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Wegwarth O, Hoffmann TC, Goldacre B, Spies C, Giese HA. General practitioners' risk literacy and real-world prescribing of potentially hazardous drugs: a cross-sectional study. BMJ Qual Saf 2024; 33:634-641. [PMID: 38631907 DOI: 10.1136/bmjqs-2023-016979] [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: 11/30/2023] [Accepted: 04/08/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Overuse of medical care is a pervasive problem. Studies using hypothetical scenarios suggest that physicians' risk literacy influences medical decisions; real-world correlations, however, are lacking. We sought to determine the association between physicians' risk literacy and their real-world prescriptions of potentially hazardous drugs, accounting for conflicts of interest and perceptions of benefit-harm ratios in low-value prescribing scenarios. SETTING AND SAMPLE Cross-sectional study-conducted online between June and October 2023 via field panels of Sermo (Hamburg, Germany)-with a convenience sample of 304 English general practitioners (GPs). METHODS GPs' survey responses on their treatment-related risk literacy, conflicts of interest and perceptions of the benefit-harm ratio in low-value prescribing scenarios were matched to their UK National Health Service records of prescribing volumes for antibiotics, opioids, gabapentin and benzodiazepines and analysed for differences. RESULTS 204 GPs (67.1%) worked in practices with ≥6 practising GPs and 226 (76.0%) reported 10-39 years of experience. Compared with GPs demonstrating low risk literacy, GPs with high literacy prescribed fewer opioids (mean (M): 60.60 vs 43.88 prescribed volumes/1000 patients/6 months, p=0.016), less gabapentin (M: 23.84 vs 18.34 prescribed volumes/1000 patients/6 months, p=0.023), and fewer benzodiazepines (M: 17.23 vs 13.58 prescribed volumes/1000 patients/6 months, p=0.037), but comparable volumes of antibiotics (M: 48.84 vs 40.61 prescribed volumes/1000 patients/6 months, p=0.076). High-risk literacy was associated with lower conflicts of interest (ϕ = 0.12, p=0.031) and higher perception of harms outweighing benefits in low-value prescribing scenarios (p=0.007). Conflicts of interest and benefit-harm perceptions were not independently associated with prescribing behaviour (all ps >0.05). CONCLUSIONS AND RELEVANCE The observed association between GPs with higher risk literacy and the prescription of fewer hazardous drugs suggests the importance of risk literacy in enhancing patient safety and quality of care.
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Affiliation(s)
- Odette Wegwarth
- Heisenberg Chair for Medical Risk Literacy & Evidence-Based Decisions, Charité Universitätsmedizin Berlin Campus Charite Mitte, Berlin, Germany
- Adpative Rationality, Max-Planck-Institute for Human Development, Berlin, Germany
| | - Tammy C Hoffmann
- Faculty of Health Sciences and Medicine, Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Ben Goldacre
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Claudia Spies
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Helge A Giese
- Heisenberg Chair for Medical Risk Literacy & Evidence-Based Decisions, Charité Universitätsmedizin Berlin Campus Charite Mitte, Berlin, Germany
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Matas J, Tokalić R, García-Costa D, López-Iñesta E, Álvarez-García E, Grimaldo F, Marušić A. Tool to assess recognition and understanding of elements in Summary of Findings Table for health evidence synthesis: a cross-sectional study. Sci Rep 2023; 13:18044. [PMID: 37872203 PMCID: PMC10593927 DOI: 10.1038/s41598-023-45359-x] [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: 05/25/2023] [Accepted: 10/18/2023] [Indexed: 10/25/2023] Open
Abstract
of Findings (SoF) tables concisely present the main findings of evidence synthesis of health evidence, but how users navigate it to understand and interpret the presented information is not clear. We quantified the interaction of medical students with an SoF table while answering a knowledge quiz. Read&Learn tool was used to measure the number of target and non-target table cells visited for each question and the time spent on these cells. Students positively identified target elements for quiz questions and answered simpler questions, but struggled with critical thinking and understanding study outcomes. The question on outcomes with the largest improvement post-intervention had the fewest correct answers, the longest interaction with table cells and the most opened cells before answering. Students spent a median of 72% of the time reading target table cells. A heatmap of the interactions showed that they were mostly answer-oriented. Further development of the tool and metrics is needed to use the tool and the metrics to study the cognitive processes during the assessment of health evidence.
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Affiliation(s)
- Jakov Matas
- Department of Research in Biomedicine and Health, Center for Evidence-Based Medicine, University of Split School of Medicine, Šoltanska 2, 21000, Split, Croatia
| | - Ružica Tokalić
- Department of Research in Biomedicine and Health, Center for Evidence-Based Medicine, University of Split School of Medicine, Šoltanska 2, 21000, Split, Croatia
| | | | - Emilia López-Iñesta
- Department of Didactics of Mathematics, Universitat de València, Valencia, Spain
| | | | | | - Ana Marušić
- Department of Research in Biomedicine and Health, Center for Evidence-Based Medicine, University of Split School of Medicine, Šoltanska 2, 21000, Split, Croatia.
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Goldstein C, Woods N, MacKinnon R, Fazelzad R, Gill B, Giuliani ME, Papadakos T, Wei Q, Papadakos J. Numeracy Education for Health Care Providers: A Scoping Review. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2023; 44:35-43. [PMID: 37341576 DOI: 10.1097/ceh.0000000000000504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
INTRODUCTION Health numeracy (numerical literacy) refers to an individual's ability to use numerical information to make effective health decisions. Numeracy is fundamental in the role of a health care provider, forming the basis of evidence-based medicine and effective patient-provider communication. Despite a high level of education, many health care providers struggle with numeracy. Numeracy is often integrated into training curricula; however, teaching modality, competencies covered, learner satisfaction, and effectiveness of these educational interventions varies. METHOD A scoping review was conducted to explore and summarize what is known about numeracy skills education programs for health care providers. A comprehensive literature search was conducted from January 2010 to April 2021 in 10 databases. Controlled vocabulary terms and text words were used. The search was restricted to human studies, adults, and the English language. Articles were included if they were related to numeracy education for health care providers or trainees and provided details regarding methods, evaluation, and results. RESULTS The literature search retrieved 31,611 results and 71 met the inclusion criteria. Most interventions were conducted in a university setting, and targeted nursing students, medical students, resident physicians, and pharmacy students. Common numeracy concepts included statistics/biostatistics, medication calculations, evidence-based medicine, research methodology, and epidemiology. A variety of teaching modalities were used, which most often combined active approaches (eg, workshops, laboratories, small-group exercises, and discussion boards) with passive approaches (eg, traditional lectures and didactic teaching). Measured outcomes included knowledge and skills, self-efficacy, attitudes, and engagement. DISCUSSION Although efforts have been made to incorporate numeracy into training curricula, greater emphasis should be placed on developing strong numeracy skills in health care providers, particularly given the role numerical information plays in clinical decision making, evidence-based practices, and patient-provider communication.
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Affiliation(s)
- Casey Goldstein
- Ms. Goldstein: Beginning a residency in Family Medicine at the University of Toronto, Ontario, Canada. Dr. Woods: Associate Professor, Temerty Faculty of Medicine, University of Toronto and Director, The Institute for Education Research, University Health Network, Toronto, Ontario, Canada. Ms. MacKinnon: Master of Public Health student at the University of Guelph, Guelph, Ontario, Canada. Ms. Fazelzad: Information Specialist at Library and Information Services University Health Network (UHN)-Princess Margaret Cancer Centre, Toronto, Ontario, Canada. Ms. Gill: A recent Master of Public Health graduate from Western University, London, Ontario. Dr. Giuliani: Director of Education at Princess Margaret Cancer Centre and an Associate Professor in the Department of Radiation Oncology, Toronto, Ontario, Canada. Ms. Papadakos: Co-Director, Cancer Self-Management Research Centre and Senior Manager Educational Design & Knowledge Translation, Cancer Education at the Princess Margaret Cancer Centre, Toronto, Ontario, Canada. Ms. Wei: Recent Master of Public Health graduate from Western University, London, Ontario, Canada. Dr. Papadakos: Co-Director, Cancer Health Literacy Research Centre, Princess Margaret Cancer Centre; Scientist, The Institute for Education Research, University Health Network; Assistant Professor, Dalla Lana School of Public Health, University of Toronto; and Provincial Head, Patient Education at Ontario Health, Toronto, Ontario, Canada
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Hoffmann TC, Del Mar C, Santhirapala R, Freeman A. Teaching clinicians shared decision making and risk communication online: an evaluation study. BMJ Evid Based Med 2021; 26:253. [PMID: 32962972 PMCID: PMC8479734 DOI: 10.1136/bmjebm-2020-111521] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To describe the development and initial evaluation of a brief e-learning course as a means of teaching shared decision making and risk communication skills to clinicians of all specialties. DESIGN Comparison pre-course and post-course of scores in subjective confidence and objective knowledge about shared decision making and risk communication. SETTING Online and open to all specialties and levels of clinical experience, including students. PARTICIPANTS The course is freely available online and all who started the course from September 2018 to May 2020 were invited to participate in the evaluation study. INTERVENTION The self-guided e-learning course is made up of four modules and takes approximately 2 hours to complete. It is hosted on the website of the Winton Centre for Risk Communication and the UK's National Health Service e-learning platform. MAIN OUTCOME MEASURES Pre-course and post-course confidence in performing shared decision making (as measured by a 10-item scale adapted from the OPTION tool; total score range 10-50), and objective knowledge about basic principles of shared decision making and risk communication, as measured by performance on four knowledge questions and three calculations. At course commencement, a single item from the Berlin Numeracy Test, and the eight-item Subjective Numeracy Test were also asked. RESULTS Of 366 unique participants who consented and commenced the course, 210 completed all modules and the final post-course test. Participants' mean age was 38.1 years, 69% were in current clinical practice and had a mean of 10.5 years of clinical practice. Numeracy was relatively low, with 50.7% correctly answering the Berlin Numeracy Test item pre-course. Participants who completed the course showed a significant improvement in their confidence by a mean summed score of 3.7 units (95% CI 2.9 to 4.6, p<0.0001) from a mean pre-course of 37.4 (SD 6.1) to post-course of 41.1 (SD 6.9). There was an increase in the proportion of correct answers for most knowledge questions (p<0.0001, p=0.013 for two directly compared), although no improvement in most skill questions that involved numbers (eg, calculating relative risks). Participants with higher numeracy appeared to show higher skill and confidence on most questions. CONCLUSIONS This online, free e-learning course was successful in increasing participants' confidence in, and some aspects of knowledge about, shared decision making and risk communication. It also highlighted the need for improvements in clinicians' numerical skills as a vital part of training. We suggest that the course is used in combination with practical face-to-face experience and more intensive numerical skills training.
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Affiliation(s)
- Tammy C Hoffmann
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Chris Del Mar
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Ramai Santhirapala
- Department of Anaesthesia and Perioperative Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Alexandra Freeman
- Winton Centre for Risk & Evidence Communication, University of Cambridge, Cambridge, UK
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Peters GW, Kelly JR, Beckta JM, White M, Marks LB, Ford E, Evans SB. An Evaluation of Health Numeracy among Radiation Therapists and Dosimetrists. Adv Radiat Oncol 2020; 6:100609. [PMID: 34027232 PMCID: PMC8134660 DOI: 10.1016/j.adro.2020.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/28/2020] [Accepted: 10/13/2020] [Indexed: 12/01/2022] Open
Abstract
Purpose Medical errors in radiation oncology sometimes involve tasks reliant on practitioners’ grasp of numeracy. Numeracy has been shown to be suboptimal across various health care professionals. Herein, we assess health numeracy among American Society of Radiologic Technologists (ASRT) members. Methods and materials The Numeracy Understanding for Medicine instrument (NUMi), an instrument to measure numeracy in the general population, was adapted to oncology for this study and distributed to ASRT members (n = 14,228) in 2017. Per NUMi scoring, health numeracy scores were categorized as low (0-7), low average (8-12), high average (13-17), or high (18-20). The impact of cGy versus Gy on numeracy performance was investigated. Spearman’s rho and a Wilcox-Mann-Whitney test were used for comparisons between the different groups. Results A total of 662 eligible participants completed the instrument and identified as radiation oncology professionals. In the cGy and Gy NUMi scores, approximately 2% of respondents scored low-average, approximately 40% scored high-average, and approximately 58% scored high, with a median score of 18.0. Although the optimum NUMi score for ASRT members is unknown, one might expect our cohort to have numeracy skills at least as high as college freshmen. Roughly one-sixth of our study group scored at or below the average score of college freshmen (NUMi = 15). In the subset analysis of NUMi questions pertaining to radiation dose unit (cGy vs Gy), respondents performed better with cGy (mean score: 2.94; range, 2-3) versus Gy (mean: 2.91; range, 0-3; P = .011). Conclusions In this study of limited sample size, overall numeracy is quite good compared with the general population. However, the range of scores is wide, and some respondents have lower scores that may be concerning, suggesting that numeracy may be an issue that requires improvement for a subset of the studied cohort. Performance was superior with the unit cGy; thus, the adoption of cGy as the standard unit is reasonable.
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Affiliation(s)
- Gabrielle W Peters
- Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Jacqueline R Kelly
- Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Jason M Beckta
- Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
| | - Marney White
- School of Public Health, Yale University School of Medicine, New Haven, Connecticut
| | - Lawrence B Marks
- Division of Health Care Engineering and Lineberger Cancer Center, Department of Radiation Oncology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Eric Ford
- Department of Radiation Oncology, University of Washington, Seattle, Washington
| | - Suzanne B Evans
- Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut
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