1
|
Charlton C, Rodrigues AM. How do young women approaching screening age interpret the NHS cervical screening leaflet? A mixed methods study of identifying interpretation difficulties, barriers, facilitators, and leaflet interpretation, engagement and future screening behaviour. Health Psychol Behav Med 2024; 12:2361005. [PMID: 38831975 PMCID: PMC11146246 DOI: 10.1080/21642850.2024.2361005] [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: 12/15/2023] [Accepted: 05/21/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Cervical cancer is a common cancer among young women aged 25-29 in England, and the NHS cervical screening leaflet is the first point of contact for those being invited for their first screening. This study aimed to explore how young women (18-24) understand and engage with the leaflet, as well as the barriers and facilitators associated with its interpretation, engagement, and screening intentions. METHODS The study used a mixed-methods approach, including a survey (n = 120) to identify interpretation difficulties and how they were affected by different characteristics, and a follow-up interview (n = 10) to assess the utility of the leaflet, identify issues with its practicality, and determine the factors that influence screening intentions. RESULTS The survey results showed that interpretation difficulties were common, particularly regarding HPV assessment, screening results, additional tests/treatment, and screening risks. Lower interpretation accuracy was associated with lower numeracy scores and non-white ethnicity. Despite these difficulties, participants had high confidence and motivation to engage with the leaflet. The interviews revealed knowledge gaps, issues with the leaflet's practicality, and a preference for digital information. Factors that were identified as barriers and facilitators of leaflet interpretation, engagement, and screening intentions included knowledge, social influence, beliefs about consequences, environmental context and resources, social role and identity, emotions and intentions. CONCLUSION The current leaflet does not provide enough information for young women to make an informed decision about screening attendance. Implementing a digital invitation featuring simplified gist representation, targeted behaviour change techniques (BCTs), videos, and interactive tools can enhance education and promote screening behaviour. Future research should consider using digital tools and strategies to address existing barriers related to interpretation and engagement.
Collapse
Affiliation(s)
- Caroline Charlton
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
| | | |
Collapse
|
2
|
Waters EA, Pachur T, Pogge G, Hunleth J, Webster GD, Shepperd JA. Linking cognitive and affective heuristic cues to interpersonal risk perceptions and behavior. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2023; 43:2610-2630. [PMID: 36781299 PMCID: PMC10423305 DOI: 10.1111/risa.14101] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 06/18/2023]
Abstract
People often use cognitive and affective heuristics when judging the likelihood of a health outcome and making health decisions. However, little research has examined how heuristics shape risk perceptions and behavior among people who make decisions on behalf of another person. We examined associations between heuristic cues and caregivers' perceptions of their child's asthma risk, the frequency of caregivers' asthma management behaviors, and child health outcomes. We used Ipsos KnowledgePanel to recruit 814 U.S. adult caregivers of children with asthma of the age <18 years. Participants completed a survey at baseline (T1) and 3 months later (T2). Caregivers who, at T1, reported greater negative affect about their child's asthma (affect heuristic cue), greater ease of imagining their child experiencing asthma symptoms (availability heuristic cue), and greater perceived similarity between their child and a child who has ever experienced asthma symptoms (representativeness heuristic cue) reported statistically significantly (p < 0.05) higher interpersonal perceived risk of their child having an exacerbation or uncontrolled asthma at T1. They also indicated at T2 that their child had poorer asthma control and more frequent exacerbations. Greater T1 negative affect was associated with more frequent T2 actions to reduce inflammation, manage triggers, and manage symptoms, and with poorer T2 child health outcomes. Heuristic cues are likely important for interpersonal-not just personal-risk perceptions. However, the interrelationship between caregivers' ratings of heuristic cues (in particular, negative affect) and risk judgments may signify a struggle with managing their child's asthma and need for extra support from health care providers or systems.
Collapse
Affiliation(s)
- Erika A. Waters
- Washington University in St. Louis, Saint Louis, Missouri, USA
| | | | | | - Jean Hunleth
- Washington University in St. Louis, Saint Louis, Missouri, USA
| | | | | |
Collapse
|
3
|
Koban D, Abroms LC, Napolitano M, Simmens S, Broniatowski DA. Trust in public health institutions moderates the effectiveness of COVID-19 vaccine discussion groups on Facebook. JOURNAL OF COMMUNICATION IN HEALTHCARE 2023; 16:375-384. [PMID: 38095610 DOI: 10.1080/17538068.2023.2283308] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND Distrust and partisan identity are theorized to undermine health communications. We examined the role of these factors on the efficacy of discussion groups intended to promote vaccine uptake. METHOD We analyzed survey data from unvaccinated Facebook users (N = 371) living in the US between January and April 2022. Participants were randomly assigned to Facebook discussion groups (intervention) or referred to Facebook's COVID-19 Information Center (control). We used Analysis of Covariance to test if the intervention was more effective at changing vaccination intentions and beliefs compared to the control in subgroups based on participants' partisan identity, political views, and information trust views. RESULTS We found a significant interaction between the intervention and trust in public health institutions (PHIs) for improving intentions to vaccinate (P = .04), intentions to encourage others to vaccinate (P = .03), and vaccine confidence beliefs (P = .01). Among participants who trusted PHIs, those in the intervention had higher posttest intentions to vaccinate (P = .008) and intentions to encourage others to vaccinate (P = .002) compared to the control. Among non-conservatives, participants in the intervention had higher posttest intentions to vaccinate (P = .048). The intervention was more effective at improving intentions to encourage others to vaccinate within the subgroups of Republicans (P = .03), conservatives (P = .02), and participants who distrusted government (P = .02). CONCLUSIONS Facebook discussion groups were more effective for people who trusted PHIs and non-conservatives. Health communicators may need to segment health messaging and develop strategies around trust views.
Collapse
Affiliation(s)
- Donald Koban
- School of Engineering & Applied Science, George Washington University, Washington, DC, USA
| | - Lorien C Abroms
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- Institute for Data Democracy and Politics, George Washington University, Washington, DC, USA
| | - Melissa Napolitano
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Samuel Simmens
- Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - David A Broniatowski
- School of Engineering & Applied Science, George Washington University, Washington, DC, USA
- Institute for Data Democracy and Politics, George Washington University, Washington, DC, USA
| |
Collapse
|
4
|
Keene T, Newman E, Pammer K. Can degrading information about patient symptoms in vignettes alter clinical reasoning in paramedics and paramedic students? An experimental application of fuzzy trace theory. Australas Emerg Care 2023; 26:279-283. [PMID: 36792390 DOI: 10.1016/j.auec.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 01/05/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Research has shown paramedics form rapid intuitive impressions on first, meeting a patient and these impressions subsequently affected their clinical reasoning. We report an experiment where theory-based interventions are developed with the goal of reducing reliance on intuitive reasoning by paramedics and paramedic students in simulated patients. METHOD Australian paramedics (n = 213; 49% female) and paramedicine students (n = 83; 55% female) attending paramedic conferences completed a 2 × 2 fully between participants experiment. They saw a written clinical vignette designed to be representative of Acute Coronary Syndrome (ACS) in which key clinical information was precise or degraded (stimulus), they then either chose the single most likely diagnosis from a list, or ranked competing diagnoses (response). Outcome variables were diagnostic rate and response time. RESULTS There were no differences in the proportion of participants choosing ACS across the four stimulus-response conditions (0.75 [0.65, 0.84] vs 0.79 [0.68, 0.87] vs, 0.78 [0.65, 0.87] vs 0.72 [0.59, 0.82], p = 0.42) CONCLUSION: This is the first study attempting to experimentally examine clinical reasoning in paramedics using a theory-based intervention. Neither of the interventions tested succeeded in altering measures of clinical reasoning. Similar to previous research on physicians, paramedic reasoning appears robust to manipulation.
Collapse
Affiliation(s)
- Toby Keene
- The Australian National University, Australia.
| | - Eryn Newman
- The Australian National University, Australia
| | | |
Collapse
|
5
|
Tubau E, Colomé À, Rodríguez-Ferreiro J. Previous beliefs affect Bayesian reasoning in conditions fostering gist comprehension. Mem Cognit 2023; 51:1819-1835. [PMID: 37268761 PMCID: PMC10638198 DOI: 10.3758/s13421-023-01435-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2023] [Indexed: 06/04/2023]
Abstract
It has been shown that Bayesian reasoning is affected by the believability of the data, but it is unknown which conditions could potentiate or reduce such belief effect. Here, we tested the hypothesis that the belief effect would mainly be observed in conditions fostering a gist comprehension of the data. Accordingly, we expected to observe a significant belief effect in iconic rather than in textual presentations and, in general, when nonnumerical estimates were requested. The results of three studies showed more accurate Bayesian estimates, either expressed numerically or nonnumerically, for icons than for text descriptions of natural frequencies. Moreover, in line with our expectations, nonnumerical estimates were, in general, more accurate for believable rather than for unbelievable scenarios. In contrast, the belief effect on the accuracy of the numerical estimates depended on the format and on the complexity of the calculation. The present findings also showed that single-event posterior probability estimates based on described frequencies were more accurate when expressed nonnumerically rather than numerically, opening new avenues for the development of interventions to improve Bayesian reasoning.
Collapse
Affiliation(s)
- Elisabet Tubau
- Department of Cognition, Development and Educational Psychology Institute of Neurosciences University of Barcelona, Pg Vall d'Hebron, 171, O8035, Barcelona, Spain.
| | - Àngels Colomé
- Department of Cognition, Development and Educational Psychology Institute of Neurosciences University of Barcelona, Pg Vall d'Hebron, 171, O8035, Barcelona, Spain
| | - Javier Rodríguez-Ferreiro
- Department of Cognition, Development and Educational Psychology Institute of Neurosciences University of Barcelona, Pg Vall d'Hebron, 171, O8035, Barcelona, Spain
| |
Collapse
|
6
|
Green SMC, Hall LH, French DP, Rousseau N, Parbutt C, Walwyn R, Smith SG. Optimization of an Information Leaflet to Influence Medication Beliefs in Women With Breast Cancer: A Randomized Factorial Experiment. Ann Behav Med 2023; 57:988-1000. [PMID: 37494669 PMCID: PMC10578395 DOI: 10.1093/abm/kaad037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Adherence to adjuvant endocrine therapy (AET) is low in women with breast cancer. Negative beliefs about the necessity of AET and high concerns are barriers to adherence. PURPOSE To use the multiphase optimization strategy to optimize the content of an information leaflet intervention, to change AET beliefs. METHODS We conducted an online screening experiment using a 25 factorial design to optimize the leaflet. The leaflet had five components, each with two levels: (i) diagrams about AET mechanisms (on/off); (ii) infographics displaying AET benefits (enhanced/basic); (iii) AET side effects (enhanced/basic); (iv) answers to AET concerns (on/off); (v) breast cancer survivor (patient) input: quotes and photographs (on/off). Healthy adult women (n = 1,604), recruited via a market research company, were randomized to 1 of 32 experimental conditions, which determined the levels of components received. Participants completed the Beliefs about Medicines Questionnaire before and after viewing the leaflet. RESULTS There was a significant main effect of patient input on beliefs about medication (β = 0.063, p < .001). There was one significant synergistic two-way interaction between diagrams and benefits (β = 0.047, p = .006), and one antagonistic two-way interaction between diagrams and side effects (β = -0.029, p = .093). There was a synergistic three-way interaction between diagrams, concerns, and patient input (β = 0.029, p = .085), and an antagonistic four-way interaction between diagrams, benefits, side effects, and concerns (β = -0.038, p = .024). In a stepped approach, we screened in four components and screened out the side effects component. CONCLUSIONS The optimized leaflet did not contain enhanced AET side effect information. Factorial experiments are efficient and effective for refining the content of information leaflet interventions.
Collapse
Affiliation(s)
- Sophie M C Green
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Louise H Hall
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - David P French
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Nikki Rousseau
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Catherine Parbutt
- Medicines Management and Pharmacy Services, Leeds Teaching Hospitals NHS Trust Leeds, Leeds, UK
| | - Rebecca Walwyn
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Samuel G Smith
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| |
Collapse
|
7
|
Tiede KE, Gaissmaier W. How Do People Process Different Representations of Statistical Information? Insights into Cognitive Effort, Representational Inconsistencies, and Individual Differences. Med Decis Making 2023; 43:803-820. [PMID: 37842816 PMCID: PMC10625726 DOI: 10.1177/0272989x231202505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/23/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Graphical representation formats (e.g., icon arrays) have been shown to lead to better understanding of the benefits and risks of treatments compared to numbers. We investigate the cognitive processes underlying the effects of format on understanding: how much cognitive effort is required to process numerical and graphical representations, how people process inconsistent representations, and how numeracy and graph literacy affect information processing. METHODS In a preregistered between-participants experiment, 665 participants answered questions about the relative frequencies of benefits and side effects of 6 medications. First, we manipulated whether the medical information was represented numerically, graphically (as icon arrays), or inconsistently (numerically for 3 medications and graphically for the other 3). Second, to examine cognitive effort, we manipulated whether there was time pressure or not. In an additional intervention condition, participants translated graphical information into numerical information before answering questions. We also assessed numeracy and graph literacy. RESULTS Processing icon arrays was more strongly affected by time pressure than processing numbers, suggesting that graphical formats required more cognitive effort. Understanding was lower when information was represented inconsistently (v. consistently) but not if there was a preceding intervention. Decisions based on inconsistent representations were biased toward graphically represented options. People with higher numeracy processed quantitative information more efficiently than people with lower numeracy did. Graph literacy was not related to processing efficiency. LIMITATIONS Our study was conducted with a nonpatient sample, and the medical information was hypothetical. CONCLUSIONS Although graphical (v. numerical) formats have previously been found to lead to better understanding, they may require more cognitive effort. Therefore, the goal of risk communication may play an important role when choosing how to communicate medical information. HIGHLIGHTS This article investigates the cognitive processes underlying the effects of representation format on the understanding of statistical information and individual differences therein.Processing icon arrays required more cognitive effort than processing numbers did.When information was represented inconsistently (i.e., partly numerically and partly graphically), understanding was lower than with consistent representation, and decisions were biased toward the graphically represented options.People with higher numeracy processed quantitative information more efficiently than people with lower numeracy did.
Collapse
Affiliation(s)
- Kevin E. Tiede
- Center for Adaptive Rationality, Max Planck Institute for Human Development, Germany
- Department of Psychology, University of Konstanz, Germany
- Graduate School of Decision Sciences, University of Konstanz, Germany
| | - Wolfgang Gaissmaier
- Department of Psychology, University of Konstanz, Germany
- Centre for the Advanced Study of Collective Behaviour, University of Konstanz, Germany
| |
Collapse
|
8
|
Gaissmaier W, Tiede KE, Garcia-Retamero R. The Lure of Beauty: People Select Representations of Statistical Information Largely Based on Attractiveness, Not Comprehensibility. Med Decis Making 2023; 43:774-788. [PMID: 37872798 PMCID: PMC10625725 DOI: 10.1177/0272989x231201579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/28/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVE People differ in whether they understand graphical or numerical representations of statistical information better. However, assessing these skills is often not feasible when deciding which representation to select or use. This study investigates whether people choose the representation they understand better, whether this choice can improve risk comprehension, and whether results are influenced by participants' skills (graph literacy and numeracy). METHODS In an experiment, 160 participants received information about the benefits and side effects of painkillers using either a numerical or a graphical representation. In the "no choice" condition, the representation was randomly assigned to each participant. In the "choice" condition, participants could select the representation they would like to receive. The study assessed gist and verbatim knowledge (immediate comprehension and recall), accessibility of the information, attractiveness of the representation, as well as graph literacy and numeracy. RESULTS In the "choice" condition, most (62.5%) chose the graphical format, yet there was no difference in graph literacy or numeracy (nor age or gender) between people who chose the graphical or the numerical format. Whereas choice slightly increased verbatim knowledge, it did not improve gist or overall knowledge compared with random assignment. However, participants who chose a representation rated the representation as more attractive, and those who chose graphs rated them as more accessible than those without a choice. LIMITATIONS The sample consisted of highly educated undergraduate students with higher graph literacy than the general population. The task was inconsequential for participants in terms of their health. CONCLUSIONS When people can choose between representations, they fail to identify what they comprehend better but largely base that choice on how attractive the representation is for them. HIGHLIGHTS People differ systematically in whether they understand graphical or numerical representations of statistical information better. However, assessing these underlying skills to get the right representation to the right people is not feasible in practice. A simple and efficient method to achieve this could be to let people choose among representations themselves.However, our study showed that allowing participants to choose a representation (numerical v. graphical) did not improve overall or gist knowledge compared with determining the representation randomly, even though it did slightly improve verbatim knowledge.Rather, participants largely chose the representation they found more attractive. Most preferred the graphical representation, including those with low graph literacy.It would therefore be important to develop graphical representations that are not only attractive but also comprehensible even for people with low graph literacy.
Collapse
Affiliation(s)
- Wolfgang Gaissmaier
- Department of Psychology, University of Konstanz, Konstanz, Germany
- Centre for the Advanced Study of Collective Behaviour, University of Konstanz, Germany
| | - Kevin E. Tiede
- Department of Psychology, University of Konstanz, Konstanz, Germany
- Center for Adaptive Rationality, Max Planck Institute for Human Development, Berlin, Germany
- Graduate School of Decision Sciences, University of Konstanz, Germany
| | | |
Collapse
|
9
|
Waddup OJ, Yearsley JM, Blasiak P, Pothos EM. Temporal Bell inequalities in cognition. Psychon Bull Rev 2023; 30:1946-1953. [PMID: 37069421 PMCID: PMC10716061 DOI: 10.3758/s13423-023-02275-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2023] [Indexed: 04/19/2023]
Abstract
There is widespread evidence that human memory is constructive, so that recollective processes may alter the information retrieved or impact on subsequent recollections. We examine a framework for narrowing down the nature of such processes, from physics. In Physics, the Temporal Bell (TB) inequality offers a general test of the sensitivity of the context of previous measurements in sequential measurement scenarios, as predicted by quantum theory. We present an empirical memory paradigm that allows a test of the TB inequality, using a novel kind of "change judgment," whereby participants are asked to decide whether there has been a change in a question across different time points of a scenario. Across two experiments, we were able to observe evidence for the violation of a TB inequality in one case, offering evidence for quantum-like processes in memory. The present results complement other recent work purporting the relevance of quantum-like representations in memory and raise questions regarding the adaptive value of such representations.
Collapse
Affiliation(s)
- Oliver J Waddup
- Department of Psychology, City, University of London, London, UK
| | - James M Yearsley
- Department of Psychology, City, University of London, London, UK
| | - Pawel Blasiak
- Institute of Nuclear Physics, Polish Academy of Sciences, Kraków, Poland
| | | |
Collapse
|
10
|
Kohut K, Morton K, Hurley K, Turner L, Dale C, Eastbrook S, Gold R, Henwood K, Patton S, Punjabi R, White H, Young C, Young J, Bancroft E, Barnett L, Cable S, Connolly G, Coad B, Forman A, Hanson H, Kavanaugh G, Sahan K, Snape K, Torr B, Way R, Winchester E, Youngs A, Eccles D, Foster C. 'A good decision is the one that feels right for me': Codesign with patients to inform theoretical underpinning of a decision aid website. Health Expect 2023; 27:e13844. [PMID: 37705192 PMCID: PMC10768874 DOI: 10.1111/hex.13844] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 07/17/2023] [Accepted: 08/01/2023] [Indexed: 09/15/2023] Open
Abstract
INTRODUCTION Patient decision aids (PtDA) complement shared decision-making with healthcare professionals and improve decision quality. However, PtDA often lack theoretical underpinning. We are codesigning a PtDA to help people with increased genetic cancer risks manage choices. The aim of an innovative workshop described here was to engage with the people who will use the PtDA regarding the theoretical underpinning and logic model outlining our hypothesis of how the PtDA would lead to more informed decision-making. METHODS Short presentations about psychological and behavioural theories by an expert were interspersed with facilitated, small-group discussions led by patients. Patients were asked what is important to them when they make health decisions, what theoretical constructs are most meaningful and how this should be applied to codesign of a PtDA. An artist created a visual summary. Notes from patient discussions and the artwork were analysed using reflexive thematic analysis. RESULTS The overarching theme was: It's personal. Contextual factors important for decision-making were varied and changed over time. There was no one 'best fit' theory to target support needs in a PtDA, suggesting an inductive, flexible framework approach to programme theory would be most effective. The PtDA logic model was revised based on patient feedback. CONCLUSION Meaningful codesign of PtDA including discussions about the theoretical mechanisms through which they support decision-making has the potential to lead to improved patient care through understanding the intricately personal nature of health decisions, and tailoring content and format for holistic care. PATIENT CONTRIBUTION Patients with lived experience were involved in codesign and coproduction of this workshop and analysis as partners and coauthors. Patient discussions were the primary data source. Facilitators provided a semi-structured guide, but they did not influence the patient discussions or provide clinical advice. The premise of this workshop was to prioritise the importance of patient lived experience: to listen, learn, then reflect together to understand and propose ideas to improve patient care through codesign of a PtDA.
Collapse
Affiliation(s)
- Kelly Kohut
- School of Health Sciences, Centre for Psychosocial Research in Cancer (CentRIC)University of SouthamptonSouthamptonUK
- St George's University Hospitals NHS Foundation TrustLondonUK
| | - Kate Morton
- School of Health Sciences, Centre for Psychosocial Research in Cancer (CentRIC)University of SouthamptonSouthamptonUK
| | - Karen Hurley
- Stanford R. Weiss, MD Center for Hereditary Colorectal NeoplasiaCleveland ClinicClevelandOhioUSA
| | | | | | | | | | | | | | | | | | | | | | | | - Elizabeth Bancroft
- Cancer Genetics Unit and Academic Urology UnitThe Royal Marsden NHS Foundation TrustLondonUK
- Oncogenetics TeamThe Institute of Cancer ResearchLondonUK
| | - Lily Barnett
- St George's University Hospitals NHS Foundation TrustLondonUK
| | - Sarah Cable
- St George's University Hospitals NHS Foundation TrustLondonUK
| | - Gaya Connolly
- St George's University Hospitals NHS Foundation TrustLondonUK
| | - Beth Coad
- St George's University Hospitals NHS Foundation TrustLondonUK
| | - Andrea Forman
- St George's University Hospitals NHS Foundation TrustLondonUK
| | - Helen Hanson
- St George's University Hospitals NHS Foundation TrustLondonUK
| | - Grace Kavanaugh
- Division of Genetics and EpidemiologyThe Institute of Cancer ResearchLondonUK
| | - Katherine Sahan
- Nuffield Department of Population Health, The Ethox CentreUniversity of OxfordOxfordUK
| | - Katie Snape
- St George's University Hospitals NHS Foundation TrustLondonUK
| | - Bethany Torr
- Division of Genetics and EpidemiologyThe Institute of Cancer ResearchLondonUK
| | - Rosalind Way
- Division of Genetics and EpidemiologyThe Institute of Cancer ResearchLondonUK
| | | | - Alice Youngs
- St George's University Hospitals NHS Foundation TrustLondonUK
| | | | - Diana Eccles
- Faculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Claire Foster
- School of Health Sciences, Centre for Psychosocial Research in Cancer (CentRIC)University of SouthamptonSouthamptonUK
| |
Collapse
|
11
|
Bainbridge L, Briffa K, Burton E, Hill KD, Fary R. Physiotherapists' decision-making about transition to independent walking in hospital after stroke: a qualitative study. Disabil Rehabil 2023:1-9. [PMID: 37578096 DOI: 10.1080/09638288.2023.2245757] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/30/2023] [Accepted: 08/03/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE Physiotherapists working in hospitals have a key role in decisions about when a person with stroke is safe to walk independently. The aim of this study was to explore the factors influencing decision-making of physiotherapists in this situation. METHODS A qualitative design with semi-structured interviews and reflexive thematic analysis was used. Fifteen physiotherapists with recent experience working in inpatient stroke rehabilitation participated. RESULTS Multiple factors influence decision-making about walking independence after stroke in hospitals. Four themes were identified: (1) Assessment of walking safety involves observation of walking function and consideration of complex individual factors; (2) Perspectives on risk vary, and influence whether a person is considered safe to walk; (3) Institutional culture involves background pressures that may influence decision-making; and (4) Physiotherapists adopt a structured, individualised mobility progression to manage risk. Physiotherapists consistently use observation of walking and understanding of attention and perception in this decision-making. There can sometimes be a conflict between goals of independence and of risk avoidance, and decisions are made by personal judgements. CONCLUSIONS Decision-making about independent walking for people in a hospital after a stroke is complex. Improved guidance about clinical assessment of capacity and determining acceptable risk may enable physiotherapists to engage more in shared decision-making.IMPLICATIONS FOR REHABILITATIONRegaining independence in walking after a stroke comes with the potential risk of falls.Assessment of walking safety should be specific to the complexity of the situation and consider perception and cognition.Benefits of activity and autonomy, and the risk of falls need to be considered in decisions about walking independence.Patients with the capacity to understand consequences and accept risk can be active participants in determining what is sufficiently safe.
Collapse
Affiliation(s)
- Liz Bainbridge
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Kathy Briffa
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Elissa Burton
- Curtin School of Allied Health, Curtin University, Perth, Australia
- enAble Institute, Curtin University, Perth, Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Melbourne, Australia
| | - Robyn Fary
- Curtin School of Allied Health, Curtin University, Perth, Australia
- enAble Institute, Curtin University, Perth, Australia
| |
Collapse
|
12
|
Kohut K, Morton K, Turner L, Shepherd J, Fenerty V, Woods L, Grimmett C, Eccles DM, Foster C. Patient decision support resources inform decisions about cancer susceptibility genetic testing and risk management: a systematic review of patient impact and experience. FRONTIERS IN HEALTH SERVICES 2023; 3:1092816. [PMID: 37395995 PMCID: PMC10311450 DOI: 10.3389/frhs.2023.1092816] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 04/26/2023] [Indexed: 07/04/2023]
Abstract
Background Patients with genetic cancer susceptibility are presented with complex management options involving difficult decisions, for example about genetic testing, treatment, screening and risk-reducing surgery/medications. This review sought to explore the experience of patients using decision support resources in this context, and the impact on decision-making outcomes. Methods Systematic review of quantitative, qualitative and mixed-methods studies involving adults with or without cancer who used a decision support resource pre- or post-genetic test for any cancer susceptibility. To gather a broad view of existing resources and gaps for development, digital or paper-based patient resources were included and not limited to decision aids. Narrative synthesis was used to summarise patient impact and experience. Results Thirty-six publications describing 27 resources were included. Heterogeneity of resources and outcome measurements highlighted the multiple modes of resource delivery and personal tailoring acceptable to and valued by patients. Impact on cognitive, emotional, and behavioural outcomes was mixed, but mainly positive. Findings suggested clear potential for quality patient-facing resources to be acceptable and useful. Conclusions Decision support resources about genetic cancer susceptibility are likely useful to support decision-making, but should be co-designed with patients according to evidence-based frameworks. More research is needed to study impact and outcomes, particularly in terms of longer term follow-up to identify whether patients follow through on decisions and whether any increased distress is transient. Innovative, streamlined resources are needed to scale up delivery of genetic cancer susceptibility testing for patients with cancer in mainstream oncology clinics. Tailored patient-facing decision aids should also be made available to patients identified as carriers of a pathogenic gene variant that increases future cancer risks, to complement traditional genetic counselling. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020220460, identifier: CRD42020220460.
Collapse
Affiliation(s)
- Kelly Kohut
- Centre for Psychosocial Research in Cancer: CentRIC, School of Health Sciences, University of Southampton, Southampton, United Kingdom
- Clinical Genetics, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Kate Morton
- Centre for Psychosocial Research in Cancer: CentRIC, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Lesley Turner
- Centre for Psychosocial Research in Cancer: CentRIC, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Jonathan Shepherd
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, United Kingdom
| | - Vicky Fenerty
- Engagement Services, University of Southampton Library, University of Southampton, Southampton, United Kingdom
| | - Lois Woods
- Southampton Health Technology Assessments Centre, University of Southampton, Southampton, United Kingdom
| | - Chloe Grimmett
- Centre for Psychosocial Research in Cancer: CentRIC, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Diana M. Eccles
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Claire Foster
- Centre for Psychosocial Research in Cancer: CentRIC, School of Health Sciences, University of Southampton, Southampton, United Kingdom
| |
Collapse
|
13
|
Reyna VF, Brainerd CJ. Numeracy, gist, literal thinking and the value of nothing in decision making. NATURE REVIEWS PSYCHOLOGY 2023; 2:1-19. [PMID: 37361389 PMCID: PMC10196318 DOI: 10.1038/s44159-023-00188-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 06/28/2023]
Abstract
The onus on the average person is greater than ever before to make sense of large amounts of readily accessible quantitative information, but the ability and confidence to do so are frequently lacking. Many people lack practical mathematical skills that are essential for evaluating risks, probabilities and numerical outcomes such as survival rates for medical treatments, income from retirement savings plans or monetary damages in civil trials. In this Review, we integrate research on objective and subjective numeracy, focusing on cognitive and metacognitive factors that distort human perceptions and foment systematic biases in judgement and decision making. Paradoxically, an important implication of this research is that a literal focus on objective numbers and mechanical number crunching is misguided. Numbers can be a matter of life and death but a person who uses rote strategies (verbatim representations) cannot take advantage of the information contained in the numbers because 'rote' strategies are, by definition, processing without meaning. Verbatim representations (verbatim is only surface form, not meaning) treat numbers as data as opposed to information. We highlight a contrasting approach of gist extraction: organizing numbers meaningfully, interpreting them qualitatively and making meaningful inferences about them. Efforts to improve numerical cognition and its practical applications can benefit from emphasizing the qualitative meaning of numbers in context - the gist - building on the strengths of humans as intuitive mathematicians. Thus, we conclude by reviewing evidence that gist training facilitates transfer to new contexts and, because it is more durable, longer-lasting improvements in decision making.
Collapse
Affiliation(s)
- Valerie F. Reyna
- Cornell University, Department of Psychology, Human Neuroscience Institute, Ithaca, NY USA
| | - Charles J. Brainerd
- Cornell University, Department of Psychology, Human Neuroscience Institute, Ithaca, NY USA
| |
Collapse
|
14
|
Shorey S, Chua CMS. Perceptions, Experiences, and Needs of Adolescents About School-Based Sexual Health Education: Qualitative Systematic Review. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:1665-1687. [PMID: 36581711 DOI: 10.1007/s10508-022-02504-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/03/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
Adolescents are particularly vulnerable to poor sexual health outcomes such as sexually transmitted diseases, sexually transmitted infections, human immunodeficiency virus, and unintended pregnancy. While school-based sexual health education (SBSHE) can address adolescents' needs, they are often insufficient. Hence, their perception of SBSHE should be explored to improve current education. This review aims to consolidate the available evidence on perceptions, experiences, and needs of adolescents about SBSHE. Six electronic databases were searched from their inception date till June 2022. The included studies were assessed using the method of the Critical Appraisal Skills Program tool, and findings were meta-synthesized using Sandelowski and Barroso (2007). This review was registered via the International Prospective Register of Systematic Reviews. Overall, 51 studies were included, and three themes were identified: (1) teachings of SBSHE and its impact, (2) adolescents' preferred approach to SBSHE, and (3) importance of engaging and safe SBSHE. In conclusion, adolescents had mixed reactions toward SBSHE. They expressed the need for inclusivity (gender identity and racial, ethnic, and cultural groups). Having a "safe space," well-trained educators, and interactive approaches were important and hence should also be considered. More qualitative studies from different geographical regions are needed. Diverse topics (e.g., mutual consent, sexual abuse, and violence) should also be discussed. The use of multiple educators (e.g., schoolteachers, specialist teachers, and peers) should also be deliberated in future SBSHE research. Findings from this review should be triangulated by evaluating the perceptions of various stakeholders (e.g., educators, adolescents, and SBSHE administrators).
Collapse
Affiliation(s)
- Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore.
| | - Crystal Min Siu Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore
| |
Collapse
|
15
|
Petrova D, Cokely ET, Sobkow A, Traczyk J, Garrido D, Garcia-Retamero R. Measuring feelings about choices and risks: The Berlin Emotional Responses to Risk Instrument (BERRI). RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2023; 43:724-746. [PMID: 35606164 DOI: 10.1111/risa.13946] [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: 06/15/2023]
Abstract
We introduce a brief instrument specifically validated for measuring positive and negative feelings about risks-the Berlin Emotional Responses to Risk Instrument (BERRI). Based on seven studies involving diverse adults from three countries (n = 2120), the BERRI was found to robustly estimate anticipatory affective reactions derived from subjective evaluations of positive (i.e., assured, hopeful, and relieved) and negative emotions (i.e., anxious, afraid, and worried). The brief BERRI outperformed a 14-item assessment, uniquely tracking costs/benefits associated with cancer screening among men and women (Studies 1 and 2). Predictive validity was further documented in paradigmatic risky choice studies wherein options varied over probabilities and severities across six contexts (health, social, financial, technological, ethical, and environmental; Study 3). Studies 4-6, conducted during the Ebola epidemic and COVID-19 pandemic, indicated BERRI responses were sensitive to subtle effects caused by emotion-related framing manipulations presented in different cultures and languages (the United States, Spain, and Poland). Study 7 indicated BERRI responses remained stable for 2 weeks. Although the BERRI can provide an estimate of overall affect, choices were generally better explained by the unique influences of positive and negative affect. Overall, results suggest the novel, brief instrument can be an efficient tool for high-stakes research on decision making and risk communication.
Collapse
Affiliation(s)
- Dafina Petrova
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Escuela Andaluza de Salud Pública, Granada, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Universidad de Granada, Granada, Spain
| | - Edward T Cokely
- University of Oklahoma, Norman, Oklahoma, USA
- Harding Center for Risk Literacy, Max Planck Institute for Human Development, Berlin, Germany
| | - Agata Sobkow
- Center for Research on Improving Decision Making (CRIDM), Faculty of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Jakub Traczyk
- Center for Research on Improving Decision Making (CRIDM), Faculty of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Dunia Garrido
- Departamento de Psicología Evolutiva y de la Educación, Universidad de Granada, Granada, Spain
| | - Rocio Garcia-Retamero
- Universidad de Granada, Granada, Spain
- Departamento de Psicología Evolutiva y de la Educación, Universidad de Granada, Granada, Spain
- Departamento de Psicología Experimental, Universidad de Granada, Granada, Spain
| |
Collapse
|
16
|
Harzheim L, Lorke M, Rostamzadeh A, Jessen F, Woopen C, Jünger S. The Promotion of Health Literacy. GEROPSYCH 2023. [DOI: 10.1024/1662-9647/a000310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Abstract: Progress in predictive medicine has increased the challenges to navigating complex risk information for patients and healthcare professionals. This contribution investigates how people facing the risk of developing Alzheimer’s dementia perceive risk, what aspects are relevant to their health literacy, and how to promote individual health literacy in predictive medicine. We conducted a qualitative study analyzing narrative interviews, body maps, and sociodemographic data from persons who had undergone early predictive procedures in a memory clinic. We understand the promotion of health literacy as an ethical task in predictive medicine and argue for (1) emphasizing personal resources to promote subjective health literacy, (2) reframing communication and decision-making about disease risk, and (3) teaching skills for value-sensitive, individualized risk communication.
Collapse
|
17
|
Helfers A, Ebersbach M. The differential effects of a governmental debunking campaign concerning COVID-19 vaccination misinformation. JOURNAL OF COMMUNICATION IN HEALTHCARE 2023; 16:113-121. [PMID: 36919806 DOI: 10.1080/17538068.2022.2047497] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Throughout the ongoing COVID-19 pandemic debunking misinformation has been one of the most employed strategies used to address vaccine hesitancy. We investigated whether - and for whom - debunking is effective or even counterproductive in decreasing misinformation belief and vaccination hesitancy. METHOD We conducted a randomized controlled trial (N = 588) utilizing a real-world debunking campaign from the German Ministry of Health. We considered the condition (debunking vs. control) as between-subjects factor, assessed misinformation belief (pretest vs. posttest) as a repeated-measures factor and vaccination intention as a dependent variable. Preregistered subgroup analyses were conducted for different levels of a priori misinformation belief and general vaccination confidence. RESULTS The analyses revealed differential effects on misinformation belief and vaccination intention in participants with low, medium, and high a priori belief: A debunking effect on misinformation belief (dRM = -0.80) was only found in participants with a medium a priori belief and did not extend to these participants' vaccination intentions. Among participants with a high a priori misinformation belief, explorative analysis revealed a small unintended backfiring effect on vaccination intentions (ηp2 = 0.03). CONCLUSIONS Our findings suggest that debunking is an effective communication strategy to address moderate levels of misinformation beliefs, but it does not constitute a one-fits-all strategy to reduce vaccination hesitancy among the general public. Although countering misinformation should certainly be an integral part of public health communication, additional initiatives, which address individual concerns with targeted and authentic communication, should be taken to enhance the impact on hesitant populations and avoid backfiring effects.
Collapse
Affiliation(s)
- Anna Helfers
- Department of Psychology, Faculty of Human Sciences, University of Kassel, Kassel, Germany
| | - Mirjam Ebersbach
- Department of Psychology, Faculty of Human Sciences, University of Kassel, Kassel, Germany
| |
Collapse
|
18
|
Torres-Cortés B, Leiva L, Canenguez K, Olhaberry M, Méndez E. Shared Components of Worldwide Successful Sexuality Education Interventions for Adolescents: A Systematic Review of Randomized Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4170. [PMID: 36901181 PMCID: PMC10002383 DOI: 10.3390/ijerph20054170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
A crucial aspect of human development is sexuality which has implications for health, particularly in adolescence, since unfavorable sexual experiences may result in physical and mental problems. Sexuality education interventions (SEI) are one of the most used actions to promote sexual health in adolescents. Nevertheless, there is variability across their components; therefore, key elements for an effective SEI targeted at adolescents (A-SEI) are not well known. Based on this background, this study aims to identify the shared components of successful A-SEI through a systematic review of randomized controlled trials (RCT). This study followed the preferred reporting items for systematic reviews and meta-analyses statement. A search was conducted in CINAHL, PsycInfo, PubMed, and Web of Science between November and December 2021. A total of 21 studies passed the inclusion test after the review of 8318 reports. A total of 18 A-SEIs were identified in these studies. The components analyzed were the intervention's approach, dose, type of intervention, theoretical framework, facilitators' training, and intervention methodology. The results established that components that should be present in the design of an effective A-SEI are behavior change theoretical models, the use of participatory methodology, be targeted at mixed-sex groups, facilitators' training, and at least ten hours of weekly intervention.
Collapse
Affiliation(s)
- Betzabé Torres-Cortés
- Department of Psychology, Faculty of Social Sciences, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4860, Macul 7820436, Chile
- Department of Psychology, Faculty of Social Sciences, Universidad de Chile, Avenida Capitán Ignacio Carrera Pinto 1045, Ñuñoa 7800284, Chile
- Millennium Institute for Research on Depression and Personality (MIDAP), Av. Vicuña Mackenna 4860, Macul 7820436, Chile
| | - Loreto Leiva
- Department of Psychology, Faculty of Social Sciences, Universidad de Chile, Avenida Capitán Ignacio Carrera Pinto 1045, Ñuñoa 7800284, Chile
| | - Katia Canenguez
- Department of Psychiatry, Massachusetts General Hospital, Yawkey 6A, 55 Fruit Street, Boston, MA 02114, USA
- Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Marcia Olhaberry
- Department of Psychology, Faculty of Social Sciences, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4860, Macul 7820436, Chile
- Millennium Institute for Research on Depression and Personality (MIDAP), Av. Vicuña Mackenna 4860, Macul 7820436, Chile
| | - Emmanuel Méndez
- Department of Psychology, Faculty of Social Sciences, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4860, Macul 7820436, Chile
- Department of Psychiatry, Faculty of Medicine, Universidad de Chile, Gran Av. José Miguel Carrera 3100, San Miguel 8900085, Chile
| |
Collapse
|
19
|
Totzkay D, Silk KJ, Thomas B, Walling BM, Smith SW. Women's Understanding of Windows of Susceptibility and the Role of the Environment in Breast Cancer Risk. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:115-126. [PMID: 34505275 PMCID: PMC8907316 DOI: 10.1007/s13187-021-02086-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 06/13/2023]
Abstract
Emerging evidence suggests women who are exposed to harmful environmental exposures, especially during certain critical periods across the lifespan, may increase their breast cancer risk. Such windows of susceptibility (WoS) occur throughout a woman's lifetime, during which she is especially vulnerable to the effects of harmful environmental exposures. This interaction makes the reduction of harmful environmental toxicants during those time periods a priority for community health promotion. Communicating about environmental exposures and their impact on women's health requires an assessment of sense-making around, and understanding of, the link between breast cancer and the environment. To that end, focus groups were conducted to assess the themes that emerge when women make sense of (a) their own breast cancer risk, (b) the environment-cancer connection, and (c) WoS. Results provide insight into how women understand these issues which can inform messaging strategies focused on reducing harmful environmental exposures. Implications are discussed within the context of communication efforts tailored to educate women, particularly mothers with daughters in the prepubertal and pubertal WoS who are particularly vulnerable to harmful environmental exposures.
Collapse
Affiliation(s)
- D Totzkay
- West Virginia University, Morgantown, WV, USA
| | - K J Silk
- University of Delaware, Newark, DE, USA
| | - B Thomas
- Michigan State University, East Lansing, MI, USA
| | - B M Walling
- Michigan State University, East Lansing, MI, USA
| | - S W Smith
- Michigan State University, East Lansing, MI, USA.
| |
Collapse
|
20
|
Monis M, O'Connell R, Andrews T. 'It will dictate how many children I will have"- Women's decision-making in pregnancy following a previous caesarean birth (CB). Midwifery 2023; 116:103533. [PMID: 36347147 DOI: 10.1016/j.midw.2022.103533] [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: 06/16/2021] [Revised: 07/17/2022] [Accepted: 10/28/2022] [Indexed: 11/08/2022]
Abstract
Vaginal birth after caesarean (VBAC) is supported in systematic reviews (Wu et al., 2019) and national guidelines (RCOG, 2015) and women are expected to be involved in the decision-making process for either a repeat caesarean birth or planned VBAC. AIM To develop a Grounded Theory (GT) of women's decision making of their birth choices in pregnancy following a previous caesarean birth (CB) OBJECTIVE: To explore what determines women's birth choice and their decision making for birth following a previous CB. DESIGN Semi structured interviews with pregnant women were undertaken in order to develop a Glasserian Grounded Theory SETTING: Antenatal clinics and wards in a large tertiary level maternity hospital. FINDINGS The theory of 'Mentalizing Possibilities' is a substantive theory which explains pregnant women's decision making about their birth choices after a previous CB. Women's main concern is to achieve a positive experience. The core category of 'Mentalizing Possibilities' explains how women process their previous experience, adapt to uncertainty and deal with the decisional conflict. There are behavioural and cognitive strategies which women use to go through this process. CONCLUSION Women want a positive birth experience after a previous CB and require support and continuity in decision making to help them decide the optimal birth choice for their current pregnancy.
Collapse
|
21
|
Wolfe CR, Eylem AA, Dandignac M, Lowe SR, Weber ML, Scudiere L, Reyna VF. Understanding the landscape of web-based medical misinformation about vaccination. Behav Res Methods 2023; 55:348-363. [PMID: 35380412 PMCID: PMC8981888 DOI: 10.3758/s13428-022-01840-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 11/16/2022]
Abstract
Given the high rates of vaccine hesitancy, web-based medical misinformation about vaccination is a serious issue. We sought to understand the nature of Google searches leading to medical misinformation about vaccination, and guided by fuzzy-trace theory, the characteristics of misinformation pages related to comprehension, inference-making, and medical decision-making. We collected data from web pages presenting vaccination information. We assessed whether web pages presented medical misinformation, had an overarching gist, used narrative, and employed emotional appeals. We used Search Engine Optimization tools to determine the number of backlinks from other web pages, monthly Google traffic, and Google Keywords. We used Coh-Metrix to measure readability and Gist Inference Scores (GIS). For medical misinformation web pages, Google traffic and backlinks were heavily skewed with means of 138.8 visitors/month and 805 backlinks per page. Medical misinformation pages were significantly more likely than other vaccine pages to have backlinks from other pages, and significantly less likely to receive at least one visitor from Google searches per month. The top Google searches leading to medical misinformation were "the truth about vaccinations," "dangers of vaccination," and "pro con vaccines." Most frequently, pages challenged vaccine safety, with 32.7% having an overarching gist, 7.7% presenting narratives, and 17.3% making emotional appeals. Emotional appeals were significantly more common with medical misinformation than other high-traffic vaccination pages. Misinformation pages had a mean readability grade level of 11.5, and a mean GIS of - 0.234. Low GIS scores are a likely barrier to understanding gist, and are the "Achilles' heel" of misinformation pages.
Collapse
Affiliation(s)
| | - Andrew A Eylem
- Department of Psychology, Miami University, Oxford, OH, 45056, USA
| | | | - Savannah R Lowe
- Department of Psychology, Miami University, Oxford, OH, 45056, USA
| | - Margo L Weber
- Department of Psychology, Miami University, Oxford, OH, 45056, USA
| | | | | |
Collapse
|
22
|
Thompson CA, Mielicki MK, Rivera F, Fitzsimmons CJ, Scheibe DA, Sidney PG, Schiller LK, Taber JM, Waters EA. Leveraging Math Cognition to Combat Health Innumeracy. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2023; 18:152-177. [PMID: 35943825 DOI: 10.1177/17456916221083277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Rational numbers (i.e., fractions, percentages, decimals, and whole-number frequencies) are notoriously difficult mathematical constructs. Yet correctly interpreting rational numbers is imperative for understanding health statistics, such as gauging the likelihood of side effects from a medication. Several pernicious biases affect health decision-making involving rational numbers. In our novel developmental framework, the natural-number bias-a tendency to misapply knowledge about natural numbers to all numbers-is the mechanism underlying other biases that shape health decision-making. Natural-number bias occurs when people automatically process natural-number magnitudes and disregard ratio magnitudes. Math-cognition researchers have identified individual differences and environmental factors underlying natural-number bias and devised ways to teach people how to avoid these biases. Although effective interventions from other areas of research can help adults evaluate numerical health information, they circumvent the core issue: people's penchant to automatically process natural-number magnitudes and disregard ratio magnitudes. We describe the origins of natural-number bias and how researchers may harness the bias to improve rational-number understanding and ameliorate innumeracy in real-world contexts, including health. We recommend modifications to formal math education to help children learn the connections among natural and rational numbers. We also call on researchers to consider individual differences people bring to health decision-making contexts and how measures from math cognition might identify those who would benefit most from support when interpreting health statistics. Investigating innumeracy with an interdisciplinary lens could advance understanding of innumeracy in theoretically meaningful and practical ways.
Collapse
Affiliation(s)
| | | | - Ferdinand Rivera
- Department of Mathematics and Statistics, San Jose State University
| | | | | | | | - Lauren K Schiller
- Department of Human Development, Teachers College, Columbia University
| | | | - Erika A Waters
- Department of Surgery, Washington University School of Medicine in St. Louis
| |
Collapse
|
23
|
Yılmaz NG, Timmermans DR, Van Weert JC, Damman OC. Breast cancer patients' visual attention to information in hospital report cards: An eye-tracking study on differences between younger and older female patients. Health Informatics J 2023; 29:14604582231155279. [PMID: 36840473 DOI: 10.1177/14604582231155279] [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: 02/26/2023]
Abstract
To (1) explore how women visually attend to a hospital report card (HRC), (2) explore whether visual attention of younger and older women (patients and non-patients) differs. Eye-tracking study with a short survey. Participants (N = 37) were provided with a hypothetical realistic HRC. Total dwell times and fixation counts were measured while participants viewed the information. Overall, no differences existed between younger and older women. Visual attention to the hospital of choice (vs not of choice) and to indicators perceived as most important (vs least important) did not differ. However, women with higher health literacy looked longer at the HRC than women with lower health literacy. Also, per fixation, older patients (vs younger patients) looked longer at the hospital of choice and at indicators perceived most important. Pre-existing conceptions of what information is relevant might result in more in-depth information processing among older patients than younger patients. In general, differences in level of health literacy, rather than (chronological) age, seem to be relevant to take into account when designing and/or updating HRCs.
Collapse
Affiliation(s)
- Nida Gizem Yılmaz
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, 1209Vrije Universiteit Amsterdam, The Netherlands; Department of Communication Science, Amsterdam School of Communication Research/ASCoR, 118065University of Amsterdam, Netherlands
| | - Danielle Rm Timmermans
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, 1209Vrije Universiteit Amsterdam, The Netherlands
| | - Julia Cm Van Weert
- Department of Communication Science, Amsterdam School of Communication Research/ASCoR, 118065University of Amsterdam, Netherlands
| | - Olga C Damman
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, 1209Vrije Universiteit Amsterdam, The Netherlands
| |
Collapse
|
24
|
Ancker JS, Benda NC, Sharma MM, Johnson SB, Weiner S, Zikmund-Fisher BJ. Taxonomies for synthesizing the evidence on communicating numbers in health: Goals, format, and structure. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2022; 42:2656-2670. [PMID: 35007354 PMCID: PMC10241486 DOI: 10.1111/risa.13875] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Many people, especially those with low numeracy, are known to have difficulty interpreting and applying quantitative information to health decisions. These difficulties have resulted in a rich body of research about better ways to communicate numbers. Synthesizing this body of research into evidence-based guidance, however, is complicated by inconsistencies in research terminology and researcher goals. In this article, we introduce three taxonomies intended to systematize terminology in the literature, derived from an ongoing systematic literature review. The first taxonomy provides a systematic nomenclature for the outcome measures assessed in the studies, including perceptions, decisions, and actions. The second taxonomy is a nomenclature for the data formats assessed, including numbers (and different formats for numbers) and graphics. The third taxonomy describes the quantitative concepts being conveyed, from the simplest (a single value at a single point in time) to more complex ones (including a risk-benefit trade-off and a trend over time). Finally, we demonstrate how these three taxonomies can be used to resolve ambiguities and apparent contradictions in the literature.
Collapse
Affiliation(s)
- Jessica S Ancker
- Vanderbilt University Medical Center, Department of Biomedical Informatics, Nashville, TN
| | - Natalie C Benda
- Weill Cornell Medicine, Department of Population Health Sciences, New York, NY
| | - Mohit M Sharma
- Weill Cornell Medicine, Department of Population Health Sciences, New York, NY
| | - Stephen B Johnson
- New York University Langone Health, Department of Population Health, New York, NY
| | - Stephanie Weiner
- Weill Cornell Medicine, Department of Population Health Sciences, New York, NY
| | - Brian J Zikmund-Fisher
- University of Michigan School of Public Health, Department of Health Behavior and Health Education, Ann Arbor, MI
| |
Collapse
|
25
|
Wolfe CR, Dandignac M, Wang C, Lowe SR. Gist Inference Scores Predict Cloze Comprehension "In Your Own Words" for Native, Not ESL Readers. HEALTH COMMUNICATION 2022; 37:1757-1764. [PMID: 33947301 DOI: 10.1080/10410236.2021.1920690] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Three patient education texts from the National Cancer Institute (NCI) were subjected to a Coh-Metrix analysis, then further analyzed to obtain Gist Inference Scores (GIS), a new measure of the likelihood that readers will make appropriate inferences about a text's bottom-line meaning. In the GIS formula, the Coh-Metrix psycholinguistic variables referential cohesion, deep cohesion, and latent semantic analysis (LSA) verb overlap increase GIS because cohesive texts that describe related actions are likely to induce gist representations. The Coh-Metrix variables word concreteness, imagability for content words, and hypernymy for nouns and verbs are negatively weighted because they tend to promote verbatim mental representations. NCI texts were modified for a cloze procedure with every tenth word replaced by a blank starting with the second sentence. Participants in two studies received all three cloze-modified texts. Fuzzy-Trace Theory suggests that people are more likely to comprehend high GIS texts "in their own words," and thus fill-the-blanks with multiple words that differ from those omitted by the cloze procedure expressing comparable meaning. In Study One, non-native English speakers appropriately filled blanks with different words at the same rate for all three texts of low-, medium-, and high-GIS. In Study Two, replicating previous findings, for high GIS texts, native English speakers filled blanks appropriately with words other than those removed significantly more often than for medium- or low-GIS texts. High GIS texts apparently afford readers more semantic and lexical flexibility, but non-native English speakers may be ill-equipped to capitalize on this characteristic of high GIS texts.
Collapse
|
26
|
Smallwood AJ, Neuner JM, Fletcher KE, Walker CM, Schapira MM. Patient-Physician Concordance for Quantitative Formats and Treatment Options and the Relationship with State Anxiety. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1684-1690. [PMID: 33904119 DOI: 10.1007/s13187-021-02013-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 06/12/2023]
Abstract
Patient-physician concordance about topics discussed in a clinic visit is essential for effective communication but may be difficult to achieve in cancer care. We conducted a multicenter, observational study at two Midwestern oncology clinics. A sample of 48 English-speaking or Spanish-speaking women with newly diagnosed stage 0-3 breast cancer completed surveys before and after a visit with an oncologist. Patient-physician dyads were coded as concordant if both patient and physician follow-up self-reports agreed whether (or not) specific treatments were discussed (i.e., treatment option concordance; mastectomy, lumpectomy, hormone therapy, neoadjuvant, and adjuvant chemotherapy) and whether risk was described using certain quantitative formats (i.e., quantitative format concordance; percentages, proportions out of 100 and 1000, graphs, pictures, evidence from clinical studies, cancer stage). Agreement was determined using percent agreement and prevalence-adjusted bias-adjusted kappa (PABAK). Pearson's correlations were used to determine relationships between anxiety and each measure concordance. Percent concordance was higher for treatment concordance (73.3%) compared to quantitative format concordance (64.5%), and PABAK scores tended to be higher for treatment options (PABAK = .21-.78). Both treatment and quantitative format concordance were negatively associated with pre-visit state anxiety, but only treatment concordance was statistically significant (treatment: r = - .504, p = .001; quantitative format: r = - .096, p = .523). Our study indicates moderate patient-physician concordance in early breast cancer care communication and that patient anxiety may impact the ability for patients and physicians to agree on the content communicated in a clinic visit.
Collapse
Affiliation(s)
- Alicia J Smallwood
- Center for Patient Care and Outcomes Research, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
| | - Joan M Neuner
- Center for Patient Care and Outcomes Research, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
- Division of General Internal Medicine, Department of Medicine, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226, USA
| | - Kathlyn E Fletcher
- Center for Patient Care and Outcomes Research, Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
- Clement J. Zablocki VA Medical Center, 5000 W National Ave, Milwaukee, WI, 53295, USA
| | - Cindy M Walker
- School of Education, Office of the Dean, Duquesne University, 600 Forbes Ave, Pittsburgh, PA, 15282, USA
| | - Marilyn M Schapira
- Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
- Center for Health Equity Research and Promotion, Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA, 19104, USA
| |
Collapse
|
27
|
Wackowski OA, O'Connor RJ, Diaz D, Rashid M, Lewis MJ, Greene K. '95% less harmful'? Exploring reactions to quantitative modified risk claims for snus and e-cigarettes. Tob Control 2022; 31:730-736. [PMID: 33753549 PMCID: PMC8455704 DOI: 10.1136/tobaccocontrol-2020-056303] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/03/2021] [Accepted: 02/11/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Studies examining perceptions of 'modified risk tobacco product' (MRTP) messages for e-cigarettes and smokeless tobacco have indicated consumers want statistics and quantification of harm reduction. However, limited research exists on reactions to quantitative MRTP messages. DESIGN We conducted 12 focus groups in the USA in 2019-6 focused on e-cigarette messages and 6 on snus messages. Eight groups were with current smokers (ages 21-66) and four with young adult (ages 18-25) non-smokers (n=57). Participants discussed messages stating that use of snus and vaping products have been estimated by scientists to be about 90% and 95% less harmful than smoking cigarettes, respectively. RESULTS Several participants agreed the messages strongly communicated that the products are less harmful than cigarettes, were attention getting and could be 'convincing'. However, participants expressed scepticism about the source and accuracy of the stated figures, and some noted the claims could be misleading and attractive to young people. Comments also reflected some claim misunderstandings (eg, that e-cigarettes only pose a 5% chance of harm). Participants also agreed that stating e-cigarette risks 'are unlikely to exceed 5% of cigarette smoking harms' was confusing and less impactful than the '95% less harmful' wording. CONCLUSIONS Quantitative claims suggesting high levels of reduced risk when comparing e-cigarettes or smokeless tobacco/snus relative to cigarettes may be successful in gaining attention and being persuasive for some audiences, particularly, if from more credible sources. However, message developers, users and evaluators should be mindful of message limitations and aim to mitigate unintended consequences.
Collapse
Affiliation(s)
- Olivia A Wackowski
- Center for Tobacco Studies, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Destiny Diaz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Mariam Rashid
- Center for Tobacco Studies, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA
| | - M Jane Lewis
- Center for Tobacco Studies, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA
| | - Kathryn Greene
- Department of Communication, Rutgers University, New Brunswick, New Jersey, USA
| |
Collapse
|
28
|
Pergolizzi D, Crespo I. The past and future of uncertainty in advanced illness: a systematic scoping review of underlying cognitive processes. ANXIETY, STRESS, & COPING 2022; 36:415-433. [DOI: 10.1080/10615806.2022.2134566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Denise Pergolizzi
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Iris Crespo
- Department of Basic Sciences, School of Medicine and Health Sciences, Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| |
Collapse
|
29
|
Heard CL, Rakow T. Examining Insensitivity to Probability in Evidence-Based Communication of Relative Risks: The Role of Affect and Communication Format. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2022; 42:2145-2159. [PMID: 34839529 DOI: 10.1111/risa.13862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 10/28/2021] [Accepted: 11/03/2021] [Indexed: 06/13/2023]
Abstract
Affect can influence judgments of event riskiness and use of risk-related information. Two studies (Ns: 85 and 100) examined the insensitivity-to-probability effect-where people discount probability information when scenarios are affect-rich-applying it to evidence-informed risk communication. We additionally investigated whether this effect is moderated by format, based on predictions from the evaluability and pattern-recognition literatures, suggesting that graphical formats may attenuate insensitivity to probability. Participants completed a prior beliefs questionnaire (Study 1), and risk perception booklet (both studies) that presented identical statistical information about the relative risks associated with two scenarios-one with an affect-rich outcome, the other an affect-poorer outcome. In Study 1, this was presented graphically. In Study 2, information was presented in one of three formats: written, tabular, or graphical. Participants provided their perceptions of the risk for each scenario at a range of risk-levels. The affect-rich scenario was perceived as higher in risk, and, importantly, despite presenting identical relative risk information in both scenarios, was associated with a reduced sensitivity to probability information (both studies). These differences were predicted by participants' prior beliefs concerning the scenario events (Study 1) and were larger for the single-item written format than graphical format (Study 2). The findings illustrate that insensitivity to probability information can occur in evidence-informed risk communications and highlight how communication format can moderate this effect. This interplay between affect and format therefore reflects an important consideration for information designers and researchers.
Collapse
Affiliation(s)
- Claire Louise Heard
- Department of Management, London School of Economics and Political Science, London, UK
| | - Tim Rakow
- Department of Psychology, King's College London, London, UK
| |
Collapse
|
30
|
Processing mode and processing contents in older and younger adults’ sunk cost decision-making. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03524-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
31
|
Swait J, de Bekker-Grob EW. A discrete choice model implementing gist-based categorization of alternatives, with applications to patient preferences for cancer screening and treatment. JOURNAL OF HEALTH ECONOMICS 2022; 85:102674. [PMID: 36041269 DOI: 10.1016/j.jhealeco.2022.102674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 03/28/2022] [Accepted: 08/16/2022] [Indexed: 05/20/2023]
Abstract
The rational microeconomic decision model is hard-coded into usual econometric specifications such as the Multinomial Logit and Probit models, inter alia. There is a very tight link between utility maximization and the apparatus of welfare theory that underlies economic policy analysis, which creates a tension around the possibility of representing other decision rules. We propose a less restrictive model of choice, built on the concept of gist-based categorization judgments that are assumed to precede (thus, condition) the maximization-driven selection process in decision making. This categorization facilitates decision making by allowing adoption of certain simpler decision rules under appropriate conditions, the drivers of which are endogenously determined. We demonstrate that the proposed model provides better fit than traditional choice models, using cancer screening and treatment choice data from two discrete choice experiments. In addition, we show that the model provides a deeper, more nuanced and insightful perspective on (healthcare) decision making.
Collapse
Affiliation(s)
- J Swait
- Erasmus School of Health Policy and Management and Erasmus Choice Modeling Centre, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam 3000 DR, the Netherlands.
| | - E W de Bekker-Grob
- Erasmus School of Health Policy and Management and Erasmus Choice Modeling Centre, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam 3000 DR, the Netherlands
| |
Collapse
|
32
|
Nie QT, Morrow DG, Rogers WA. Designing Feedback Visualizations for Anti-Hypertensive Medication Adherence for Older Adults. PROCEEDINGS OF THE HUMAN FACTORS AND ERGONOMICS SOCIETY ... ANNUAL MEETING. HUMAN FACTORS AND ERGONOMICS SOCIETY. ANNUAL MEETING 2022; 66:23-27. [PMID: 36532106 PMCID: PMC9756795 DOI: 10.1177/1071181322661076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Adhering to anti-hypertensive medications contributes to control of blood pressure and improved health outcomes. However, adherence rates among older adults are low. Patient monitoring of medication taking helps increase adherence and technology has great potential to support self-monitoring, in part by providing visual feedback about medication taking performance. However, little attention has been paid to designing feedback visualizations in medication-monitoring technology for older adults. In this research, we identified guidelines for designing understandable and effective adherence visualizations for older adults from existing theories and literature. With the guidelines in mind, we designed, refined, and evaluated visualizations that provided adherence feedback for a smartphone application with 17 older participants. Based on theory and evidence, we identified design guidelines for feedback visualizations. These guidelines can support design of useful feedback visualizations that may improve medication adherence among older adults.
Collapse
|
33
|
Rothman AJ. Capitalizing on Opportunities to Integrate Theory and Practice in Medical Decision Making. Med Decis Making 2022; 42:723-725. [PMID: 35819271 DOI: 10.1177/0272989x221109543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
34
|
Schwartz PH. The Framing Dilemma: Quantitative Information, Shared Decision Making, and Nudging. Med Decis Making 2022; 42:726-728. [PMID: 35819270 DOI: 10.1177/0272989x221109830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Peter H Schwartz
- Department of Medicine, Indiana University School of Medicine, Indiana University Center for Bioethics, Indianapolis, IN, USA.,Department of Philosophy, Indiana University School of Liberal Arts, Indiana University-Purdue University, Indianapolis, IN, USA
| |
Collapse
|
35
|
Hurtado-de-Mendoza A, Reyna VF, Wolfe CR, Gómez-Trillos S, Sutton AL, Brennan A, Sheppard VB. Adapting a Theoretically-Based intervention for underserved clinical populations at increased risk for hereditary Cancer: Lessons learned from the BRCA-Gist experience. Prev Med Rep 2022; 28:101887. [PMID: 35855922 PMCID: PMC9287635 DOI: 10.1016/j.pmedr.2022.101887] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 06/04/2022] [Accepted: 07/01/2022] [Indexed: 11/15/2022] Open
Abstract
The use of GCT in underserved diverse populations is suboptimal. Translational genomics research has been conducted with mostly NHW. Adapting EBIs can enhance the reach of EBI to underserved diverse populations. This paper describes the adaptation BRCA Gist, for at-risk Blacks and Latinas. Findings illustrate the need to integrate fidelity and adaptation considerations.
Background Minorities at increased risk for Hereditary Breast and Ovarian Cancer (HBOC) frequently have low awareness and use of genetic counseling and testing (GCT). Making sure that evidence-based interventions (EBIs) reach minorities is key to reduce disparities. BRCA-Gist is a theory-informed EBI that has been proven to be efficacious in mostly non-Hispanic White non-clinical populations. We conducted formative work to inform adaptations of BRCA-Gist for use in clinical settings with at-risk diverse women. Methods Genetic counselors (n = 20) were recruited nationally; at-risk Latinas and Blacks (n = 21) were recruited in Washington DC and Virginia. They completed the BRCA-Gist EBI between April 2018 – September 2019. Participants completed an acceptability scale and an interview to provide suggestions about implementation adaptations. T-tests for independent samples compared acceptability between at-risk women and genetic counselors. The Consensual Qualitative Research Framework was used to code adaptation suggestions. Suggested adaptations were discussed by a multidisciplinary team to integrate fidelity and adaptation considerations. Results At-risk women had a significantly higher acceptability (M = 4.17, SD = 0.47 vs. M = 3.24, SD = 0.64; p = 0.000; scale 1–5) and satisfaction scores (M = 8.3, SD = 1.3 vs. M = 4.2, SD = 2.0; p = 0.000; scale 1–10) than genetic counselors. Genetic counselors and at-risk women suggested contextual (e.g. format) and content (e.g. shortening) adaptations to enhance the fit of BRCA-Gist for diverse clinical populations. Conclusions Findings illustrate the process of integrating fidelity and adaptation considerations to ensure that EBIs retain their core components while enhancing the fit to minoritized clinical populations. Future studies will test the efficacy of the adapted BRCA-Gist in a Randomized Controlled Trial.
Collapse
Affiliation(s)
- Alejandra Hurtado-de-Mendoza
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
| | - Valerie F Reyna
- Human Neuroscience Institute, Cornell University, Ithaca, NY, USA
| | | | - Sara Gómez-Trillos
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Jess and Mildred Fisher Center for Hereditary Cancer and Clinical Cancer Genomics, Washington, DC, USA
| | - Arnethea L Sutton
- Department of Health Behavior Policy, Virginia Commonwealth University, VA, USA
| | - Ashleigh Brennan
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA
| | - Vanessa B Sheppard
- Department of Health Behavior Policy, Virginia Commonwealth University, VA, USA
| |
Collapse
|
36
|
Reyna VF, Edelson S, Hayes B, Garavito D. Supporting Health and Medical Decision Making: Findings and Insights from Fuzzy-Trace Theory. Med Decis Making 2022; 42:741-754. [PMID: 35735225 PMCID: PMC9283268 DOI: 10.1177/0272989x221105473] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
HIGHLIGHTS Fuzzy-trace theory (FTT) supports practical approaches to improving health and medicine.FTT differs in important respects from other theories of decision making, which has implications for how to help patients, providers, and health communicators.Gist mental representations emphasize categorical distinctions, reflect understanding in context, and help cue values relevant to health and patient care.Understanding the science behind theory is crucial for evidence-based medicine.
Collapse
Affiliation(s)
- Valerie F Reyna
- Human Neuroscience Institute and Center for Behavioral Economics and Decision Research, Cornell University, Ithaca, NY, USA
| | - Sarah Edelson
- Human Neuroscience Institute and Center for Behavioral Economics and Decision Research, Cornell University, Ithaca, NY, USA
| | - Bridget Hayes
- Human Neuroscience Institute and Center for Behavioral Economics and Decision Research, Cornell University, Ithaca, NY, USA
| | - David Garavito
- Human Neuroscience Institute and Center for Behavioral Economics and Decision Research, Cornell University, Ithaca, NY, USA
| |
Collapse
|
37
|
Tomsho KS, Polka E, Chacker S, Queeley D, Alvarez M, Scammell MK, Emmons KM, Rudd RE, Adamkiewicz G. A process for creating data report-back tools to improve equity in environmental health. Environ Health 2022; 21:67. [PMID: 35821055 PMCID: PMC9277935 DOI: 10.1186/s12940-022-00880-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/27/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Although there is increasing interest in reporting results of environmental research efforts back to participants, evidence-based tools have not yet been applied to developed materials to ensure their accessibility in terms of literacy, numeracy, and data visualization demand. Additionally, there is not yet guidance as to how to formally assess the created materials to assure a match with the intended audience. METHODS Relying on formative qualitative research with participants of an indoor air quality study in Dorchester, Massachusetts, we identified means of enhancing accessibility of indoor air quality data report-back materials for participants. Participants (n = 20) engaged in semi-structured interviews in which they described challenges they encountered with scientific and medical materials and outlined written and verbal communication techniques that would help facilitate engagement with and accessibility of environmental health report-back materials. We coupled these insights from participants with best practice guidelines for written materials by operationalizing health literacy tools to produce accessible audience-informed data report-back materials. RESULTS The resulting data report-back materials had a 7th -grade reading level, and between a 4th -8th grade level of overall document complexity. The numeracy skills required to engage with the material were of the lowest demand, and we incorporated best practices for risk communication and facilitating understanding and actionability of the materials. Use of a rigorous assessment tool provides evidence of accessibility and appropriateness of the material for the audience. CONCLUSIONS We outline a process for developing and evaluating environmental health data reports that are tailored to inspire risk-reduction actions, and are demonstrably accessible in terms of their literacy, numeracy, and data visualization demand. Adapting health literacy tools to create and evaluate environmental data report-back materials is a novel and evidence-based means of ensuring their accessibility.
Collapse
Affiliation(s)
- Kathryn S. Tomsho
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 02215 Boston, MA USA
| | - Erin Polka
- Department of Environmental Health, Boston University School of Public Health, 02118 Boston, MA USA
| | | | - David Queeley
- Mystic River Watershed Association, 02476 Arlington, MA USA
| | - Marty Alvarez
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 02215 Boston, MA USA
| | - Madeleine K. Scammell
- Department of Environmental Health, Boston University School of Public Health, 02118 Boston, MA USA
| | - Karen M. Emmons
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 02115 Boston, MA USA
| | - Rima E. Rudd
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 02115 Boston, MA USA
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, 02215 Boston, MA USA
| |
Collapse
|
38
|
Wegwarth O, Ludwig WD, Spies C, Schulte E, Hertwig R. The role of simulated-experience and descriptive formats on perceiving risks of strong opioids: A randomized controlled trial with chronic noncancer pain patients. PATIENT EDUCATION AND COUNSELING 2022; 105:1571-1580. [PMID: 34696941 DOI: 10.1016/j.pec.2021.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 08/30/2021] [Accepted: 10/04/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Opioid prescription rates worldwide suggest miscalibrated risk perceptions among those who prescribe, dispense, and take opioids. Findings from cognitive science show that risk perceptions can differ systematically depending on whether people learn about risks by description or experience. We investigated the effects of descriptive and simulated experience risk formats on patients' risk perceptions and behavior regarding long-term strong opioid use. METHODS 300 German patients with chronic noncancer pain were randomly assigned in an exploratory randomized controlled trial to either a descriptive format (fact box) or a simulated experience format (interactive simulation). Primary endpoints were subjective and objective risk perceptions and intended intake behavior. RESULTS Both formats significantly improved patients' objective risk perception; patients who saw the fact box estimated some outcomes more accurately (p = .031). Formats were equally effective in improving patients' subjective risk perception in terms of opioids' harms; however, patients receiving the simulation showed a greater reduction and termination of their opioid intake (p = .030) and a higher uptake of alternative therapies. CONCLUSIONS Descriptive and simulated experience risk formats improve risk perceptions and behavior regarding potent but highly risky drugs. PRACTICE IMPLICATIONS To eliminate risky behavior, simulated experience formats may be superior to descriptive formats.
Collapse
Affiliation(s)
- Odette Wegwarth
- Center for Adaptive Rationality, Max Planck Institute for Human Development, Berlin, Germany; Institute for Medical Sociology & Rehabilitation Science, Charité - University Hospital Berlin, Berlin, Germany; Center for Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Germany.
| | | | - Claudia Spies
- Center for Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Germany
| | - Erika Schulte
- Center for Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Germany
| | - Ralph Hertwig
- Center for Adaptive Rationality, Max Planck Institute for Human Development, Berlin, Germany
| |
Collapse
|
39
|
Zhang X, Zhao J, Zheng L, Li X, Hao Y. Implementation strategies to improve evidence-based practice for post-stroke dysphagia identification and management: A before-and-after study. Int J Nurs Sci 2022; 9:295-302. [PMID: 35891917 PMCID: PMC9305012 DOI: 10.1016/j.ijnss.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/26/2022] [Accepted: 06/11/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Xiaoyan Zhang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Junqiang Zhao
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ontario, Canada
| | - Liping Zheng
- Department of Neurosurgery, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
| | - Xuejing Li
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Yufang Hao
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
- Corresponding author.
| |
Collapse
|
40
|
Sungur H, van den Muijsenbergh METC, van Weert JCM, Schouten BC. Caring for older culturally and linguistically diverse patients with Cancer: Healthcare Providers' perceived barriers to communication. J Geriatr Oncol 2022; 13:862-870. [PMID: 35589543 DOI: 10.1016/j.jgo.2022.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 02/16/2022] [Accepted: 04/11/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Due to various socio-cultural and language related factors, healthcare providers experience barriers when communicating with older culturally and linguistically diverse (CALD) patients with cancer, which can lower the quality of care received by patients and negatively impact healthcare providers. Studies focusing on communication barriers of older CALD patients with cancer and a systematic comparison of those barriers between different healthcare providers have been largely missing. OBJECTIVES In order to lay out the healthcare providers' perceived barriers to communication, the present study identified and compared communication barriers among different healthcare providers when caring for older CALD patients with cancer. METHODS An online survey was conducted among healthcare providers in the Netherlands who identified as being involved in the care of CALD patients with cancer (N = 191), specifically; GPs (NGPs = 54), specialists (Nspecialists = 29), oncology nurses (Nnurses = 77), and pharmacists (Npharmacists = 31). Providers assessed twelve pre-specified factors on (i) importance and (ii) frequency of these factors as barriers to communication. A composite score by employing the QUOTE (Quality Of care Through the patients' Eyes) methodology was used to rank, and classify factors as either potential or influential barriers. RESULTS AND CONCLUSION Overall, low Dutch language proficiency of older CALD patients with cancer, family interpreters providing inadequate translations, not knowing the extent of patients' informational needs, cultural differences in views about healthcare (i.e., illnesses and treatments) and family members blocking communication were found to be influential communication barriers. Healthcare providers showed several differences in what they perceived to be a potential or an influential barrier: Cultural differences in views about healthcare and patients getting treatment in their home countries were important barriers for GPs, while not knowing the patient's contact person was for pharmacists. Nurses perceived the highest number of influential barriers, while specialists perceived the least. We conclude that specific interventions that address differences in perceived barriers among providers are needed, and we highlight potential interventions that involve digital communication tools, such as the Conversation Starter.
Collapse
Affiliation(s)
- Hande Sungur
- Department of Communication Science, Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, the Netherlands.
| | - Maria E T C van den Muijsenbergh
- Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands; Prevention and care Programme, Pharos, National Centre of Expertise on Health Disparities, Utrecht, the Netherlands.
| | - Julia C M van Weert
- Department of Communication Science, Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, the Netherlands.
| | - Barbara C Schouten
- Department of Communication Science, Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, the Netherlands.
| |
Collapse
|
41
|
Fansher M, Adkins TJ, Lalwani P, Boduroglu A, Carlson M, Quirk M, Lewis RL, Shah P, Zhang H, Jonides J. Icon arrays reduce concern over COVID-19 vaccine side effects: a randomized control study. Cogn Res Princ Implic 2022; 7:38. [PMID: 35524896 PMCID: PMC9077983 DOI: 10.1186/s41235-022-00387-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
On April 13, 2021, the CDC announced that the administration of Johnson and Johnson’s COVID-19 vaccine would be paused due to a rare blood clotting side effect in ~ 0.0001% of people given the vaccine. Most people who are hesitant to get a COVID-19 vaccine list potential side effects as their main concern (PEW, 2021); thus, it is likely that this announcement increased vaccine hesitancy among the American public. Two days after the CDC’s announcement, we administered a survey to a group of 2,046 Americans to assess their changes in attitudes toward COVID-19 vaccines. The aim of this study was to investigate whether viewing icon arrays of side effect risk would prevent increases in COVID-19 vaccine hesitancy due to the announcement. We found that using icon arrays to illustrate the small chance of experiencing the blood clotting side effect significantly prevented increases in aversion toward the Johnson and Johnson vaccine as well as all other COVID-19 vaccines.
Collapse
Affiliation(s)
- Madison Fansher
- Department of Psychology, University of Michigan, 530 Church St, East Hall, Room 1004i, Ann Arbor, MI, 48109, USA.
| | - Tyler J Adkins
- Department of Psychology, University of Michigan, 530 Church St, East Hall, Room 1004i, Ann Arbor, MI, 48109, USA.
| | - Poortata Lalwani
- Department of Psychology, University of Michigan, 530 Church St, East Hall, Room 1004i, Ann Arbor, MI, 48109, USA
| | | | - Madison Carlson
- Department of Psychology, University of Michigan, 530 Church St, East Hall, Room 1004i, Ann Arbor, MI, 48109, USA
| | - Madelyn Quirk
- Department of Psychology, University of Michigan, 530 Church St, East Hall, Room 1004i, Ann Arbor, MI, 48109, USA
| | - Richard L Lewis
- Department of Psychology, University of Michigan, 530 Church St, East Hall, Room 1004i, Ann Arbor, MI, 48109, USA.,Department of Linguistics, University of Michigan, Ann Arbor, MI, 48109, USA.,Weinberg Institute for Cognitive Science, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Priti Shah
- Department of Psychology, University of Michigan, 530 Church St, East Hall, Room 1004i, Ann Arbor, MI, 48109, USA
| | - Han Zhang
- Department of Psychology, University of Michigan, 530 Church St, East Hall, Room 1004i, Ann Arbor, MI, 48109, USA
| | - John Jonides
- Department of Psychology, University of Michigan, 530 Church St, East Hall, Room 1004i, Ann Arbor, MI, 48109, USA
| |
Collapse
|
42
|
Allen RJ, Saeed F. Dialysis Organization Online Information on Kidney Failure Treatments: A Content Analysis Using Corpus Linguistics. Kidney Med 2022; 4:100462. [PMID: 35620083 PMCID: PMC9127690 DOI: 10.1016/j.xkme.2022.100462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Rationale & Objective Dialysis organizations’ websites may influence patient decision making, but the websites have received almost no consideration. We investigated how/whether these websites present all kidney replacement therapy options and how the quality of life of these options is portrayed. Study Design Content analysis using corpus linguistics (computer-assisted language analysis). Setting Website content aimed at patients from the 2 major dialysis organizations’ websites, totaling 226,968 words. The analysis took place from November 12, 2020, to March 30, 2021. Analytical Approach We used linguistic software (AntConc) to document the frequencies of words needed to present treatment options and quality of life information. Results Over both sites, dialysis mentions outstripped transplantation mentions. Organization A did not appear to reference conservative kidney management. Organization B mentioned dialysis more often than conservative management, at a ratio of 34:1. Organization A did not attribute symptoms to dialysis, whereas organization B had 12 mentions of dialysis-induced symptoms out of 87 total symptom references. Both organizations framed life on dialysis optimistically, suggesting that patients can continue to engage in “work,” “sex,” or “travel”; organization A referenced sex, work, and/or travel 123 times and organization B referenced these 262 times. Limitations We used quantitative analysis and linked ideas with certain keywords. We did not conduct a detailed qualitative inquiry. Conclusions The websites emphasized dialysis as a treatment for kidney failure, and the quality of life on dialysis was framed very optimistically. Qualitative studies of treatment modalities and the quality of life on dialysis in the patient-targeted material of dialysis organizations are needed.
Collapse
|
43
|
Lee YK, Fried TR, Costello DM, Hajduk AM, O'Leary JR, Cohen AB. Perceived dementia risk and advance care planning among older adults. J Am Geriatr Soc 2022; 70:1481-1486. [PMID: 35274737 PMCID: PMC9106856 DOI: 10.1111/jgs.17721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/12/2022] [Accepted: 01/16/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although advance care planning (ACP) is beneficial if dementia develops, and virtually all older adults are at risk for this disease, older adults do not consistently engage in ACP. Health behavior models have highlighted the importance of perceived susceptibility to medical conditions in motivating behavior. Following these models, we sought to determine how often older adults believe they are not at risk of developing dementia and to examine the association between perceived dementia risk and ACP participation. METHODS We performed a cross-sectional study of community-dwelling adults without cognitive impairment, aged ≥65 years, who were interviewed for the Health and Retirement Study in 2016 and asked about their perceived dementia risk (n = 711). Perceived dementia risk was ascertained with this question: "on a scale of 0 to 100, what is the percent chance that you will develop dementia sometime in the future?" We used multivariable-adjusted logistic regression to evaluate the association between perceived risk (0% versus >0%) and completion of a living will, appointment of a durable power of attorney for healthcare decisions, and discussion of treatment preferences. RESULTS Among respondents, 10.5% reported a perceived dementia risk of 0%. Perceived risk of 0% was associated with lower odds of completing a living will (OR 0.53; 95% CI, 0.30-0.93) and discussing treatment preferences (OR 0.51; 95% CI, 0.28-0.93) but not appointment of a durable power of attorney (OR 0.77; 95% CI, 0.42-1.39). Many respondents with perceived dementia risk >0% had not completed ACP activities, including a substantial minority of those with perceived risk >50%. CONCLUSIONS Older adults with no perceived dementia risk are less likely to participate in several forms of ACP, but the fact that many older adults with high levels of perceived risk had not completed ACP activities suggests that efforts beyond raising risk awareness are needed to increase engagement.
Collapse
Affiliation(s)
- Yu Kyung Lee
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Terri R Fried
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,VA Connecticut Health System, West Haven, Connecticut, USA
| | - Darcé M Costello
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Alexandra M Hajduk
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - John R O'Leary
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Andrew B Cohen
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,VA Connecticut Health System, West Haven, Connecticut, USA
| |
Collapse
|
44
|
Karuturi MS, Giordano SH, Hoover DS, Volk RJ, Housten AJ. Exploring and supporting older women's chemotherapy decision-making in early-stage breast cancer. J Geriatr Oncol 2022; 13:170-175. [PMID: 34955445 PMCID: PMC9045544 DOI: 10.1016/j.jgo.2021.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/29/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Few studies have focused on the therapeutic decision-making process in older adults with breast cancer. This study investigated older adult breast cancer patients' perspectives on neo/adjuvant chemotherapy, thereby identifying informational needs and preferences as patients navigate the treatment decision-making process. MATERIALS AND METHODS Women ≥65 years diagnosed with early-stage breast cancer were recruited from an academic cancer center after deciding whether or not to receive neo/adjuvant chemotherapy. Participants completed surveys assessing sociodemographic characteristics, health literacy/numeracy, and shared decision making. They took part in individual semi-structured interviews to explore their perspectives, experiences, and values regarding treatment. Interviews were audio-recorded and transcribed. Transcripts were analyzed using the Sort and Sift, Think and Shift qualitative approach. Quantitative data was summarized using descriptive statistics. RESULTS Of the 26 participants (age range 65-92 years; 81% non-Hispanic White; 72% ≥ college degree; 50% unmarried), 58% elected to undergo chemotherapy and 42% declined. The majority of participants had adequate health literacy/numeracy and engaged in shared decision-making. Thematic analysis revealed several commonalities regardless of the decision to undergo chemotherapy. Participants sought information regarding their disease/treatment. They referenced subjective experiences of friends/family members with cancer. Self-perception of health and the side effects of chemotherapy were also key factors. Participants placed importance on the maintenance of quality of life throughout treatment. CONCLUSIONS Decision-making strategies in older patients were shaped by knowledge, values, and the anecdotal experiences of others. Results can inform the development of decision support tools for older patients and physicians to better facilitate the shared decision-making process.
Collapse
Affiliation(s)
- Meghan S Karuturi
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.
| | - Sharon H Giordano
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States; Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Diana S Hoover
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Robert J Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Ashley J Housten
- Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, United States
| |
Collapse
|
45
|
Kaye DK. Navigating ethical challenges of conducting randomized clinical trials on COVID-19. Philos Ethics Humanit Med 2022; 17:2. [PMID: 35086524 PMCID: PMC8794733 DOI: 10.1186/s13010-022-00115-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 01/10/2022] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND The contemporary frameworks for clinical research require informed consent for research participation that includes disclosure of material information, comprehension of disclosed information and voluntary consent to research participation. There is thus an urgent need to test, and an ethical imperative, to test, modify or refine medications or healthcare plans that could reduce patient morbidity, lower healthcare costs or strengthen healthcare systems. METHODS Conceptual review. DISCUSSION Although some allocation principles seem better than others, no single moral principle allocates interventions justly, necessitating combining the moral principles into multiprinciple allocation systems. The urgency notwithstanding, navigating ethical challenges related to conducting corona virus disease (COVID-19) clinical trials is mandatory, in order to safeguard the safety and welfare of research participants, ensure autonomy of participants, reduce possibilities for exploitation and ensure opportunities for research participation. The ethical challenges to can be categorized as challenges in allocation of resources for research; challenges of clinical equipoise in relation to the research questions; challenges of understanding disclosed information in potential participants; and challenges in obtaining informed consent. CONCLUSION To navigate these challenges, stakeholders need a delicate balance of moral principles during allocation of resources for research. Investigators need to apply information processing theories to aid decision-making about research participation or employ acceptable modifications to improve the informed consent process. Research and ethics committees should strengthen research review and oversight to ensure rigor, responsiveness and transparency.
Collapse
Affiliation(s)
- Dan Kabonge Kaye
- College of Health Sciences, Department of Obstetrics and Gynecology, Makerere University, P.O. Box 7072, Kampala, Uganda.
- Johns Hopkins Berman Institute of Bioethics, Deering Hall, 1809 Ashland Avenue, Baltimore, MD, 21205, USA.
| |
Collapse
|
46
|
Parker G, Shahid N, Rappon T, Kastner M, Born K, Berta W. Using theories and frameworks to understand how to reduce low-value healthcare: a scoping review. Implement Sci 2022; 17:6. [PMID: 35057832 PMCID: PMC8772067 DOI: 10.1186/s13012-021-01177-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 11/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is recognition that the overuse of procedures, testing, and medications constitutes low-value care which strains the healthcare system and, in some circumstances, can cause unnecessary stress and harm for patients. Initiatives across dozens of countries have raised awareness about the harms of low-value care but have had mixed success and the levels of reductions realized have been modest. Similar to the complex drivers of implementation processes, there is a limited understanding of the individual and social behavioral aspects of de-implementation. While researchers have begun to use theory to elucidate the dynamics of de-implementation, the research remains largely atheoretical. The use of theory supports the understanding of how and why interventions succeed or fail and what key factors predict success. The purpose of this scoping review was to identify and characterize the use of theoretical approaches used to understand and/or explain what influences efforts to reduce low-value care. METHODS We conducted a review of MEDLINE, EMBASE, CINAHL, and Scopus databases from inception to June 2021. Building on previous research, 43 key terms were used to search the literature. The database searches identified 1998 unique articles for which titles and abstracts were screened for inclusion; 232 items were selected for full-text review. RESULTS Forty-eight studies met the inclusion criteria. Over half of the included articles were published in the last 2 years. The Theoretical Domains Framework (TDF) was the most commonly used determinant framework (n = 22). Of studies that used classic theories, the majority used the Theory of Planned Behavior (n = 6). For implementation theories, Normalization Process Theory and COM-B were used (n = 7). Theories or frameworks were used primarily to identify determinants (n = 37) and inform data analysis (n = 31). Eleven types of low-value care were examined in the included studies, with prescribing practices (e.g., overuse, polypharmacy, and appropriate prescribing) targeted most frequently. CONCLUSIONS This scoping review provides a rigorous, comprehensive, and extensive synthesis of theoretical approaches used to understand and/or explain what factors influence efforts to reduce low-value care. The results of this review can provide direction and insight for future primary research to support de-implementation and the reduction of low-value care.
Collapse
Affiliation(s)
- Gillian Parker
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario M5T 3M6 Canada
| | - Nida Shahid
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario M5T 3M6 Canada
| | - Tim Rappon
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario M5T 3M6 Canada
| | - Monika Kastner
- Centre for Research and Innovation, North York General Hospital, 4001, Leslie Street, Toronto, Ontario M2K 1E1 Canada
| | - Karen Born
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario M5T 3M6 Canada
| | - Whitney Berta
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, Ontario M5T 3M6 Canada
| |
Collapse
|
47
|
Kimata A, Kumagai K, Kondo N, Adachi K, Fujita R, Tsuchiya M. Development and validation of the Cancer Knowledge Scale for the general population: An item response theory approach. PATIENT EDUCATION AND COUNSELING 2022; 105:151-157. [PMID: 34020840 DOI: 10.1016/j.pec.2021.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 02/05/2021] [Accepted: 05/05/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To develop and validate a new measure of cancer knowledge for members of the general population who have never been diagnosed with cancer. METHODS Initially, 20 items were generated to measure cancer knowledge. After expert refinement and cognitive interviews, 11 items remained and were completed by 1,076 adults with no history of cancer. Responses were assessed using an item response theory (IRT) approach and differential item functioning. RESULTS Items were analyzed using a two-parameter logistic IRT model. Two items with tetrachoric correlation coefficients>0.8 and one item with a discrimination parameter>2.0 were excluded. The final eight items demonstrated a good range of discrimination (1.13 to 1.86) and difficulty (-1.11 to 0.85). No meaningful differential item functioning by participant attributes was detected for these eight items. CONCLUSION The Cancer Knowledge Scale appears to be a reliable and valid measure for the general population. PRACTICE IMPLICATIONS The eight-item scale could be used to assess the effects of psychoeducational programs, including those on cancer knowledge, for members of the general population with no cancer history.
Collapse
Affiliation(s)
- Akiko Kimata
- Division of Cancer Survivorship Research, Center for Cancer Control and Information Services, National Cancer Center, Japan
| | - Kaori Kumagai
- School of Nursing and Social Service, Health Sciences University of Hokkaido, Japan
| | - Nami Kondo
- Department of Palliative Medicine, Saitama Medical University International Medical Center, Japan
| | - Keiichiro Adachi
- Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Japan
| | - Risako Fujita
- Division of Cancer Survivorship Research, Center for Cancer Control and Information Services, National Cancer Center, Japan
| | - Miyako Tsuchiya
- Division of Cancer Survivorship Research, Center for Cancer Control and Information Services, National Cancer Center, Japan.
| |
Collapse
|
48
|
Morton K, Kohut K, Turner L, Smith S, Crosbie EJ, Ryan N, Grimmett C, Eccles DM, Foster C. Person-based co-design of a decision aid template for people with a genetic predisposition to cancer. Front Digit Health 2022; 4:1039701. [PMID: 36518561 PMCID: PMC9743799 DOI: 10.3389/fdgth.2022.1039701] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 10/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background People with genetic predispositions to cancer are faced with complex health decisions about managing their risk. Decision aids can support informed, values-based decisions, alongside shared decision-making with a clinician. Whilst diagnoses of genetic predispositions to cancer are increasing, there is no scalable decision aid to support these people. This paper presents an accessible, relevant decision aid template which can be adapted for different predispositions to cancer. Methods The decision aid template was co-developed with 12 patients affected by cancer and informed by empirical and theoretical literature. In addition, consultations were conducted with a further 19 people with Lynch syndrome; a specific genetic predisposition to cancer. Clinical stakeholders were consulted regularly. Coulter's framework for decision aid development guided the process, and these activities were complemented by the International Patient Decision Aid Standards, and the latest evidence on communicating risk in decision aids. Programme theory was developed to hypothesise how the decision aid would support decision-making and contextual factors which could influence the process. Guiding principles co-developed with the patient panel described how the decision aid could effectively engage people. Results The in-depth co-design process led to the identification of five core components of an accessible decision aid template for people with a genetic predisposition to cancer: defining the decision; option grid showing implications of each option; optional further details such as icon arrays to show tailored risk and personal narratives; values clarification activity; and a summary to facilitate discussion with a clinician. Specific guidance was produced describing how to develop each component. The guiding principles identified that the decision aid template needed to promote trust, reduce distress, and be comprehensive, personally relevant and accessible in order to engage people. Conclusion Adopting a co-design process helped ensure that the decision aid components were relevant and accessible to the target population. The template could have widespread application through being adapted for different genetic predispositions. The exact content should be co-designed with people from diverse backgrounds with lived experience of the specific predisposition to ensure it is as useful, engaging and relevant as possible.
Collapse
Affiliation(s)
- Kate Morton
- Centre for Psychosocial Research in Cancer, Health Sciences, University of Southampton, Southampton, United Kingdom
- Correspondence: Kate Morton
| | - Kelly Kohut
- Centre for Psychosocial Research in Cancer, Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Lesley Turner
- Patient and Public Contributor, Southampton, United Kingdom
| | - Sian Smith
- Aston University, College of Health and Life Sciences, School of Optometry, Birmingham, United Kingdom
| | - Emma J. Crosbie
- Department of Gynaecology, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
- Division of Cancer Science, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, United Kingdom
| | - Neil Ryan
- College of Medicine and Veterinary Medicine, University of Edinburgh, United Kingdom
| | - Chloe Grimmett
- Centre for Psychosocial Research in Cancer, Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Diana M. Eccles
- Department of Medicine, University of Southampton, Southampton, United Kingdom
| | - Claire Foster
- Centre for Psychosocial Research in Cancer, Health Sciences, University of Southampton, Southampton, United Kingdom
| | | |
Collapse
|
49
|
AlGethami R, AlGhamdi A, Almalki N, Al-Amri A, Al-Barry M. The preferences and practices regarding refractive surgeries among Saudi Ophthalmology Society members of ophthalmologists. SAUDI JOURNAL FOR HEALTH SCIENCES 2022. [DOI: 10.4103/sjhs.sjhs_81_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
50
|
Lateef F, Kiat KTB, Yunus M, Rahman MAA, Galwankar S, Al Thani H, Agrawal A. BRAVE: A Point of Care Adaptive Leadership Approach to Providing Patient-Centric Care in the Emergency Department. J Emerg Trauma Shock 2022; 15:47-52. [PMID: 35431488 PMCID: PMC9006722 DOI: 10.4103/jets.jets_138_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 10/09/2021] [Indexed: 11/23/2022] Open
Abstract
The practice of emergency medicine has reached its cross roads. Emergency physicians (EPs) are managing many more time-dependent conditions, initiating complex treatments in the emergency department (ED), handling ethical and end of life care discussions upfront, and even performing procedures which used to be done only in critical care settings, in the resuscitation room. EPs manage a wide spectrum of patients, 24 h a day, which reflects the community and society they practice in. Besides the medical and “technical” issues to handle, they have to learn how to resolve confounding elements which their patients can present with. These may include social, financial, cultural, ethical, relationship, and even employment matters. EPs cannot overlook these, in order to provide holistic care. More and more emphasis is also now given to the social determinants of health. We, from the emergency medicine fraternity, are proposing a unique “BRAVE model,” as a mnemonic to assist in the provision of point of care, adaptive leadership at the bedside in the ED. This represents another useful tool for use in the current climate of the ED, where patients have higher expectations, need more patient-centric resolution and handling of their issues, looming against the background of a more complex society and world.
Collapse
Affiliation(s)
- Fatimah Lateef
- Department of Emergency Medicine, Singapore General Hospital, Singapore.,Duke NUS Graduate Medical School, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Lee Kong Chian Medical School, Nanyang Technological University, Singapore.,SingHealth Duke NUS Institute of Medical Simulation, Singapore
| | - Kenneth Tan Boon Kiat
- Department of Emergency Medicine, Singapore General Hospital, Singapore.,Duke NUS Graduate Medical School, Singapore
| | - Md Yunus
- Department of Trauma and Emergency Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | | | - Sagar Galwankar
- The Florida State University Emergency Medicine Residency Program, Sarasota Memorial Hospital, Sarasota, Florida, USA
| | - Hassan Al Thani
- Department of Surgery, Hamad Trauma Centre, Hamad General Hospital, Doha, Qatar
| | - Amit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| |
Collapse
|