylvania (JSD)
| | - Rema Padman
- H. John Heinz III College, Carnegie Mellon University, Pittsburgh, Pennsylvania (CAH, RP)
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Akl EA, Oxman AD, Herrin J, Vist GE, Terrenato I, Sperati F, Costiniuk C, Blank D, Schünemann H. Framing of health information messages. Cochrane Database Syst Rev 2011:CD006777. [PMID: 22161408 DOI: 10.1002/14651858.cd006777.pub2] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The same information about the evidence on health effects can be framed either in positive words or in negative words. Some research suggests that positive versus negative framing can lead to different decisions, a phenomenon described as the framing effect. Attribute framing is the positive versus negative description of a specific attribute of a single item or a state, for example, "the chance of survival with cancer is 2/3" versus "the chance of mortality with cancer is 1/3". Goal framing is the description of the consequences of performing or not performing an act as a gain versus a loss, for example, "if you undergo a screening test for cancer, your survival will be prolonged" versus "if you don't undergo screening test for cancer, your survival will be shortened". OBJECTIVES To evaluate the effects of attribute (positive versus negative) framing and of goal (gain versus loss) framing of the same health information, on understanding, perception of effectiveness, persuasiveness, and behavior of health professionals, policy makers, and consumers. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, issue 3 2007), MEDLINE (Ovid) (1966 to October 2007), EMBASE (Ovid) (1980 to October 2007), PsycINFO (Ovid) (1887 to October 2007). There were no language restrictions. We reviewed the reference lists of related systematic reviews, included studies and of excluded but closely related studies. We also contacted experts in the field. SELECTION CRITERIA We included randomized controlled trials, quasi-randomised controlled trials, and cross-over studies with health professionals, policy makers, and consumers evaluating one of the two types of framing. DATA COLLECTION AND ANALYSIS Two review authors extracted data in duplicate and independently. We graded the quality of evidence for each outcome using the GRADE approach. We standardized the outcome effects using standardized mean difference (SMD). We stratified the analysis by the type of framing (attribute, goal) and conducted pre-planned subgroup analyses based on the type of message (screening, prevention, and treatment). The primary outcome was behaviour. We did not assess any adverse outcomes. MAIN RESULTS We included 35 studies involving 16,342 participants (all health consumers) and reporting 51 comparisons.In the context of attribute framing, participants in one included study understood the message better when it was framed negatively than when it was framed positively (1 study; SMD -0.58 (95% confidence interval (CI) -0.94 to -0.22); moderate effect size; low quality evidence). Although positively-framed messages may have led to more positive perception of effectiveness than negatively-framed messages (2 studies; SMD 0.36 (95% CI -0.13 to 0.85); small effect size; low quality evidence), there was little or no difference in persuasiveness (11 studies; SMD 0.07 (95% CI -0.23 to 0.37); low quality evidence) and behavior (1 study; SMD 0.09 (95% CI -0.14 to 0.31); moderate quality evidence).In the context of goal framing, loss messages led to a more positive perception of effectiveness compared to gain messages for screening messages (5 studies; SMD -0.30 (95% CI -0.49 to -0.10); small effect size; moderate quality evidence) and may have been more persuasive for treatment messages (3 studies; SMD -0.50 (95% CI -1.04 to 0.04); moderate effect size; very low quality evidence). There was little or no difference in behavior (16 studies; SMD -0.06 (95% CI -0.15 to 0.03); low quality evidence). No study assessed the effect on understanding. AUTHORS' CONCLUSIONS Contrary to commonly held beliefs, the available low to moderate quality evidence suggests that both attribute and goal framing may have little if any consistent effect on health consumers' behaviour. The unexplained heterogeneity between studies suggests the possibility of a framing effect under specific conditions. Future research needs to investigate these conditions.
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Affiliation(s)
- Elie A Akl
- Department of Medicine, State University of New York at Buffalo, ECMC CC-142, 462 Grider Street, Buffalo, NY, USA, 14215
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Perneger TV, Agoritsas T. Doctors and patients' susceptibility to framing bias: a randomized trial. J Gen Intern Med 2011; 26:1411-7. [PMID: 21792695 PMCID: PMC3235613 DOI: 10.1007/s11606-011-1810-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 06/23/2011] [Accepted: 07/06/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND Framing of risk influences the perceptions of treatment benefit. OBJECTIVE To determine which risk framing format corresponds best to comprehensive multi-faceted information, and to compare framing bias in doctors and in patients. DESIGN Randomized mail surveys. PARTICIPANTS One thousand four hundred and thirty-one doctors (56% response rate) and 1121 recently hospitalized patients (65% response rate). INTERVENTION Respondents were asked to interpret the results of a hypothetical clinical trial comparing an old and a new drug. They were randomly assigned to the following framing formats: absolute survival (new drug: 96% versus old drug: 94%), absolute mortality (4% versus 6%), relative mortality reduction (reduction by a third) or all three (fully informed condition). The new drug was reported to cause more side-effects. MAIN MEASURE Rating of the new drug as more effective than the old drug. RESULTS The proportions of doctors who rated the new drug as more effective varied by risk presentation format (abolute survival 51.8%, absolute mortality 68.3%, relative mortality reduction 93.8%, and fully informed condition 69.8%, p < 0.001). In patients these proportions were similar (abolute survival 51.7%, absolute mortality 66.8%, relative mortality reduction 89.3%, and fully informed condition 71.2%, p < 0.001). In both doctors (p = 0.72) and patients (p = 0.23) the fully informed condition was similar to the absolute risk format, but it differed significantly from the other conditions (all p < 0.01). None of the differences between doctors and patients were significant (all p > 0.1). In comparison to the fully informed condition, the odds ratio of greater perceived effectiveness was 0.45 for absolute survival (p < 0.001), 0.89 for absolute mortality (p = 0.29), and 4.40 for relative mortality reduction (p < 0.001). CONCLUSIONS Framing bias affects doctors and patients similarly. Describing clinical trial results as absolute risks is the least biased format, for both doctors and patients. Presenting several risk formats (on both absolute and relative scales) should be encouraged.
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Affiliation(s)
- Thomas V Perneger
- Division of clinical epidemiology, University Hospitals of Geneva, 4 rue Gabrielle-Perret-Gentil, CH-1211, Geneva, Switzerland.
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Brown SM, Culver JO, Osann KE, MacDonald DJ, Sand S, Thornton AA, Grant M, Bowen DJ, Metcalfe KA, Burke HB, Robson ME, Friedman S, Weitzel JN. Health literacy, numeracy, and interpretation of graphical breast cancer risk estimates. PATIENT EDUCATION AND COUNSELING 2011; 83:92-8. [PMID: 20554149 PMCID: PMC4041683 DOI: 10.1016/j.pec.2010.04.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 03/12/2010] [Accepted: 04/28/2010] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Health literacy and numeracy are necessary to understand health information and to make informed medical decisions. This study explored the relationships among health literacy, numeracy, and ability to accurately interpret graphical representations of breast cancer risk. METHODS Participants (N=120) were recruited from the Facing Our Risk of Cancer Empowered (FORCE) membership. Health literacy and numeracy were assessed. Participants interpreted graphs depicting breast cancer risk, made hypothetical treatment decisions, and rated preference of graphs. RESULTS Most participants were Caucasian (98%) and had completed at least one year of college (93%). Fifty-two percent had breast cancer, 86% had a family history of breast cancer, and 57% had a deleterious BRCA gene mutation. Mean health literacy score was 65/66; mean numeracy score was 4/6; and mean graphicacy score was 9/12. Education and numeracy were significantly associated with accurate graph interpretation (r=0.42, p<0.001 and r=0.65, p<0.001, respectively). However, after adjusting for numeracy in multivariate linear regression, education added little to the prediction of graphicacy (r(2)=0.41 versus 0.42, respectively). CONCLUSION In our highly health-literate population, numeracy was predictive of graphicacy. PRACTICE IMPLICATIONS Effective risk communication strategies should consider the impact of numeracy on graphicacy and patient understanding.
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Affiliation(s)
- Sandra M. Brown
- Saddleback Memorial Medical Center, USA
- University of California, Irvine, USA
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Abstract
Patients with epilepsy are frequently confronted with complex treatment decisions. Communicating treatment risks is often difficult because patients may have difficulty with basic statistical concepts (i.e., low numeracy) or might misconceive the statistical information based on the way information is presented, a phenomenon known as "framing bias." We assessed numeracy and framing bias in 95 adults with chronic epilepsy and explored cognitive correlates of framing bias. Compared with normal controls, patients with epilepsy had significantly poorer performance on the Numeracy scale (P=0.02), despite a higher level of education than normal controls (P<0.001). Compared with patients with higher numeracy, patients with lower numeracy were significantly more likely to exhibit framing bias. Abstract problem solving performance correlated with the degree of framing bias (r=0.631, P<0.0001), suggesting a relationship between aspects of executive functioning and framing bias. Poor numeracy and susceptibility framing bias place patients with epilepsy at risk for uninformed decisions.
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