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Mellinger JL, Winder GS, Fernandez AC, Asefah H, Zikmund-Fisher BJ. Critical misconceptions and knowledge gaps regarding alcohol cessation and risk of relapse in alcohol-related liver disease patients: A qualitative mental models study. J Subst Use Addict Treat 2024; 161:209292. [PMID: 38364995 DOI: 10.1016/j.josat.2024.209292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/27/2023] [Accepted: 01/11/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Despite the mortality benefits of alcohol cessation and alcohol treatment, few patients with alcohol-related liver disease (ALD) get such treatment. To understand reasons for low treatment rates, we performed a qualitative mental models study to explore how ALD patients understand factors influencing alcohol cessation, relapse and their liver health. METHODS Using a mental models framework, we interviewed experts in alcohol use disorder (AUD) and ALD to determine factors influencing alcohol cessation, risk of relapse and liver health. An expert influence diagram was constructed and used to develop a patient interview guide. We recruited participants with ALD enrolled in hepatology or transplant clinics at a single tertiary-care center. We conducted interviews either face-to-face or by phone, per participant preference. We transcribed all interviews verbatim and analyzed them using combined deductive coding schema based on both the interview guide and emergent coding. RESULTS 25 (10 women, 15 men) participants with a mean age of 57 years completed interviews. 68 % had decompensated cirrhosis. Major omissions included gender (as a factor in alcohol use or liver disease) and the influence of benzodiazepines/opioids on relapse. Misconceptions were common, in particular the idea that the absence of urges to drink meant participants were safe from relapse. Conceptual differences from the expert model emerged as well. Participants tended to view the self as primary and the only thing that could influence relapse in many cases, resulting in a linear mental model with few nodes influencing alcohol cessation. Participants' risky drinking signals (i.e., elevated liver enzymes) differed from known definitions of hazardous or high-risk drinking, which largely emphasize dose of alcohol consumed irrespective of consequences. Finally, participants sometimes viewed stopping on one's own as the primary means of stopping alcohol use, not recognizing the many other nodes in the influence diagram impacting ability to stop alcohol. CONCLUSION Patients with ALD had critical misconceptions, omissions, and conceptual reorganizations in their mental models of the ability to stop alcohol use. Attention to these differences may allow clinicians and researchers to craft more impactful interventions to improve rates of alcohol abstinence and AUD treatment engagement.
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Affiliation(s)
- Jessica L Mellinger
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, United States of America; Department of Psychiatry, Michigan Medicine, Ann Arbor, MI, United States of America.
| | - Gerald Scott Winder
- Department of Psychiatry, Michigan Medicine, Ann Arbor, MI, United States of America; University of Michigan Department of Surgery, Michigan Medicine, Ann Arbor, MI, United States of America; University of Michigan Department of Neurology, Michigan Medicine, Ann Arbor, MI, United States of America
| | - Anne C Fernandez
- Department of Psychiatry, Michigan Medicine, Ann Arbor, MI, United States of America; University of Michigan Addiction Treatment Service, Michigan Medicine, Ann Arbor, MI, United States of America
| | - Haila Asefah
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, United States of America
| | - Brian J Zikmund-Fisher
- Department of Internal Medicine, Michigan Medicine, Ann Arbor, MI, United States of America; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States of America
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Jaffe K, Greene AK, Chen L, Ryan KA, Krenz C, Roberts JS, Zikmund-Fisher BJ, McGuire AL, Thomas JD, Marsh EE, Spector-Bagdady K. Genetic Researchers' Use of and Interest in Research With Diverse Ancestral Groups. JAMA Netw Open 2024; 7:e246805. [PMID: 38625702 PMCID: PMC11022111 DOI: 10.1001/jamanetworkopen.2024.6805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/18/2024] [Indexed: 04/17/2024] Open
Abstract
Importance Genetic researchers must have access to databases populated with data from diverse ancestral groups to ensure research is generalizable or targeted for historically excluded communities. Objective To determine genetic researchers' interest in doing research with diverse ancestral populations, which database stewards offer adequate samples, and additional facilitators for use of diverse ancestral data. Design, Setting, and Participants This survey study was conducted from June to December 2022 and was part of an exploratory sequential mixed-methods project in which previous qualitative results informed survey design. Eligible participants included genetic researchers who held US academic affiliations and conducted research using human genetic databases. Exposure Internet-administered survey to genetic research professionals. Main Outcomes and Measures The survey assessed respondents' experience and interest in research with diverse ancestral data, perceptions of adequacy of diverse data across database stewards (ie, private, government, or consortia), and identified facilitators for encouraging use of diverse ancestral data. Descriptive statistics, χ2 tests, and z tests were used to describe respondents' perspectives and experiences. Results A total of 294 researchers (171 men [58.5%]; 121 women [41.2%]) were included in the study, resulting in a response rate of 20.4%. Across seniority level, 109 respondents (37.1%) were senior researchers, 85 (28.9%) were mid-level researchers, 71 (24.1%) were junior researchers, and 27 (9.2%) were trainees. Significantly more respondents worked with data from European ancestral populations (261 respondents [88.8%]) compared with any other ancestral population. Respondents who had not done research with Indigenous ancestral groups (210 respondents [71.4%]) were significantly more likely to report interest in doing so than not (121 respondents [41.2%] vs 89 respondents [30.3%]; P < .001). Respondents reported discrepancies in the adequacy of ancestral populations with significantly more reporting European samples as adequate across consortium (203 respondents [90.6%]), government (200 respondents [89.7%]), and private (42 respondents [80.8%]) databases, compared with any other ancestral population. There were no significant differences in reported adequacy of ancestral populations across database stewards. A majority of respondents without access to adequate diverse samples reported that increasing the ancestral diversity of existing databases (201 respondents [68.4%]) and increasing access to databases that are already diverse (166 respondents [56.5%]) would increase the likelihood of them using a more diverse sample. Conclusions and Relevance In this survey study of US genetic researchers, respondents reported existing databases only provide adequate ancestral samples for European populations, despite their interest in other ancestral populations. These findings suggest there are specific gaps in access to and composition of genetic databases, highlighting the urgent need to boost diversity in research samples to improve inclusivity in genetic research practices.
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Affiliation(s)
- Kaitlyn Jaffe
- Department of Health Promotion and Policy, University of Massachusetts, Amherst
| | - Amanda K. Greene
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor
| | - Luyun Chen
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor
| | - Kerry A. Ryan
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor
| | - Chris Krenz
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor
| | - J. Scott Roberts
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor
| | - Brian J. Zikmund-Fisher
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Amy L. McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
| | - J. Denard Thomas
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor
| | - Erica E. Marsh
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor
| | - Kayte Spector-Bagdady
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor
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Ancker JS, Benda NC, Zikmund-Fisher BJ. Do you want to promote recall, perceptions, or behavior? The best data visualization depends on the communication goal. J Am Med Inform Assoc 2024; 31:525-530. [PMID: 37468448 PMCID: PMC10797268 DOI: 10.1093/jamia/ocad137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/27/2023] [Accepted: 07/08/2023] [Indexed: 07/21/2023] Open
Abstract
Data visualizations can be effective and inclusive means for helping people understand health-related data. Yet numerous high-quality studies comparing data visualizations have yielded relatively little practical design guidance because of a lack of clarity about what communicators want their audience to accomplish. When conducting rigorous evaluations of communication (eg, applying the ISO 9186 method), describing the process simply as evaluating "comprehension" or "interpretation" of visualizations fails to do justice to the true range of outcomes being studied. We present newly developed taxonomies of outcome measures and tasks that are guiding a large-scale systematic review of the health numbers communication literature. Using these taxonomies allows a designer to determine whether a specific data presentation format or feature supports or inhibits the desired audience cognitions, feelings, or behaviors. We argue that taking a granular, outcomes-based approach to designing and evaluating information visualization research is essential to deriving practical, actionable knowledge from it.
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Affiliation(s)
- Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Natalie C Benda
- School of Nursing, Columbia University, New York, New York, USA
| | - Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Suresh U, Ancker JS, Zikmund-Fisher BJ, Benda NC. Designing Support to help Health Communication Professionals Convey Numbers Clearly to the Public - A Needs Assessment and Formative Usability Evaluation. AMIA Annu Symp Proc 2024; 2023:1277-1286. [PMID: 38222428 PMCID: PMC10785911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Communicating health-related probabilities to patients and the public presents challenges, although multiple studies have demonstrated that we can promote comprehension and appropriate application of numbers by matching presentation formats (e.g., percentage, bar charts, icon arrays) to communication goal (e.g., improving recall, decreasing worry, taking action). We used this literature to create goal-driven, evidence-based guidance to support health communicators in conveying probabilities. We then conducted semi-structured interviews with 39 health communicators to understand: communicators' goals for expressing probabilities, formats they choose to convey probabilities, and perceptions of prototypes of our "communicating numbers clearly" guidance. We found that communicators struggled to articulate granular goals for their communication, impeding their ability to select appropriate guidance. Future work should consider how best to support health communicators in selecting granular, differentiable goals to support broadly comprehensible information design.
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Affiliation(s)
- Uday Suresh
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jessica S Ancker
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, Department of Internal Medicine, and the Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
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Saini SD, Lewis CL, Kerr EA, Zikmund-Fisher BJ, Hawley ST, Forman JH, Zauber AG, Lansdorp-Vogelaar I, van Hees F, Saffar D, Myers A, Gauntlett LE, Lipson R, Kim HM, Vijan S. Personalized Multilevel Intervention for Improving Appropriate Use of Colorectal Cancer Screening in Older Adults: A Cluster Randomized Clinical Trial. JAMA Intern Med 2023; 183:1334-1342. [PMID: 37902744 PMCID: PMC10616770 DOI: 10.1001/jamainternmed.2023.5656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 09/01/2023] [Indexed: 10/31/2023]
Abstract
Importance Despite guideline recommendations, clinicians do not systematically use prior screening or health history to guide colorectal cancer (CRC) screening decisions in older adults. Objective To evaluate the effect of a personalized multilevel intervention on screening orders in older adults due for average-risk CRC screening. Design, Setting, and Participants Interventional 2-group parallel unmasked cluster randomized clinical trial conducted from November 2015 to February 2019 at 2 US Department of Veterans Affairs (VA) facilities: 1 academic VA medical center and 1 of its connected outpatient clinics. Randomization at the primary care physician/clinician (PCP) level, stratified by study site and clinical full-time equivalency. Participants were 431 average-risk, screen-due US veterans aged 70 to 75 years attending a primary care visit. Data analysis was performed from August 2018 to August 2023. Intervention The intervention group received a multilevel intervention including a decision-aid booklet with detailed information on screening benefits and harms, personalized for each participant based on age, sex, prior screening, and comorbidity. The control group received a multilevel intervention including a screening informational booklet. All participants received PCP education and system-level modifications to support personalized screening. Main Outcomes and Measures The primary outcome was whether screening was ordered within 2 weeks of clinic visit. Secondary outcomes were concordance between screening orders and screening benefit and screening utilization within 6 months. Results A total of 436 patients were consented, and 431 were analyzed across 67 PCPs. Patients had a mean (SD) age of 71.5 (1.7) years; 424 were male (98.4%); 374 were White (86.8%); 89 were college graduates (21.5%); and 351 (81.4%) had undergone prior screening. A total of 258 (59.9%) were randomized to intervention, and 173 (40.1%) to control. Screening orders were placed for 162 of 258 intervention patients (62.8%) vs 114 of 173 control patients (65.9%) (adjusted difference, -4.0 percentage points [pp]; 95% CI, -15.4 to 7.4 pp). In a prespecified interaction analysis, the proportion receiving orders was lower in the intervention group than in the control group for those in the lowest benefit quartile (59.4% vs 71.1%). In contrast, the proportion receiving orders was higher in the intervention group than in the control group for those in the highest benefit quartile (67.6% vs 52.2%) (interaction P = .049). Fewer intervention patients (106 of 256 [41.4%]) utilized screening overall at 6 months than controls (96 of 173 [55.9%]) (adjusted difference, -13.4 pp; 95% CI, -25.3 to -1.6 pp). Conclusions and Relevance In this cluster randomized clinical trial, patients who were presented with personalized information about screening benefits and harms in the context of a multilevel intervention were more likely to receive screening orders concordant with benefit and were less likely to utilize screening. Trial Registration ClinicalTrials.gov Identifier: NCT02027545.
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Affiliation(s)
- Sameer D. Saini
- Center for Clinical Management Research, LTC Charles S. Kettles VA Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | | | - Eve A. Kerr
- Center for Clinical Management Research, LTC Charles S. Kettles VA Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Brian J. Zikmund-Fisher
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor
| | - Sarah T. Hawley
- Center for Clinical Management Research, LTC Charles S. Kettles VA Healthcare System, Ann Arbor, Michigan
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Jane H. Forman
- Center for Clinical Management Research, LTC Charles S. Kettles VA Healthcare System, Ann Arbor, Michigan
| | - Ann G. Zauber
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Darcy Saffar
- Center for Clinical Management Research, LTC Charles S. Kettles VA Healthcare System, Ann Arbor, Michigan
| | - Aimee Myers
- Center for Clinical Management Research, LTC Charles S. Kettles VA Healthcare System, Ann Arbor, Michigan
| | - Lauren E. Gauntlett
- Center for Clinical Management Research, LTC Charles S. Kettles VA Healthcare System, Ann Arbor, Michigan
| | - Rachel Lipson
- Center for Clinical Management Research, LTC Charles S. Kettles VA Healthcare System, Ann Arbor, Michigan
| | - H. Myra Kim
- Center for Clinical Management Research, LTC Charles S. Kettles VA Healthcare System, Ann Arbor, Michigan
- Consulting for Statistics, Computing and Analytics Research (CSCAR), University of Michigan, Ann Arbor
| | - Sandeep Vijan
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
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Brotzman LE, Zikmund-Fisher BJ. Perceived Barriers Among Clinicians and Older Adults Aged 65 and Older Regarding Use of Life Expectancy to Inform Cancer Screening: A Narrative Review and Comparison. Med Care Res Rev 2023; 80:372-385. [PMID: 36800914 DOI: 10.1177/10775587231153269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
While cancer screening guidelines increasingly recommend incorporating life expectancy estimates to inform screening decisions for older adults, little is known about how this happens in practice. This review summarizes current knowledge about primary care clinician and older adult (65+) perspectives about use of life expectancy to guide cancer screening decisions. Clinicians report operational barriers, uncertainty, and hesitation around use of life expectancy in screening decisions. They recognize it may help them more accurately weigh benefits and harms but are unsure how to estimate life expectancy for individual patients. Older adults face conceptual barriers and are generally unconvinced of the benefits of considering their life expectancy when making screening decisions. Life expectancy will always be a difficult topic for clinicians and patients, but there are advantages to incorporating it in cancer screening decisions. We highlight key takeaways from both clinician and older adult perspectives to guide future research.
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Teo AR, Niederhausen M, Handley R, Metcalf EE, Call AA, Jacob RL, Zikmund-Fisher BJ, Dobscha SK, Kaboli PJ. Using Nudges to Reduce Missed Appointments in Primary Care and Mental Health: a Pragmatic Trial. J Gen Intern Med 2023:10.1007/s11606-023-08131-5. [PMID: 37340264 DOI: 10.1007/s11606-023-08131-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 03/01/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Missed appointments ("no-shows") are a persistent and costly problem in healthcare. Appointment reminders are widely used but usually do not include messages specifically designed to nudge patients to attend appointments. OBJECTIVE To determine the effect of incorporating nudges into appointment reminder letters on measures of appointment attendance. DESIGN Cluster randomized controlled pragmatic trial. PATIENTS There were 27,540 patients with 49,598 primary care appointments, and 9420 patients with 38,945 mental health appointments, between October 15, 2020, and October 14, 2021, at one VA medical center and its satellite clinics that were eligible for analysis. INTERVENTIONS Primary care (n = 231) and mental health (n = 215) providers were randomized to one of five study arms (four nudge arms and usual care as a control) using equal allocation. The nudge arms included varying combinations of brief messages developed with veteran input and based on concepts in behavioral science, including social norms, specific behavioral instructions, and consequences of missing appointments. MAIN MEASURES Primary and secondary outcomes were missed appointments and canceled appointments, respectively. STATISTICAL ANALYSIS Results are based on logistic regression models adjusting for demographic and clinical characteristics, and clustering for clinics and patients. KEY RESULTS Missed appointment rates in study arms ranged from 10.5 to 12.1% in primary care clinics and 18.0 to 21.9% in mental health clinics. There was no effect of nudges on missed appointment rate in primary care (OR = 1.14, 95%CI = 0.96-1.36, p = 0.15) or mental health (OR = 1.20, 95%CI = 0.90-1.60, p = 0.21) clinics, when comparing the nudge arms to the control arm. When comparing individual nudge arms, no differences in missed appointment rates nor cancellation rates were observed. CONCLUSIONS Appointment reminder letters incorporating brief behavioral nudges were ineffective in improving appointment attendance in VA primary care or mental health clinics. More complex or intensive interventions may be necessary to significantly reduce missed appointments below their current rates. TRIAL NUMBER ClinicalTrials.gov, Trial number NCT03850431.
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Affiliation(s)
- Alan R Teo
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care, 3710 SW US Veterans Hospital Road (R&D 66), Portland, OR, USA.
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA.
| | - Meike Niederhausen
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care, 3710 SW US Veterans Hospital Road (R&D 66), Portland, OR, USA
- Oregon Health & Science University - Portland State University (OHSU-PSU) School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Robert Handley
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care, 3710 SW US Veterans Hospital Road (R&D 66), Portland, OR, USA
| | - Emily E Metcalf
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care, 3710 SW US Veterans Hospital Road (R&D 66), Portland, OR, USA
| | - Aaron A Call
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care, 3710 SW US Veterans Hospital Road (R&D 66), Portland, OR, USA
| | - R Lorie Jacob
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care, 3710 SW US Veterans Hospital Road (R&D 66), Portland, OR, USA
| | - Brian J Zikmund-Fisher
- Department of Health Behavior of Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, USA
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Steven K Dobscha
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care, 3710 SW US Veterans Hospital Road (R&D 66), Portland, OR, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Peter J Kaboli
- Comprehensive Access and Delivery Research and Evaluation Center, Iowa City Veterans Affairs Healthcare System, Iowa City, IA, USA
- Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Schroder HS, Devendorf A, Zikmund-Fisher BJ. Framing depression as a functional signal, not a disease: Rationale and initial randomized controlled trial. Soc Sci Med 2023; 328:115995. [PMID: 37301109 DOI: 10.1016/j.socscimed.2023.115995] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023]
Abstract
Depression is often framed as a disease or dysfunctional syndrome, yet this framing has unintended negative consequences including increased stigma. Here, we consider an alternative messaging framework - that depression serves an adaptive function. We describe the historical development of popular messages about depression and draw from the fields of evolutionary psychiatry and social cognition to describe the alternative framework that depression is a "signal" that serves a purpose. We then present data from a pre-registered, online randomized-controlled study in which participants with self-reported depression histories viewed a series of videos that explained depression as a "disease like any other" with known biopsychosocial risk factors (BPS condition), or as a signal that serves an adaptive function (Signal condition). In the entire sample (N = 877), three of the six hypotheses were supported: The Signal condition led to less self-stigma, greater offset efficacy, and more adaptive beliefs about depression. Exploratory analyses revealed these Signal effects were stronger among females (N = 553), who also showed a greater growth mindset of depression after the Signal explanation. Results suggest that framing depression as an adaptive signal can benefit patients and avoid harmful consequences of popular etiological presentations. We conclude that alternative framings of depression are worthy of further study.
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Affiliation(s)
- Hans S Schroder
- Department of Psychiatry, University of Michigan Medical School, United States.
| | - Andrew Devendorf
- Department of Psychology, University of South Florida, United States
| | - Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, University of Michigan, United States; Department of Internal Medicine, University of Michigan, United States; Center for Bioethics and Social Sciences in Medicine, University of Michigan, United States
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Wagner AL, Moniz MH, Stout MJ, Townsel C, Hawley ST, Zikmund-Fisher BJ. Experiences, risk perceptions, and COVID-19 vaccination outcomes among hospital workers. Vaccine 2023; 41:1247-1253. [PMID: 36639271 PMCID: PMC9826991 DOI: 10.1016/j.vaccine.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 04/29/2022] [Accepted: 01/05/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND Although COVID-19 vaccinations have been available to hospital workers in the U.S. since December 2020, coverage is far from universal, even in groups with patient contact. The aim of this study was to describe COVID-19-related experiences at work and in the personal lives of nurses, allied health workers, and non-clinical staff with patient contact, and to assess whether these experiences relate to COVID-19 vaccination. METHODS Health care workers at a large Midwestern hospital in the U.S. were contacted to participate in an online cross-sectional survey during February 2021. A logistic regression model was used to estimate odds ratios (OR) for vaccination by different experiences, and we assessed mediation through models that also included measures of risk perceptions. RESULTS Among 366 nurse practitioners / nurse midwives / physician assistant, 1,698 nurses, 1,798 allied health professionals, and 1,307 non-clinical staff with patient contact, the proportions who had received or intended to receive a COVID-19 vaccination were 94 %, 87 %, 82 %, and 88 %, respectively. Working and being physically close to COVID-19 patients was not significantly associated with vaccine intent. Vaccination intent was significantly lower among those with a previous COVID-19 diagnosis vs not (OR = 0.33, 95 % CI: 0.27, 0.40) and higher for those who knew close family members of friends hospitalized or died of COVID-19 (OR = 1.33, 95 % CI: 1.10, 1.60). CONCLUSION Even when COVID-19 vaccination was available in February 2021, a substantial minority of hospital workers with patient contact did not intend to be vaccinated. Moreover, their experiences working close to COVID-19 patients were not significantly related to vaccination intent. Instead, personal experiences with family members and friends were associated with vaccination intent through changes in risk perceptions. Interventions to increase uptake among hospital workers should emphasize protection of close family members or friends and the severity of COVID-19.
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Affiliation(s)
- Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Michelle H Moniz
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Michigan, Ann Arbor, MI, USA; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA; Program on Women's Healthcare Effectiveness Research, University of Michigan, Ann Arbor, MI, USA
| | - Molly J Stout
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Courtney Townsel
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Sarah T Hawley
- Department of Internal Medicine, Division of General Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Ann Arbor VA Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Brian J Zikmund-Fisher
- Department of Internal Medicine, Division of General Medicine, University of Michigan, Ann Arbor, MI, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
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Prosser LA, Wagner AL, Wittenberg E, Zikmund-Fisher BJ, Rose AM, Pike J. A Discrete Choice Analysis Comparing COVID-19 Vaccination Decisions for Children and Adults. JAMA Netw Open 2023; 6:e2253582. [PMID: 36716030 PMCID: PMC9887501 DOI: 10.1001/jamanetworkopen.2022.53582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
IMPORTANCE COVID-19 vaccination rates in the US remain below optimal levels. Patient preferences for different attributes of vaccine products and the vaccination experience can be important in determining vaccine uptake decisions. OBJECTIVE To assess preferences for attributes of adult and pediatric COVID-19 vaccination among US adults. DESIGN, SETTING, AND PARTICIPANTS An online survey of a national panel of 1040 US adults was conducted in May and June 2021. A discrete choice analysis was used to measure the relative value of each attribute in the decision to choose a COVID-19 vaccination option for adults or children. Six attributes were used to described hypothetical vaccination options: vaccine effectiveness, mild side effects, rare adverse events, number of doses, time required for vaccination, and regulatory approval. Respondents chose between hypothetical vaccination profiles or no vaccination. Additional survey questions asked about vaccination beliefs, COVID-19 illness experience, COVID-19 risk factors, vaccination status, and opinions about the risk of COVID-19. EXPOSURES Respondents chose which vaccine profile they would prefer to receive for themselves (or no vaccination). Respondents then considered an identical set of profiles for a hypothetical child aged 0 to 17 years. MAIN OUTCOMES AND MEASURES Relative value of vaccination-related attributes were estimated using Bayesian logit regression. Preference profiles for subgroups were estimated using latent class analyses. RESULTS A total of 1040 adults (610 [59%] female; 379 participants [36%] with an age of 55 years and older years) responded to the survey. When asked about vaccination choices for themselves, participants indicated that vaccine effectiveness (95% vs 60%) was a significant attribute (β, 9.59 [95% CrI, 9.20-10.00] vs β, 0.41 [95% CrI, 0-0.80]). Respondents also preferred fewer rare adverse events (β, 6.35 [95% CrI, 5.74-6.86), fewer mild side effects (β, 5.49; 95% CrI, 5.12-5.87), 1 dose (β, 5.41; 95% CrI, 5.04-5.78), FDA approval (β, 6.01; 95% CrI, 5.64-6.41), and shorter waiting times (β, 5.67; 95% CrI, 4.87-6.48). Results were very similar when framing the question as adult or child vaccination, with slightly stronger preference for fewer rare adverse events for children. Latent class analysis revealed 4 groups of respondents: (1) individuals sensitive to safety and regulatory status, (2) individuals sensitive to convenience, (3) individuals who carefully considered all attributes in making their choices, and (4) individuals who rejected the vaccine. CONCLUSIONS AND RELEVANCE In this survey study of US adults, the identification of 4 distinct preference groups provides new information to guide communications to support vaccine decision making. In particular, the group that prioritize convenience (less time required for vaccination and fewer doses) may present an opportunity to create actionable strategies to increase vaccination uptake for both adult and pediatric populations.
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Affiliation(s)
| | | | - Eve Wittenberg
- Harvard Chan School of Public Health, Boston, Massachusetts
| | | | | | - Jamison Pike
- Centers for Disease Control and Prevention, Atlanta, Georgia
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11
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Trinidad MG, Ryan KA, Krenz CD, Roberts JS, McGuire AL, De Vries R, Zikmund-Fisher BJ, Kardia S, Marsh E, Forman J, Kent M, Wilborn D, Spector-Bagdady K. "Extremely slow and capricious": A qualitative exploration of genetic researcher priorities in selecting shared data resources. Genet Med 2023; 25:115-124. [PMID: 36371759 PMCID: PMC9843821 DOI: 10.1016/j.gim.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 09/04/2022] [Accepted: 09/06/2022] [Indexed: 11/14/2022] Open
Abstract
PURPOSE Genetic researchers' selection of a database can have scientific, regulatory, and ethical implications. It is important to understand what is driving database selection such that database stewards can be responsive to user needs while balancing the interests of communities in equitably benefiting from advances. METHODS We conducted 23 semistructured interviews with US academic genetic researchers working with private, government, and collaboratory data stewards to explore factors that they consider when selecting a genetic database. RESULTS Interviewees used existing databases to avoid burdens of primary data collection, which was described as expensive and time-consuming. They highlighted ease of access as the most important selection factor, integrating concepts of familiarity and efficiency. Data features, such as size and available phenotype, were also important. Demographic diversity was not originally cited by any interviewee as a pivotal factor; when probed, most stated that the option to consider diversity in database selection was limited. Database features, including integrity, harmonization, and storage were also described as key components of efficient use. CONCLUSION There is a growing market and competition between genetic data stewards. Data need to be accessible, harmonized, and administratively supported for their existence to be translated into use and, in turn, result in scientific advancements across diverse communities.
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Affiliation(s)
- M Grace Trinidad
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI
| | - Kerry A Ryan
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Chris D Krenz
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - J Scott Roberts
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI; Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI
| | - Amy L McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX
| | - Raymond De Vries
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI; Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI; Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Brian J Zikmund-Fisher
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI; Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI
| | - Sharon Kardia
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI
| | - Erica Marsh
- Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, MI
| | - Jane Forman
- VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Madison Kent
- David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA
| | | | - Kayte Spector-Bagdady
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, MI; Department of Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, MI.
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12
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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 Anal 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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13
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Schaefer JK, Barnes GD, Sussman JB, Saini SD, Caverly TJ, Read S, Zikmund-Fisher BJ, Kurlander JE. A survey of internists' recommendations for aspirin in older adults and barriers to evidence-based use. J Thromb Thrombolysis 2022; 54:639-646. [PMID: 35699872 DOI: 10.1007/s11239-022-02669-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 12/25/2022]
Abstract
Recent trials suggest that aspirin for primary prevention may do more harm than good for some, including adults over 70 years of age. We sought to assess how primary care providers (PCPs) use aspirin for the primary prevention in older patients and to identify barriers to use according to recent guidelines, which recommend against routine use in patients over age 70. We surveyed PCPs about whether they would recommend aspirin in clinical vignettes of a 75-year-old patient with a 10-year atherosclerotic cardiovascular disease risk of 25%. We also queried perceived difficulty following guideline recommendations, as well as perceived barriers and facilitators. We obtained responses from 372 PCPs (47.9% response). In the patient vignette, 45.4% of clinicians recommended aspirin use, which did not vary by whether the patient was using aspirin initially (p = 0.21); 41.7% believed aspirin was beneficial. Perceived barriers to guideline-based aspirin use included concern about patients being upset (41.6%), possible malpractice claims (25.0%), and not having a strategy for discussing aspirin use (24.5%). The estimated adjusted probability of rating the guideline as "hard to follow" was higher in clinicians who believed aspirin was beneficial (29.4% vs. 8.0%; p < 0.001) and who worried the patient would be upset if told to stop aspirin (26.7% vs. 12.5%; p = 0.001). Internists vary considerably in their recommendations for aspirin use for primary prevention in older patients. A high proportion of PCPs continue to believe aspirin is beneficial in this setting. These results can inform de-implementation efforts to optimize evidence-based aspirin use.
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Affiliation(s)
- Jordan K Schaefer
- Department of Internal Medicine, Division of Hematology/Oncology, University of Michigan, C366 Med Inn Building, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA.
| | - Geoffrey D Barnes
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jeremy B Sussman
- Department of Internal Medicine, Division of General Medicine, University of Michigan, Ann Arbor, MI, USA.,Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Sameer D Saini
- Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA.,Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
| | - Tanner J Caverly
- Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA.,Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA.,Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
| | - Susan Read
- Research Center, American College of Physicians, Philadelphia, PA, USA
| | - Brian J Zikmund-Fisher
- Department of Internal Medicine, Division of General Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA.,Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jacob E Kurlander
- Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA.,Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA
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Voepel-Lewis T, Boyd CJ, Tait AR, McCabe SE, Zikmund-Fisher BJ. A Risk Education Program Decreases Leftover Prescription Opioid Retention: An RCT. Am J Prev Med 2022; 63:564-573. [PMID: 35909029 PMCID: PMC10866200 DOI: 10.1016/j.amepre.2022.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/14/2022] [Accepted: 04/22/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Retaining leftover prescription opioids poses the risks of diversion, misuse, overdose, and death for youth and other family members. This study examined whether a new educational program would enhance risk perceptions and disposal intentions among parents and decrease their retention of leftover prescription opioids. STUDY DESIGN This study is an RCT (NCT03287622). SETTING/PARTICIPANTS A total of 648 parents whose children were prescribed opioid analgesics were recruited from a Midwestern, academic pediatric hospital between 2017 and 2019. Parents were randomized to receive routine information (control) with or without Scenario-Tailored Opioid Messaging Program intervention. INTERVENTION The intervention provided opioid risk and mitigation advice using interactive decisional feedback. MAIN OUTCOME MEASURES The main outcome measures were parents' perceptions of the riskiness of keeping/sharing opioids and child misuse measured at baseline, Days 3 and 14, their intention to dispose of leftover opioids, and their final retention decisions after the child's use (at or around Day 14). RESULTS Perceived riskiness of child misuse and keeping/sharing opioids increased from baseline through Day 14 only for parents in the intervention group (p≤0.006). However, there were no significant differences in risk perceptions between groups and no intervention effect on disposal intentions at either follow-up. Despite these findings, the intervention reduced the likelihood of parents' opioid retention when adjusted for important parent and child covariates (AOR=0.48; 95% CI=0.25, 0.93; p=0.028). Parents who reported past opioid misuse also showed higher retention behavior (AOR=4.78; 95% CI=2.05, 11.10; p<0.001). CONCLUSIONS A scenario-specific educational intervention emphasizing the potential risks that leftover opioids pose to children and that provided risk mitigation advice decreased parents' retention of their child's leftover opioid medication. Removing leftover prescription drugs from homes with children may be an important step to reducing diversion, accidental poisoning, and misuse among youth. TRIAL REGISTRATION This study is registered at www. CLINICALTRIALS gov NCT03287622.
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Affiliation(s)
- Terri Voepel-Lewis
- School of Nursing, University of Michigan, Ann Arbor, Michigan; Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan; Center for the Study of Drugs, Alcohol, Smoking and Health (DASH Center), University of Michigan, Ann Arbor, Michigan.
| | - Carol J Boyd
- School of Nursing, University of Michigan, Ann Arbor, Michigan; Center for the Study of Drugs, Alcohol, Smoking and Health (DASH Center), University of Michigan, Ann Arbor, Michigan
| | - Alan R Tait
- Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan; Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan
| | - Sean Esteban McCabe
- School of Nursing, University of Michigan, Ann Arbor, Michigan; Center for the Study of Drugs, Alcohol, Smoking and Health (DASH Center), University of Michigan, Ann Arbor, Michigan; Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Brian J Zikmund-Fisher
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan; Department of Health Behavior Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan; Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
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15
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Yan H, Kukora SK, Pituch K, Deldin PJ, Arslanian-Engoren C, Zikmund-Fisher BJ. Adapting user-centered design principles to improve communication of peer parent narratives on pediatric tracheostomy. BMC Med Inform Decis Mak 2022; 22:197. [PMID: 35879768 PMCID: PMC9316812 DOI: 10.1186/s12911-022-01911-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Parents who have to make tracheostomy decisions for their critically ill child may face forecasting errors and wish to learn from peer parents. We sought to develop an intervention with peer parent narratives to help parents anticipate and prepare for future challenges before making a decision. METHODS To ensure that the intervention reflects parents' needs (rather than experts' opinions), we adapted a user-centered design (UCD) process to identify decision-critical information and refine the presentation format by interviewing parents who had tracheostomy decision making experience. Phase 1 (n = 10) presented 15 possible forecasting errors and asked participants to prioritize and justify the problematic ones. It also asked participants to comment on the draft narratives and preferred delivery mode and time of the intervention. Phase 2 (n = 9 additional parents and 1 previous parent) iteratively collected feedback over four waves of user interviews to guide revisions to the informational booklet. RESULTS Phase 1 revealed that parents wanted information to address all forecasting errors as soon as tracheostomy becomes an option. They also highlighted diverse family situations and the importance of offering management strategies. The resulting prototype booklet contained five sections: introduction, child's quality of life, home care, practical challenges, and resources. Feedback from Phase 2 focused on emphasizing individualized situations, personal choice, seriousness of the decision, and caregiver health as well as presenting concrete illustrations of future challenges with acknowledgement of positive outcomes and advice. We also learned that parents preferred to use the booklet with support from the care team rather than read it alone. CONCLUSIONS A UCD process enabled inclusion of parental perspectives that were initially overlooked and tailoring of the intervention to meet parental expectations. Similar UCD-based approaches may be valuable in the design of other types of patient communications (e.g., decision aids).
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Affiliation(s)
- Haoyang Yan
- Department of Psychology, University of Michigan, 530 Church Street, Ann Arbor, MI, 48109, USA. .,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Avenue, 21st Floor, Chicago, IL, 60611, USA.
| | - Stephanie K Kukora
- Department of Pediatrics, C.S. Mott Children's Hospital, Michigan Medicine, 1540 E Hospital Drive, Ann Arbor, MI, 48109, USA
| | - Kenneth Pituch
- Department of Pediatrics, C.S. Mott Children's Hospital, Michigan Medicine, 1540 E Hospital Drive, Ann Arbor, MI, 48109, USA
| | - Patricia J Deldin
- Department of Psychology, University of Michigan, 530 Church Street, Ann Arbor, MI, 48109, USA.,Department of Psychiatry, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Cynthia Arslanian-Engoren
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 North Ingalls, Ann Arbor, MI, 48109, USA
| | - Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.,Department of Internal Medicine, University of Michigan, 2800 Plymouth Road, Ann Arbor, MI, 48109, USA
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16
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Zikmund-Fisher BJ, Tuepker A, Metcalf EE, Strange W, Teo AR. Applying user-centered design in the development of nudges for a pragmatic trial to reduce no-shows among veterans. Patient Educ Couns 2022; 105:1620-1627. [PMID: 34756639 PMCID: PMC9033881 DOI: 10.1016/j.pec.2021.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/12/2021] [Accepted: 10/20/2021] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To incorporate user-centered design processes into the refinement of nudges designed to reduce no-shows among healthcare appointments for military veterans in the Veterans Health Administration (VA). METHODS We developed candidate nudges as brief messages based on four broad concepts in behavioral science. We then conducted iterative waves of multi-stage interviews (N = 27) that included a pile sorting task, a "think-aloud" review of each message, and prototype letter reviews. Rapid consensus analysis of each wave's feedback iteratively refined message language. RESULTS Veterans rejected several theoretically plausible messages focusing on avoiding the burden of rescheduling missed appointments or the monetary cost of no-shows. Participants suggested framing calling to cancel an appointment as helping other veterans and emphasized a new motivational theme: expressing personal concern for the veteran. CONCLUSION Use of iterative UCD methods allowed for early identification of both messages inappropriate for veterans and new veteran-generated nudges around non-judgmental validation that could be incorporated in the design of our pragmatic trial. PRACTICE IMPLICATIONS Rapid team-based qualitative analysis, iterative material design, and space in the study design to incorporate entirely new insights from participants into study materials are all approaches that can improve communications of what matters most to a specific population.
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Affiliation(s)
- Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Anaïs Tuepker
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), Portland, OR, USA; Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, Portland, OR, USA
| | - Emily E Metcalf
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), Portland, OR, USA
| | - Wynn Strange
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), Portland, OR, USA
| | - Alan R Teo
- VA Portland Health Care System, HSR&D Center to Improve Veteran Involvement in Care (CIVIC), Portland, OR, USA; Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA; School of Public Health, Oregon Health & Science University and Portland State University, Portland, OR, USA
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17
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Scherer LD, Shaffer VA, Zikmund-Fisher BJ. Maximizing–satisficing and medical maximizing–minimizing are related but distinct dispositions. Decision 2022. [DOI: 10.1037/dec0000183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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18
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Zikmund-Fisher BJ. Toward Transparent Demographic Analyses: Statement on the Use and Reporting of Classification Variables Presented as Measuring Individual Characteristics Such as Race, Ethnicity, Indigeneity, National Origin, Gender, Sexual Orientation, or Socioeconomic Status. Med Decis Making 2022; 42:277-279. [DOI: 10.1177/0272989x221082998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Brian J. Zikmund-Fisher
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
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19
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Huang Z, Ji M, Ren J, Sun X, Boulton ML, Zikmund-Fisher BJ, Wagner AL. Effect of the framing of HPV vaccination on parents' willingness to accept an HPV vaccine. Vaccine 2022; 40:897-903. [PMID: 34996644 PMCID: PMC8816874 DOI: 10.1016/j.vaccine.2021.12.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 12/14/2021] [Accepted: 12/21/2021] [Indexed: 11/25/2022]
Abstract
In China, HPV vaccines are not mandatory and have low uptake. In light of the U.S.'s experience in rolling out the vaccine with an initial focus primarily on HPV as a sexually transmitted infection but transitioning later to cancer messaging, we used a multifactorial experiment to create several different messages about the HPV vaccine across age, communicability, and cancer domains. In this study, we assess the effect of the different messages on willingness to accept an HPV vaccine, and characterize how parental sociodemographics and the age/gender of a child also impact willingness to obtain an HPV vaccine. In total, 1,021 parents of children aged<18 years old in Shanghai, China were randomized to receive a message about cancer (HPV causes cervical cancers vs cancers in general), infectiousness (HPV is sexually transmitted, or is an infectious disease in general, or not mentioned), and recommended age of vaccination (before middle school, before college/work, or not mentioned). Parents were asked if they would vaccinate a hypothetical son or daughter of different ages 6, 12, or 18 years old). In a multivariable logistic regression model adjusting for parental sociodemographic characteristics, parents were more likely to want to vaccinate a daughter vs a son, and an older vs younger child. Messaging had some effect in certain circumstances: parents were more likely to accept a vaccine for a 6-year-old son if given information that it protected against cancers in general. Providing information about a sexually transmitted infection led to higher willingness to vaccinate a son 6 years old and a daughter 6 or 12 years old. This study showed messaging had some limited impact on willingness to vaccinate against HPV, but more research is needed on how to increase uptake of the HPV vaccine when it is not publicly funded.
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Affiliation(s)
- Zhuoying Huang
- Department of Immunization Program, Shanghai Municipal Centers for Disease Control & Prevention, NO. 1380, West Zhongshan Road, 200336, Shanghai, China
| | - Mengdi Ji
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - Jia Ren
- Department of Immunization Program, Shanghai Municipal Centers for Disease Control & Prevention, NO. 1380, West Zhongshan Road, 200336, Shanghai, China
| | - Xiaodong Sun
- Department of Immunization Program, Shanghai Municipal Centers for Disease Control & Prevention, NO. 1380, West Zhongshan Road, 200336, Shanghai, China
| | - Matthew L. Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA,Department of Internal Medicine, Division of Infectious Disease, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Brian J. Zikmund-Fisher
- Department of Health Behavior & Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA,Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Abram L. Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
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20
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Dossett LA, Mott NM, Bredbeck BC, Wang T, Jobin CTC, Hughes TM, Hawley ST, Zikmund-Fisher BJ. Using Tailored Messages to Target Overuse of Low-Value Breast Cancer Care in Older Women. J Surg Res 2022; 270:503-512. [PMID: 34801801 PMCID: PMC8734932 DOI: 10.1016/j.jss.2021.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/19/2021] [Accepted: 10/11/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND National recommendations allow for the omission of sentinel lymph node biopsy (SLNB) and post-lumpectomy radiotherapy in women ≥ 70 y/o with early-stage, hormone-receptor positive invasive breast cancer, but these therapies remain common. Previous work demonstrates an individual's maximizing-minimizing trait-an inherent preference for more or less medical care-may influence the preference for low-value care. MATERIALS AND METHODS We recruited an equal number of women ≥ 70 yrs who were maximizers, minimizers, or neutral based on a validated measure between September 2020 and November 2020. Participants were presented a hypothetical breast cancer diagnosis before randomization to one of three follow-up messages: maximizer-tailored, minimizer-tailored, or neutral. Tailored messaging aimed to redirect maximizers and minimizers toward declining SLNB and radiotherapy. The main outcome measure was predicted probability of choosing SLNB or radiotherapy. RESULTS The final analytical sample (n = 1600) was 515 maximizers (32%), 535 neutral (33%) and 550 (34%) minimizers. Higher maximizing tendency positively correlated with electing both SLNB and radiotherapy on logistic regression (P < 0.01). Any tailoring (maximizer- or minimizer-tailored) reduced preference for SLNB in maximizing and neutral women but had no effect in minimizing women. Tailoring had no impact on radiotherapy decision, except for an increased probability of minimizers electing radiotherapy when presented with maximizer-tailored messaging. CONCLUSIONS Maximizing-minimizing tendencies are associated with treatment preferences among women facing a hypothetical breast cancer diagnosis. Targeted messaging may facilitate avoidance of low-value breast cancer care, particularly for SLNB.
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Affiliation(s)
- Lesly A. Dossett
- University of Michigan, Department of Surgery, Ann Arbor, MI, USA,University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA,Center for Bioethics and Social Sciences in Medicine (CBSSM), Ann Arbor, MI, USA
| | - Nicole M. Mott
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Brooke C. Bredbeck
- University of Michigan, Department of Surgery, Ann Arbor, MI, USA,University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Ton Wang
- University of Michigan, Department of Surgery, Ann Arbor, MI, USA,University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Chad TC. Jobin
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Tasha M. Hughes
- University of Michigan, Department of Surgery, Ann Arbor, MI, USA,University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA,Center for Bioethics and Social Sciences in Medicine (CBSSM), Ann Arbor, MI, USA
| | - Sarah T. Hawley
- University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA,Center for Bioethics and Social Sciences in Medicine (CBSSM), Ann Arbor, MI, USA,University of Michigan, Department of Internal Medicine, Ann Arbor, MI, USA,University of Michigan, Department of Health Education and Health Behavior, Ann Arbor, MI, USA
| | - Brian J. Zikmund-Fisher
- Center for Bioethics and Social Sciences in Medicine (CBSSM), Ann Arbor, MI, USA,University of Michigan, Department of Internal Medicine, Ann Arbor, MI, USA,University of Michigan, Department of Health Education and Health Behavior, Ann Arbor, MI, USA
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21
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Caverly TJ, Skurla SE, Robinson CH, Zikmund-Fisher BJ, Hayward RA. The Need for Brevity During Shared Decision Making (SDM) for Cancer Screening: Veterans' Perspectives on an "Everyday SDM" Compromise. MDM Policy Pract 2021; 6:23814683211055120. [PMID: 34722882 PMCID: PMC8554567 DOI: 10.1177/23814683211055120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/09/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction. Detailed or “full” shared decision making (SDM) about cancer screening is difficult in the primary care setting. Time spent discussing cancer screening is time not spent on other important issues. Given time constraints, brief SDM that is incomplete but addresses key elements may be feasible and acceptable. However, little is known about how patients feel about abbreviated SDM. This study assessed patient perspectives on a compromise solution (“everyday SDM”): 1) primary care provided makes a tailored recommendation, 2) briefly presents qualitative information on key tradeoffs, and 3) conveys full support for decisional autonomy and desires for more information. Methods. We recruited a stratified random sample of Veterans from an academic Veterans Affairs medical center who were eligible for lung cancer screening, oversampling women and minority patients, to attend a 6-hour deliberative focus group. Experts informed participants about cancer screening, factors that influence screening benefits, and the role of patient preferences. Then, facilitator-led small groups elicited patient questions and informed opinions about the everyday SDM proposal, its acceptability, and their recommendations for improvement. Results. Thirty-six Veterans with a heavy smoking history participated (50% male, 83% white). There was a strong consensus that everyday SDM was acceptable if patients were the final deciders and could get more information on request. Participants broadly recommended that clinicians only mention downsides directly related to screening and avoid discussion of potential downstream harms (such as biopsies). Discussion. Although further testing in more diverse populations and different conditions is needed, these patients found the everyday SDM approach to be acceptable for routine lung cancer screening discussions, despite its use of an explicit recommendation and presentation of only qualitative information.
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Affiliation(s)
- Tanner J Caverly
- Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor, MI, USA
| | - Sarah E Skurla
- Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor, MI, USA
| | - Claire H Robinson
- Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor, MI, USA
| | - Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Rodney A Hayward
- Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor, MI, USA
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22
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Piper MS, Zikmund-Fisher BJ, Maratt JK, Kurlander J, Metko V, Waljee AK, Saini SD. Patients' Willingness to Share Limited Endoscopic Resources: A Brief Report on the Results of a Large Regional Survey. MDM Policy Pract 2021; 6:23814683211045648. [PMID: 34616912 PMCID: PMC8488065 DOI: 10.1177/23814683211045648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 08/05/2021] [Indexed: 12/25/2022] Open
Abstract
Background. In some health care systems, patients face long wait times for screening colonoscopy. We sought to assess whether patients at low risk for colorectal cancer (CRC) would be willing to delay their own colonoscopy so higher-risk peers could undergo colonoscopy sooner. Methods. We surveyed 1054 Veterans regarding their attitudes toward repeat colonoscopy and risk-based prioritization. We used multivariable regression to identify patient factors associated with willingness to delay screening for a higher-risk peer. Results. Despite a physician recommendation to stop screening, 29% of respondents reported being "not at all likely" to stop. However, 94% reported that they would be willing to delay their own colonoscopy for a higher-risk peer. Greater trust in physician and greater health literacy were positively associated with willingness to wait, while greater perceived threat of CRC and Black or Latino race/ethnicity were negatively associated with willingness to wait. Conclusion. Despite high enthusiasm for repeat screening, patients were willing to delay their own colonoscopy for higher-risk peers. Appealing to altruism could be effective when utilizing scarce resources.
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Affiliation(s)
- Marc S. Piper
- Marc S. Piper, 30055 Northwestern Highway,
Suite 250, Farmington Hills, MI 48334, USA; Telephone: (248) 882-8639
()
| | - Brian J. Zikmund-Fisher
- Department of Health Behavior and Health
Education, University of Michigan School of Public Health, Ann Arbor,
Michigan,Department of Internal Medicine, University of
Michigan Medical School, Ann Arbor, Michigan
| | - Jennifer K. Maratt
- Division of Gastroenterology, Department of
Internal Medicine, University of Michigan, Ann Arbor, Michigan,Division of Gastroenterology, Department of
Internal Medicine, Indiana University School of Medicine, Indianapolis,
Indiana,Richard L. Roudebush VA Medical Center,
Indianapolis, Indiana,Regenstrief Institute, Inc, Indianapolis,
Indiana
| | - Jacob Kurlander
- Division of Gastroenterology, Department of
Internal Medicine, University of Michigan, Ann Arbor, Michigan,VA HSR&D Center for Clinical Management
Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Valbona Metko
- Division of Gastroenterology, Department of
Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Akbar K. Waljee
- Division of Gastroenterology, Department of
Internal Medicine, University of Michigan, Ann Arbor, Michigan,VA HSR&D Center for Clinical Management
Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Sameer D. Saini
- Division of Gastroenterology, Department of
Internal Medicine, University of Michigan, Ann Arbor, Michigan,VA HSR&D Center for Clinical Management
Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
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23
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Shih SF, Wagner AL, Masters NB, Prosser LA, Lu Y, Zikmund-Fisher BJ. Vaccine Hesitancy and Rejection of a Vaccine for the Novel Coronavirus in the United States. Front Immunol 2021; 12:558270. [PMID: 34194418 PMCID: PMC8236639 DOI: 10.3389/fimmu.2021.558270] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/27/2021] [Indexed: 12/15/2022] Open
Abstract
The arrival of the COVID-19 vaccine has been accompanied by increased discussion of vaccine hesitancy. However, it is unclear if there are shared patterns between general vaccine hesitancy and COVID-19 vaccine rejection, or if these are two different concepts. This study characterized rejection of a hypothetical COVID-19 vaccine, and compared patterns of association between general vaccine hesitancy and COVID-19 vaccine rejection. The survey was conducted online March 20-22, 2020. Participants answered questions on vaccine hesitancy and responded if they would accept the vaccine given different safety and effectiveness profiles. We assessed differences in COVID-19 rejection and general vaccine hesitancy through logistic regressions. Among 713 participants, 33.0% were vaccine hesitant, and 18.4% would reject a COVID-19 vaccine. Acceptance varied by effectiveness profile: 10.2% would reject a 95% effective COVID-19 vaccine, but 32.4% would reject a 50% effective vaccine. Those vaccine hesitant were significantly more likely to reject COVID-19 vaccination [odds ratio (OR): 5.56, 95% confidence interval (CI): 3.39, 9.11]. In multivariable logistic regression models, there were similar patterns for vaccine hesitancy and COVID-19 vaccine rejection by gender, race/ethnicity, family income, and political affiliation. But the direction of association flipped by urbanicity (P=0.0146, with rural dwellers less likely to be COVID-19 vaccine rejecters but more likely to be vaccine hesitant in general), and age (P=0.0037, with fewer pronounced differences across age for COVID-19 vaccine rejection, but a gradient of stronger vaccine hesitancy in general among younger ages). During the COVID-19 epidemic’s early phase, patterns of vaccine hesitancy and COVID-19 vaccine rejection were relatively similar. A significant minority would reject a COVID-19 vaccine, especially one with less-than-ideal effectiveness. Preparations for introducing the COVID-19 vaccine should anticipate substantial hesitation and target concerns, especially among younger adults.
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Affiliation(s)
- Shu-Fang Shih
- Department of Health Administration, College of Health Professions, Virginia Commonwealth University, Richmond, VA, United States
| | - Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Nina B Masters
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States
| | - Lisa A Prosser
- Department of Health Administration, College of Health Professions, Virginia Commonwealth University, Richmond, VA, United States.,Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Yihan Lu
- Department of Epidemiology, Key Laboratory of Public Health Safety (Ministry of Education), Fudan University School of Public Health, Shanghai, China
| | - Brian J Zikmund-Fisher
- Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, United States.,Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
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24
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Bonner C, Trevena LJ, Gaissmaier W, Han PKJ, Okan Y, Ozanne E, Peters E, Timmermans D, Zikmund-Fisher BJ. Current Best Practice for Presenting Probabilities in Patient Decision Aids: Fundamental Principles. Med Decis Making 2021; 41:821-833. [PMID: 33660551 DOI: 10.1177/0272989x21996328] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Shared decision making requires evidence to be conveyed to the patient in a way they can easily understand and compare. Patient decision aids facilitate this process. This article reviews the current evidence for how to present numerical probabilities within patient decision aids. METHODS Following the 2013 review method, we assembled a group of 9 international experts on risk communication across Australia, Germany, the Netherlands, the United Kingdom, and the United States. We expanded the topics covered in the first review to reflect emerging areas of research. Groups of 2 to 3 authors reviewed the relevant literature based on their expertise and wrote each section before review by the full authorship team. RESULTS Of 10 topics identified, we present 5 fundamental issues in this article. Although some topics resulted in clear guidance (presenting the chance an event will occur, addressing numerical skills), other topics (context/evaluative labels, conveying uncertainty, risk over time) continue to have evolving knowledge bases. We recommend presenting numbers over a set time period with a clear denominator, using consistent formats between outcomes and interventions to enable unbiased comparisons, and interpreting the numbers for the reader to meet the needs of varying numeracy. DISCUSSION Understanding how different numerical formats can bias risk perception will help decision aid developers communicate risks in a balanced, comprehensible manner and avoid accidental "nudging" toward a particular option. Decisions between probability formats need to consider the available evidence and user skills. The review may be useful for other areas of science communication in which unbiased presentation of probabilities is important.
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Affiliation(s)
- Carissa Bonner
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, NSW, Australia.,ASK-GP NHMRC Centre of Research Excellence, The University of Sydney, Australia
| | - Lyndal J Trevena
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, NSW, Australia.,ASK-GP NHMRC Centre of Research Excellence, The University of Sydney, Australia
| | | | - Paul K J Han
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, USA.,School of Medicine, Tufts University, USA
| | - Yasmina Okan
- Centre for Decision Research, University of Leeds, Leeds, UK
| | | | - Ellen Peters
- Center for Science Communication Research, University of Oregon, Eugene, OR, USA
| | - Daniëlle Timmermans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, North Holland, The Netherlands
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25
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Trevena LJ, Bonner C, Okan Y, Peters E, Gaissmaier W, Han PKJ, Ozanne E, Timmermans D, Zikmund-Fisher BJ. Current Challenges When Using Numbers in Patient Decision Aids: Advanced Concepts. Med Decis Making 2021; 41:834-847. [PMID: 33660535 DOI: 10.1177/0272989x21996342] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Decision aid developers have to convey complex task-specific numeric information in a way that minimizes bias and promotes understanding of the options available within a particular decision. Whereas our companion paper summarizes fundamental issues, this article focuses on more complex, task-specific aspects of presenting numeric information in patient decision aids. METHODS As part of the International Patient Decision Aids Standards third evidence update, we gathered an expert panel of 9 international experts who revised and expanded the topics covered in the 2013 review working in groups of 2 to 3 to update the evidence, based on their expertise and targeted searches of the literature. The full panel then reviewed and provided additional revisions, reaching consensus on the final version. RESULTS Five of the 10 topics addressed more complex task-specific issues. We found strong evidence for using independent event rates and/or incremental absolute risk differences for the effect size of test and screening outcomes. Simple visual formats can help to reduce common judgment biases and enhance comprehension but can be misleading if not well designed. Graph literacy can moderate the effectiveness of visual formats and hence should be considered in tool design. There is less evidence supporting the inclusion of personalized and interactive risk estimates. DISCUSSION More complex numeric information. such as the size of the benefits and harms for decision options, can be better understood by using incremental absolute risk differences alongside well-designed visual formats that consider the graph literacy of the intended audience. More research is needed into when and how to use personalized and/or interactive risk estimates because their complexity and accessibility may affect their feasibility in clinical practice.
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Affiliation(s)
- Lyndal J Trevena
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Ask Share Know NHMRC Centre for Research Excellence, The University of Sydney, Australia
| | - Carissa Bonner
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Ask Share Know NHMRC Centre for Research Excellence, The University of Sydney, Australia
| | - Yasmina Okan
- Centre for Decision Research, University of Leeds, Leeds, UK
| | | | | | - Paul K J Han
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, USA.,School of Medicine, Tufts University, Medford, MA, USA
| | | | - Danielle Timmermans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, North Holland, The Netherlands
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26
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Zikmund-Fisher BJ, Shaffer VA, Scherer LD. Promoting Reflection on Medical Maximizing-Minimizing Preferences May Create Undesired Effects on Decisions About Low-Benefit and High-Benefit Care. MDM Policy Pract 2021; 6:2381468320987498. [PMID: 33598547 PMCID: PMC7863160 DOI: 10.1177/2381468320987498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 12/21/2020] [Indexed: 11/15/2022] Open
Abstract
Background Medical maximizing-minimizing (MM) preferences predict a variety of medical decisions. We tested whether informing people about their MM preferences and asking them to reflect on the pros and cons of that preference would improve medical decisions when clear clinical recommendations exist. Methods We surveyed 1219 US adults age 40+ that were sampled to ensure a 50%/50% distribution of medical maximizers versus minimizers. Participants either received no MM feedback (Control) or received feedback about their MM type and instructions to reflect on how that MM type can be helpful in some circumstances and problematic in others (Reflection). All participants then completed five hypothetical decision scenarios regarding low-value care services (e.g., head computed tomography scan for mild concussion) and three about high-value care (e.g., flu vaccination). Results There were no significant differences between the Control and Reflection groups in five of eight scenarios. In three scenarios (two low-benefit and one high-benefit), we observed small effects in the nonhypothesized direction for the MM subgroup least likely to follow the recommendation (e.g., maximizers in the Reflection group were more likely to request low-benefit care). Conclusions Asking people to reflect on their MM preferences may be a counterproductive strategy for optimizing patient decision making around quality of care.
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Affiliation(s)
- Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, Department of Internal Medicine, and Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan
| | - Victoria A Shaffer
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri
| | - Laura D Scherer
- Division of Cardiology, University of Colorado, Denver, Colorado
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27
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Yan H, Deldin PJ, Kukora SK, Arslanian-Engoren C, Pituch K, Zikmund-Fisher BJ. Using Narratives to Correct Forecasting Errors in Pediatric Tracheostomy Decision Making. Med Decis Making 2021; 41:305-316. [PMID: 33559518 DOI: 10.1177/0272989x21990693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE Parents who face goals-of-care tracheostomy decisions may lack an understanding of challenges affecting their child's and family's long-term quality of life (QOL) to accurately forecast possible outcomes for decision making. We sought to examine whether and how parents' narratives of the child's and family's long-term QOL influence parental tracheostomy decisions and forecasting. METHOD We recruited US adult Amazon Mechanical Turk participants (N = 1966) who self-reported having a child (<6 y old) or planning a pregnancy within 5 y. Participants read a vignette about making a tracheostomy decision for their hypothetical neurologically impaired baby. They were randomized to 1 of the following 4 conditions: 1) Baby QOL narratives, 2) Family QOL narratives, 3) Baby QOL + Family QOL narratives, and 4) control: no narratives. They then made a decision about whether or not to pursue tracheostomy, forecasted their concerns about the baby's and family's QOL, reported their values and social norm beliefs about tracheostomy, comfort care, and parental medical decision making, and completed individual differences scales and demographics. RESULTS Controlling for individual characteristics, participants in the Baby QOL and Baby QOL + Family QOL conditions were less likely to choose tracheostomy as compared with the control (odds ratio [OR] = 0.38 and 0.25, respectively, P < 0.001). Fewer participants in the Family QOL condition chose tracheostomy compared with the control, but this difference was not statistically significant (OR = 0.70, P = 0.11). Moreover, narratives increased pessimistic forecasting, which was associated with less interest in tracheostomy. CONCLUSION Narratives clarifying long-term implications of pursuing tracheostomy have the potential to influence forecasting and decisions. Narrative-based interventions may be valuable in other situations in which forecasting errors are common.
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Affiliation(s)
- Haoyang Yan
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Patricia J Deldin
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Stephanie K Kukora
- C.S. Mott Children's Hospital and Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
| | - Cynthia Arslanian-Engoren
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Kenneth Pituch
- C.S. Mott Children's Hospital and Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA
| | - Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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28
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Townsel C, Moniz MH, Wagner AL, Zikmund-Fisher BJ, Hawley S, Jiang L, Stout MJ. COVID-19 vaccine hesitancy among reproductive-aged female tier 1A healthcare workers in a United States Medical Center. J Perinatol 2021; 41:2549-2551. [PMID: 34497336 PMCID: PMC8424167 DOI: 10.1038/s41372-021-01173-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/08/2021] [Accepted: 07/14/2021] [Indexed: 02/02/2023]
Affiliation(s)
- Courtney Townsel
- University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, MI, USA.
| | - Michelle H. Moniz
- grid.214458.e0000000086837370University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, MI USA ,grid.214458.e0000000086837370University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI USA
| | - Abram L. Wagner
- grid.214458.e0000000086837370University of Michigan, Department of Epidemiology, Ann Arbor, MI USA
| | - Brian J. Zikmund-Fisher
- grid.214458.e0000000086837370University of Michigan, Department of Health Behavior and Health Education, Ann Arbor, MI USA ,grid.214458.e0000000086837370University of Michigan, Department of Internal Medicine, Ann Arbor, MI USA
| | - Sarah Hawley
- grid.214458.e0000000086837370University of Michigan, Institute for Healthcare Policy and Innovation, Ann Arbor, MI USA ,grid.214458.e0000000086837370University of Michigan, Center for Bioethics and Social Sciences in Medicine, Ann Arbor, MI USA
| | - Li Jiang
- grid.214458.e0000000086837370University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, MI USA
| | - Molly J. Stout
- grid.214458.e0000000086837370University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, MI USA
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29
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Wagner AL, Huang Z, Ren J, Laffoon M, Ji M, Pinckney LC, Sun X, Prosser LA, Boulton ML, Zikmund-Fisher BJ. Vaccine Hesitancy and Concerns About Vaccine Safety and Effectiveness in Shanghai, China. Am J Prev Med 2021; 60:S77-S86. [PMID: 33189502 PMCID: PMC7877188 DOI: 10.1016/j.amepre.2020.09.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Rapidly urbanizing communities in middle-income countries could be sources of vaccine hesitancy, and may create hot spots of low vaccination coverage. This study characterizes vaccine hesitancy in Shanghai and identifies disparities in vaccine safety and efficacy concerns by residency status-a marker for recent migration into the city. METHODS Parents of children aged ≤18 years from immunization clinics in Shanghai were enrolled in summer 2019, with the data analyzed during winter 2019-2020. The paper questionnaire used the Parental Attitudes towards Childhood Vaccines scale, which included questions about vaccine safety and efficacy concerns. The primary independent variable was residency-whether an individual was a Shanghai local or a recent migrant (i.e., non-local). Linear regression models assessed the relationship between residency and vaccine safety and efficacy concerns. RESULTS Among 1,021 participants, 65.4% had local residency, and the remainder were urban non-locals (13.1%) or rural non-locals (21.5%). A majority of parents expressed concerns about vaccine side effects (73.8%), vaccine safety (63.9%), and vaccine effectiveness (52.4%). Compared with locals, rural non-locals were more concerned about vaccine side effects (β=0.26, 95% CI=0.07, 0.46), vaccine safety (β=0.42, 95% CI=0.19, 0.65), and vaccine effectiveness (β=0.37, 95% CI=0.16, 0.58). CONCLUSIONS Differences in vaccine hesitancy by residency could lead to geographical and sociodemographic disparities in vaccination coverage and outbreaks of vaccine-preventable disease. SUPPLEMENT INFORMATION This article is part of a supplement entitled Global Vaccination Equity, which is sponsored by the Global Institute for Vaccine Equity at the University of Michigan School of Public Health.
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Affiliation(s)
- Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan.
| | - Zhuoying Huang
- Department of Immunization Program, Shanghai Municipal Centers for Disease Control and Prevention, Shanghai, China
| | - Jia Ren
- Department of Immunization Program, Shanghai Municipal Centers for Disease Control and Prevention, Shanghai, China
| | - Megan Laffoon
- Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Mengdi Ji
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Leah C Pinckney
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Xiaodong Sun
- Department of Immunization Program, Shanghai Municipal Centers for Disease Control and Prevention, Shanghai, China
| | - Lisa A Prosser
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Department of Internal Medicine, Division of Infectious Disease, University of Michigan Medical School, Ann Arbor, Michigan
| | - Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan; Department of Internal Medicine, Division of General Medicine, University of Michigan Medical School, Ann Arbor, Michigan
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Zikmund-Fisher BJ. A Call for Explainer/Tutorial Articles and Changes to Manuscript Submission and Review at MDM and MDM P&P. MDM Policy Pract 2020; 5:2381468320966542. [PMID: 33178889 PMCID: PMC7592320 DOI: 10.1177/2381468320966542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 08/25/2020] [Indexed: 11/16/2022] Open
Affiliation(s)
- Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
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Scherer LD, Shaffer VA, Caverly T, DeWitt J, Zikmund-Fisher BJ. Medical Maximizing-Minimizing Predicts Patient Preferences for High- and Low-Benefit Care. Med Decis Making 2020; 40:72-80. [PMID: 31975657 DOI: 10.1177/0272989x19891181] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Purpose. People vary in their general preferences for more v. less health care, and the validated Medical Maximizing-Minimizing Scale (MMS) reliably measures this orientation. Medical maximizers (people scoring highly on the MMS) prefer to receive more health care visits, medications, tests, and treatments, whereas minimizers prefer fewer services. However, it is unclear how maximizing-minimizing preferences relate to willingness to pursue appropriate health care. We hypothesized that minimizers are at increased risk of rejecting evidence-based high-benefit care and that maximizers are at risk of wanting low-benefit care. Design. In total, 785 US adults recruited through an online panel expressed preferences to receive or forgo a health care intervention in 18 hypothetical scenarios. In 8 scenarios, the intervention was high benefit per evidence-based guidelines. In the remaining 10 scenarios, the intervention was low benefit. We assessed associations between participants' MMS score and their preferences for medical intervention in each scenario using regression analyses that adjusted for hypochondriasis, health risk tolerance, health status, and demographic variables. Results. MMS score was significantly associated with preferences in all 18 scenarios after adjusting for other variables. The MMS uniquely explained 11% of the variance in preferences for high-benefit care and 29% of the variance in preferences for low-benefit care. Differences between strong minimizers (10th percentile) and strong maximizers (90th percentile) across the 18 scenarios ranged from 5.6 to 32.3 points on a 1 to 100 preference scale. Conclusions. The MMS reliably predicts people's willingness to pursue appropriate care, both when appropriate care means taking high-benefit actions and when appropriate care means avoiding low-benefit actions. Targeting and tailoring messages according to maximizing-minimizing preferences might increase the effectiveness of both efforts to reduce overutilization of low-benefit services and campaigns to support uptake of high-benefit care.
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Affiliation(s)
- Laura D Scherer
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA.,VA Denver Center for Innovation (COIN), Denver, CO, USA
| | - Victoria A Shaffer
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - Tanner Caverly
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA.,Department of Medicine, University of Michigan, Ann Arbor, MI, USA.,Center for Clinical Management Research (CCMR), Ann Arbor VA, Ann Arbor, MI, USA
| | - Jeff DeWitt
- Center for Clinical Management Research (CCMR), Ann Arbor VA, Ann Arbor, MI, USA.,Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Brian J Zikmund-Fisher
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
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Vordenberg SE, Zikmund-Fisher BJ. Characteristics of older adults predict concern about stopping medications. J Am Pharm Assoc (2003) 2020; 60:773-780. [DOI: 10.1016/j.japh.2020.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 11/22/2019] [Accepted: 01/23/2020] [Indexed: 01/16/2023]
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Zikmund-Fisher BJ. A Call for Explainer/Tutorial Articles and Changes to Manuscript Submission and Review at MDM and MDM P&P. Med Decis Making 2020; 40:859-861. [PMID: 33081577 DOI: 10.1177/0272989x20958702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA (BJZ); Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI (BJZ); Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI (BJZ)
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Kukora SK, Batell B, Umoren R, Gray MM, Ravi N, Thompson C, Zikmund-Fisher BJ. Hilariously Bad News: Medical Improv as a Novel Approach to Teach Communication Skills for Bad News Disclosure. Acad Pediatr 2020; 20:879-881. [PMID: 32389759 DOI: 10.1016/j.acap.2020.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 03/11/2020] [Accepted: 05/03/2020] [Indexed: 11/18/2022]
Abstract
A targeted, improv-based exercise was developed as a novel skills training approach to bad news disclosure for medical professionals and trainees, focusing on specific characteristics that influence these conversations including nature of the bad news, implications, personal responsibility, and status differences.
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Affiliation(s)
- Stephanie K Kukora
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, CS Mott Children's Hospital, University of Michigan (S Kukora and B Batell), Ann Arbor, Mich; Center for Bioethics and Social Sciences in Medicine, University of Michigan (S Kukora and BJ Zikmund-Fisher), Ann Arbor, Mich.
| | - Brittany Batell
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, CS Mott Children's Hospital, University of Michigan (S Kukora and B Batell), Ann Arbor, Mich
| | - Rachel Umoren
- Division of Neonatology, Department of Pediatrics, University of Washington (R Umoren and MM Gray), Seattle, Wash; Seattle Children's Hospital (R Umoren and MM Gray), Seattle, Wash
| | - Megan M Gray
- Division of Neonatology, Department of Pediatrics, University of Washington (R Umoren and MM Gray), Seattle, Wash; Seattle Children's Hospital (R Umoren and MM Gray), Seattle, Wash
| | - Nithin Ravi
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh (N Ravi), Pittsburgh, Pa
| | | | - Brian J Zikmund-Fisher
- Center for Bioethics and Social Sciences in Medicine, University of Michigan (S Kukora and BJ Zikmund-Fisher), Ann Arbor, Mich; University of Michigan School of Public Health (BJ Zikmund-Fisher), Ann Arbor, Mich
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Mott N, Wang T, Miller J, Berlin NL, Hawley S, Jagsi R, Zikmund-Fisher BJ, Dossett LA. Medical Maximizing-Minimizing Preferences in Relation to Low-Value Services for Older Women with Hormone Receptor-Positive Breast Cancer: A Qualitative Study. Ann Surg Oncol 2020; 28:941-949. [PMID: 32720038 DOI: 10.1245/s10434-020-08924-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/08/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Multiple studies have demonstrated the safety of omitting therapies in older women with breast cancer. Despite de-implementation guidelines, up to 65% of older women continue to receive one or more of these low-value services. Previous work has investigated the role of both provider and patient attitudes as barriers to de-implementation; however, the importance of the patient's maximizing-minimizing preferences within this context remains unclear. METHODS In this qualitative study, we conducted 30 semi-structured interviews with women ≥ 70 years of age without a previous diagnosis of breast cancer to elicit perspectives on breast cancer treatment in relation to their medical maximizing-minimizing preferences, as determined by the single-item maximizer-minimizer elicitation question (MM1). We used an interpretive description approach in analysis to produce a thematic survey. RESULTS Participants were relatively evenly distributed across the MM1 (minimizer, n = 8; neutral, n = 13; maximizer, n = 9). Despite being told of recommendations allowing for the safe omission of sentinel lymph node biopsy and post-lumpectomy radiotherapy, maximizers consistently stated preferences for more medical intervention and aggressive therapies over minimizers and neutral individuals. CONCLUSION Medical maximizing-minimizing preferences in older women correspond with preferences for breast cancer treatment options that guidelines identify as potentially unnecessary. Increased awareness of patient-level variability in maximizing-minimizing preferences may be valuable in developing optimal intervention strategies to reduce utilization of low-value care.
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Affiliation(s)
- Nicole Mott
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ton Wang
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Jacquelyn Miller
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas L Berlin
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Sarah Hawley
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Health Education and Health Behavior, University of Michigan, Ann Arbor, MI, USA.,Center for Bioethics and Social Sciences in Medicine (CBSSM), Ann Arbor, MI, USA
| | - Reshma Jagsi
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.,Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA.,Center for Bioethics and Social Sciences in Medicine (CBSSM), Ann Arbor, MI, USA
| | - Brian J Zikmund-Fisher
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,Department of Health Education and Health Behavior, University of Michigan, Ann Arbor, MI, USA.,Center for Bioethics and Social Sciences in Medicine (CBSSM), Ann Arbor, MI, USA
| | - Lesly A Dossett
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA. .,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA. .,Center for Bioethics and Social Sciences in Medicine (CBSSM), Ann Arbor, MI, USA.
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Fridman I, Ubel PA, Blumenthal-Barby J, England CV, Currier JS, Eyal N, Freedberg KA, Halpern SD, Kelley CF, Kuritzkes DR, Le CN, Lennox JL, Pollak KI, Zikmund-Fisher BJ, Scherr KA. "Cure" Versus "Clinical Remission": The Impact of a Medication Description on the Willingness of People Living with HIV to Take a Medication. AIDS Behav 2020; 24:2054-2061. [PMID: 31900813 DOI: 10.1007/s10461-019-02769-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Many people living with HIV (PLWHIV) state that they would be willing to take significant risks to be "cured" of the virus. However, how they interpret the word "cure" in this context is not clear. We used a randomized survey to examine whether PLWHIV had a different willingness to take a hypothetical HIV medication if it causes flu-like symptoms, but provides: (a) cure, (b) remission that was labeled "cure", or (c) remission. PLWHIV (n = 454) were more willing to take a medication that provided a "cure" versus a "remission" if the side effects lasted less than 1 year. PLWHIV were more willing to take a medication that provided a remission that was labeled "cure" versus a "remission" (p = 0.01) if the side effects lasted 2 weeks. Clinicians and researchers should be aware of the impact of the word "cure" and ensure that PLWHIV fully understand the possible outcomes of their treatment options.
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Vordenberg SE, Zikmund-Fisher BJ. Older adults' strategies for obtaining medication refills in hypothetical scenarios in the face of COVID-19 risk. J Am Pharm Assoc (2003) 2020; 60:915-922.e4. [PMID: 32680780 PMCID: PMC7315968 DOI: 10.1016/j.japh.2020.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/09/2020] [Accepted: 06/15/2020] [Indexed: 12/05/2022]
Abstract
Objective To determine whether older adults would avoid going to the pharmacy (e.g., by restricting medications or requesting delivery) due to the risk of coronavirus disease (COVID-19). Our secondary objectives were to determine the types of medications that the older adults are more likely to restrict and to determine the factors that influence these decisions. Design Cross-sectional survey experiment in which participants read 6 scenarios, each stating that they had a 3-day supply of a particular medication remaining. Setting and participants National Web-based survey distributed to 1457 U.S. adults aged 65 years and older by Dynata from March 25, 2020, to April 1, 2020. Outcome measures Participants reported whether they would go to a pharmacy, have a medication delivered, or restrict the use of each medication. They reported their perceptions and experiences with COVID-19, health risk factors, preferences for more or less care (medical maximizer-minimizer), medication attitudes (beliefs about medicines questionnaire), health literacy, prescription insurance status, and demographics. Results Most participants (84%) were told to shelter in place, but only 12% reported attempting to obtain extra medications. Participants most often reported that they would go to the pharmacy to obtain each medication (ranging from tramadol 48.9% to insulin 64.9%) except for zolpidem, which they were most likely to restrict (45.4%). Participants who reported comorbidities that increased their risk of COVID-19 were just as likely to go to the pharmacy as those without. In multinomial logistic regression analyses, women and the oldest participants were more likely to seek delivery of medications. Restricting medications was most common for 2 symptom-focused medications (tramadol and zolpidem), and both demographic factors (e.g., gender) and beliefs (e.g., medical maximizing-minimizing preferences) were associated with such decisions. Conclusion Many older adults intend to continue to go to the pharmacy to obtain their medications during a pandemic, even those who have health conditions that further increase their risk for COVID-19.
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Scherer LD, Zikmund-Fisher BJ. Eliciting Medical Maximizing-Minimizing Preferences with a Single Question: Development and Validation of the MM1. Med Decis Making 2020; 40:545-550. [PMID: 32522094 DOI: 10.1177/0272989x20927700] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The 10-item validated Medical Maximizer-Minimizer Scale (MMS-10) assesses patients' preferences for aggressive v. more passive approaches to health care. However, because many research or clinical situations do not allow for use of a 10-item scale, we developed a single-item maximizer-minimizer elicitation question (the MM1) based on our experiences describing the construct to patient groups, clinical researchers, and the public. In 2 large samples of US adults (N = 368 and N = 814), the correlation between MMS-10 scores and the MM1 was .52 and .60, respectively. Both measures were robust predictors of medical preferences in a set of 12 hypothetical scenarios, and both had strong (and roughly equivalent) associations with 7 self-report measures of health care utilization. Our results demonstrate that the MM1 is a valid, brief elicitation of maximizing-minimizing preferences that can be used in clinical or research contexts where the 10-item scale is infeasible.
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Affiliation(s)
- Laura D Scherer
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA.,VA Denver Center for Innovation (COIN), Denver, CO, USA
| | - Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.,Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
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Witteman HO, Julien AS, Ndjaboue R, Exe NL, Kahn VC, (Angie) Fagerlin A, Zikmund-Fisher BJ. What Helps People Make Values-Congruent Medical Decisions? Eleven Strategies Tested across 6 Studies. Med Decis Making 2020; 40:266-278. [DOI: 10.1177/0272989x20904955] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. High-quality health decisions are often defined as those that are both evidence informed and values congruent. A values-congruent decision aligns with what matters to those most affected by the decision. Values clarification methods are intended to support values-congruent decisions, but their effects on values congruence are rarely evaluated. Methods. We tested 11 strategies, including the 3 most commonly used values clarification methods, across 6 between-subjects online randomized experiments in demographically diverse US populations ( n1 = 1346, n2 = 456, n3 = 840, n4 = 1178, n5 = 841, n6 = 2033) in the same hypothetical decision. Our primary outcome was values congruence. Decisional conflict was a secondary outcome in studies 3 to 6. Results. Two commonly used values clarification methods (pros and cons, rating scales) reduced decisional conflict but did not encourage values-congruent decisions. Strategies using mathematical models to show participants which option aligned with what mattered to them encouraged values-congruent decisions and reduced decisional conflict when assessed. Limitations. A hypothetical decision was necessary for ethical reasons, as we believed some strategies may harm decision quality. Later studies used more outcomes and covariates. Results may not generalize outside US-based adults with online access. We assumed validity and stability of values during the brief experiments. Conclusions. Failing to explicitly support the process of aligning options with values leads to increased proportions of values-incongruent decisions. Methods representing more than half of values clarification methods commonly in use failed to encourage values-congruent decisions. Methods that use models to explicitly show people how options align with their values offer more promise for helping people make decisions aligned with what matters to them. Decisional conflict, while arguably an important outcome in and of itself, is not an appropriate proxy for values congruence.
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Affiliation(s)
| | | | - Ruth Ndjaboue
- Universite Laval Faculte de medecine, Quebec, QC, Canada
| | - Nicole L. Exe
- University of Michigan Medical School, Ann Arbor, MI, USA
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Kurlander JE, Rubenstein JH, Richardson CR, Krein SL, De Vries R, Zikmund-Fisher BJ, Yang YX, Laine L, Weissman A, Saini SD. Physicians' Perceptions of Proton Pump Inhibitor Risks and Recommendations to Discontinue: A National Survey. Am J Gastroenterol 2020; 115:689-696. [PMID: 32091419 PMCID: PMC7196016 DOI: 10.14309/ajg.0000000000000558] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To provide contemporary estimates of internists' perceptions of adverse effects associated with proton pump inhibitors (PPIs) and self-reported clinical use. METHODS We invited 799 internists, including specialists and postgraduate trainees, to complete an online survey. Topics included perceptions of PPI adverse effects (AEs) and effectiveness for upper gastrointestinal bleeding (UGIB) prevention, changes in prescribing, and management recommendations for patients using PPIs for gastroesophageal reflux disease or UGIB prevention. We used logistic regression to identify factors associated with appropriate PPI continuation in the scenario of a patient at high risk for UGIB. RESULTS Among 437 respondents (55% response rate), 10% were trainees and 72% specialized in general medicine, 70% were somewhat/very concerned about PPI AEs, and 76% had somewhat/very much changed their prescribing. A majority believed PPIs increase the risk for 6 of 12 AEs queried. Fifty-two percent perceived PPIs to be somewhat/very effective for UGIB prevention. In a gastroesophageal reflux disease scenario in which PPI can be safely discontinued, 86% appropriately recommended PPI discontinuation. However, in a high-risk UGIB prevention scenario in which long-term PPI use is recommended, 79% inappropriately recommended discontinuation. In this latter scenario, perceived effectiveness for bleeding prevention was strongly associated with continuing PPI (odds ratio 7.68, P < 0.001 for moderately; odds ratio 17.3, P < 0.001 for very effective). Other covariates, including concern about PPI AEs, had no significant association. DISCUSSION Most internists believe PPIs cause multiple AEs and recommend discontinuation even in patients at high risk for UGIB. Future interventions should focus on ensuring that PPIs are prescribed appropriately according to individual risks and benefits.
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Affiliation(s)
- Jacob E Kurlander
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Joel H Rubenstein
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan, USA
| | - Caroline R Richardson
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Sarah L Krein
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan, USA
| | - Raymond De Vries
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, Michigan, USA
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Brian J Zikmund-Fisher
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Yu-Xiao Yang
- Department of Medicine, The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- The Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
| | - Loren Laine
- Yale School of Medicine, New Haven, Connecticut, USA
- Veterans Affair Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Arlene Weissman
- Research Center, American College of Physicians, Philadelphia, Pennsylvania, USA
| | - Sameer D Saini
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan, USA
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Chen DW, Reyes-Gastelum D, Wallner LP, Papaleontiou M, Hamilton AS, Ward KC, Hawley ST, Zikmund-Fisher BJ, Haymart MR. Disparities in risk perception of thyroid cancer recurrence and death. Cancer 2020; 126:1512-1521. [PMID: 31869452 PMCID: PMC7178109 DOI: 10.1002/cncr.32670] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 11/17/2019] [Accepted: 11/26/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND To the authors' knowledge, studies regarding risk perception among survivors of thyroid cancer are scarce. METHODS The authors surveyed patients who were diagnosed with differentiated thyroid cancer from the Surveillance, Epidemiology, and End Results registries of Georgia and Los Angeles County (2632 patients; 63% response rate). The analytic cohort was defined by a ≤5% risk of disease recurrence and mortality (1597 patients). Patients estimated their recurrence and mortality risks separately (increments of 10% and endpoints of ≤5% and ≥95%). Both outcomes were dichotomized between reasonably accurate estimates (risk perception of ≤5% or 10%) versus overestimation (risk perception of ≥20%). Multivariable logistic regression was used to identify factors associated with risk overestimation, and the relationships between overestimation and both worry and quality of life were evaluated. RESULTS In the current study sample, 24.7% of patients overestimated their recurrence risk and 12.5% overestimated their mortality risk. A lower educational level was associated with overestimating disease recurrence (≤high school diploma: odds ratio [OR], 1.64 [95% CI, 1.16-2.31]; and some college: OR, 1.36 [95% CI, 1.02-1.81]) and mortality (≤high school diploma: OR, 1.86 [95% CI, 1.18-2.93]) risk compared with those attaining at least a college degree. Hispanic ethnicity was found to be associated with overestimating recurrence risk (OR, 1.44, 95% CI 1.02-2.03) compared with their white counterparts. Worry about recurrence and death was found to be greater among patients who overestimated versus those who had a reasonably accurate estimate of their risk of disease recurrence and mortality, respectively (P < .001). Patients who overestimated mortality risk also reported a decreased physical quality of life (mean T score, 43.1; 95% CI, 41.6-44.7) compared with the general population. CONCLUSIONS Less educated patients and Hispanic patients were more likely to report inaccurate risk perceptions, which were associated with worry and a decreased quality of life.
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Affiliation(s)
- Debbie W. Chen
- Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, MI, United States
| | - David Reyes-Gastelum
- Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, MI, United States
| | - Lauren P. Wallner
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Maria Papaleontiou
- Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, MI, United States
| | - Ann S. Hamilton
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, United States
| | - Kevin C. Ward
- Department of Epidemiology, Emory University, Atlanta, GA, United States
| | - Sarah T. Hawley
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Brian J. Zikmund-Fisher
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, United States
- Division of General Internal Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Megan R. Haymart
- Metabolism, Endocrinology & Diabetes, University of Michigan, Ann Arbor, MI, United States
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Huang Z, Wagner AL, Lin M, Sun X, Zikmund-Fisher BJ, Boulton ML, Ren J, Prosser LA. Preferences for vaccination program attributes among parents of young infants in Shanghai, China. Hum Vaccin Immunother 2020; 16:1905-1910. [PMID: 31977272 DOI: 10.1080/21645515.2020.1712937] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Compared to many other countries, China offers fewer pediatric vaccines. Future attempts to add mandatory vaccines may run counter to parents' preferences for shot-limiting. The aim of this study was to assess Chinese parents' preferences and willingness-to-pay (WTP) for programmatic attributes of vaccination services. Parents of young infants ≤3 months of age presenting at immunization clinics in Shanghai, China, in 2017 completed a discrete choice experiment (DCE) on vaccination program attributes: waiting time at the clinic, number of shots before 7 months, number of injections per visit, cost per visit, and location of the shot. We estimated preference utilities and WTP using logistic regression. In total, 590 completed the DCE. Caregivers expressed greater utility for less waiting time, fewer office visits, lower cost of vaccines, and fewer injections co-administered. Over the course of their child's first 6 months, parents were willing to pay 113 RMB ($17) to avoid an additional 10 minutes of waiting at each appointment (95% confidence interval [CI]: 213, 929), 474 RMB ($70) to avoid an additional office visit (95% CI: 241, 707), and 703 RMB ($104) to avoid an additional injection at each appointment (95% CI: 337, 1068). As China expands its list of publicly funded vaccines, public health officials will have to counter Chinese parents' strong preferences for limiting the total number of office visits and the number of injections administered at each visit, potentially through the use of combination vaccines.
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Affiliation(s)
- Zhuoying Huang
- Department of Immunization Program, Shanghai Municipal Centers for Disease Control & Prevention , Shanghai, China
| | - Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan , Ann Arbor, MI, USA
| | - Muzi Lin
- Department of Epidemiology, School of Public Health, University of Michigan , Ann Arbor, MI, USA
| | - Xiaodong Sun
- Department of Immunization Program, Shanghai Municipal Centers for Disease Control & Prevention , Shanghai, China
| | - Brian J Zikmund-Fisher
- Department of Health Behavior & Health Education, School of Public Health, University of Michigan , Ann Arbor, MI, USA.,Department of Internal Medicine, Division of General Medicine, Michigan Medicine , Ann Arbor, MI, USA
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan , Ann Arbor, MI, USA.,Department of Internal Medicine, Division of Infectious Disease, Michigan Medicine , Ann Arbor, MI, USA
| | - Jia Ren
- Department of Immunization Program, Shanghai Municipal Centers for Disease Control & Prevention , Shanghai, China
| | - Lisa A Prosser
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics and Communicable Diseases, Michigan Medicine , Ann Arbor, MI, USA
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43
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Voepel-Lewis T, Farley FA, Grant J, Tait AR, Boyd CJ, McCabe SE, Weber M, Harbagh CM, Zikmund-Fisher BJ. Behavioral Intervention and Disposal of Leftover Opioids: A Randomized Trial. Pediatrics 2020; 145:peds.2019-1431. [PMID: 31871245 PMCID: PMC6939843 DOI: 10.1542/peds.2019-1431] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Leftover prescription opioids pose risks to children and adolescents, yet many parents keep these medications in the home. Our objective in this study was to determine if providing a behavioral disposal method (ie, Nudge) with or without a Scenario-Tailored Opioid Messaging Program (STOMP) (risk-enhancement education) improves parents' opioid-disposal behavior after their children's use. METHODS Parents whose children were prescribed a short course of opioids were recruited and randomly assigned to the Nudge or control groups with or without STOMP. Parents completed surveys at baseline and 7 and 14 days. Main outcomes were (1) prompt disposal (ie, immediate disposal of leftovers after use) and (2) planned retention (intention to keep leftovers). RESULTS There were 517 parents who took part, and 93% had leftovers after use. Prompt disposal behavior was higher for parents who received both the STOMP and Nudge interventions (38.5%), Nudge alone (33.3%), or STOMP alone (31%) compared with controls (19.2%; P ≤ .02). Furthermore, the STOMP intervention independently decreased planned retention rates (5.6% vs 12.5% no STOMP; adjusted odds ratio [aOR] 0.40 [95% confidence interval (CI) 0.19-0.85]). Higher risk perception lowered the odds of planned retention (aOR 0.87 [95% CI 0.79-0.96]), whereas parental past opioid misuse increased those odds (aOR 4.44 [95% CI 1.67-11.79]). CONCLUSIONS Providing a disposal method nudged parents to dispose of their children's leftover opioids promptly after use, whereas STOMP boosted prompt disposal and reduced planned retention. Such strategies can reduce the presence of risky leftover medications in the home and decrease the risks posed to children and adolescents.
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Affiliation(s)
- Terri Voepel-Lewis
- Departments of Anesthesiology, .,Health Behaviors and Biological Science, School of Nursing, and
| | | | | | | | - Carol J. Boyd
- Psychiatry,,Health Behaviors and Biological Science, School of
Nursing, and
| | | | | | | | - Brian J. Zikmund-Fisher
- Internal Medicine, and,Division of Health Behavior and Health Education,
School of Public Health, University of Michigan, Ann Arbor, Michigan
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44
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Kullgren JT, Malani P, Kirch M, Singer D, Clark S, Zikmund-Fisher BJ, Kerr EA. Older Adults' Perceptions of Overuse. J Gen Intern Med 2020; 35:365-367. [PMID: 31654353 PMCID: PMC6957658 DOI: 10.1007/s11606-019-05434-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 08/01/2019] [Accepted: 09/12/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Jeffrey T Kullgren
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, 48113-0170, USA. .,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA. .,University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.
| | - Preeti Malani
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.,University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Matthias Kirch
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Dianne Singer
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.,Child Health Evaluation and Research Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sarah Clark
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.,Child Health Evaluation and Research Center, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Brian J Zikmund-Fisher
- University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA.,Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Eve A Kerr
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, 48113-0170, USA.,Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.,University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
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45
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Valley TS, Scherer AM, Knaus M, Zikmund-Fisher BJ, Das E, Fagerlin A. Prior Vaccination and Effectiveness of Communication Strategies Used to Describe Infectious Diseases. Emerg Infect Dis 2019; 25:821-823. [PMID: 30882322 PMCID: PMC6433032 DOI: 10.3201/eid2504.171408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We tested the effect of prior vaccination on response to communication strategies in a hypothetical news article about an influenza pandemic. Vaccinated were more likely than nonvaccinated participants to plan future vaccination, and future vaccination intent was greater with certain communication strategies. Using these findings to target communication may increase vaccination rates.
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46
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Fisher CF, Birkeland LE, Reiser CA, Zhao Q, Palmer CGS, Zikmund-Fisher BJ, Petty EM. Alternative option labeling impacts decision-making in noninvasive prenatal screening. J Genet Couns 2019; 29:910-918. [PMID: 31793699 DOI: 10.1002/jgc4.1191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/22/2019] [Accepted: 10/28/2019] [Indexed: 11/08/2022]
Abstract
Prenatal genetic screening should be an informed, autonomous patient choice. Extrinsic factors which influence patient decision-making threaten the ethical basis of prenatal genetic screening. Prior research in the area of medical decision-making has identified that labeling may have unanticipated effects on patient perceptions and decision-making processes. This Internet-administered study explored the impact of option labeling on the noninvasive prenatal screening (NIPS) selections of US adults. A total of 1,062 participants were recruited through Amazon Mechanical Turk (MTurk) and randomly assigned to one of three possible label sets reflecting provider-derived and industry-derived option labels used in prenatal screening. Multinomial logistic regression analysis showed option labeling had a statistically significant impact on the NIPS selections of study participants (p = .0288). Outcomes of the Satisfaction with Decision Scale (SWD) indicated option labels did not play a role in participant satisfaction with screening selection. The results of this study indicate a need for further evaluation of the impact NIPS option labeling has on patient screening decisions in real-world clinical interactions. Clinical providers and testing laboratories offering NIPS should give careful consideration to the option labels used with prenatal screening so as to minimize influence on patient screening selection and decision-making processes.
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Affiliation(s)
- Camille F Fisher
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Section of Clinical and Metabolic Genetics, Dell Children's Medical Group, Austin, TX, USA
| | - Laura E Birkeland
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Center for Perinatal Care, UnityPoint Health Meriter Hospital, Madison, WI, USA
| | - Catherine A Reiser
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Qianqian Zhao
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Christina G S Palmer
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA.,Division of General Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Elizabeth M Petty
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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47
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Piltch-Loeb R, Zikmund-Fisher BJ, Shaffer VA, Scherer LD, Knaus M, Fagerlin A, Abramson DM, Scherer AM. Cross-Sectional Psychological and Demographic Associations of Zika Knowledge and Conspiracy Beliefs Before and After Local Zika Transmission. Risk Anal 2019; 39:2683-2693. [PMID: 31290166 DOI: 10.1111/risa.13369] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 05/21/2019] [Accepted: 05/30/2019] [Indexed: 05/13/2023]
Abstract
Perceptions of infectious diseases are important predictors of whether people engage in disease-specific preventive behaviors. Having accurate beliefs about a given infectious disease has been found to be a necessary condition for engaging in appropriate preventive behaviors during an infectious disease outbreak, while endorsing conspiracy beliefs can inhibit preventive behaviors. Despite their seemingly opposing natures, knowledge and conspiracy beliefs may share some of the same psychological motivations, including a relationship with perceived risk and self-efficacy (i.e., control). The 2015-2016 Zika epidemic provided an opportunity to explore this. The current research provides some exploratory tests of this topic derived from two studies with similar measures, but different primary outcomes: one study that included knowledge of Zika as a key outcome and one that included conspiracy beliefs about Zika as a key outcome. Both studies involved cross-sectional data collections that occurred during the same two periods of the Zika outbreak: one data collection prior to the first cases of local Zika transmission in the United States (March-May 2016) and one just after the first cases of local transmission (July-August). Using ordinal logistic and linear regression analyses of data from two time points in both studies, the authors show an increase in relationship strength between greater perceived risk and self-efficacy with both increased knowledge and increased conspiracy beliefs after local Zika transmission in the United States. Although these results highlight that similar psychological motivations may lead to Zika knowledge and conspiracy beliefs, there was a divergence in demographic association.
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Affiliation(s)
| | | | | | | | | | - Angie Fagerlin
- University of Utah/Salt Lake City VA, Salt Lake City, UT, USA
| | - David M Abramson
- College of Global Public Health, New York University, New York, NY, USA
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48
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Evron JM, Reyes-Gastelum D, Banerjee M, Scherer LD, Wallner LP, Hamilton AS, Ward KC, Hawley ST, Zikmund-Fisher BJ, Haymart MR. Role of Patient Maximizing-Minimizing Preferences in Thyroid Cancer Surveillance. J Clin Oncol 2019; 37:3042-3049. [PMID: 31573822 PMCID: PMC6839910 DOI: 10.1200/jco.19.01411] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2019] [Indexed: 01/07/2023] Open
Abstract
PURPOSE To understand the effect of patient preferences on thyroid cancer surveillance intensity. PATIENTS AND METHODS Eligible patients diagnosed with thyroid cancer between January 1, 2014, and December 31, 2015, from the Georgia and Los Angeles County SEER registries were surveyed between February 2017 and October 2018 (N = 2,632; response rate, 63%). Patient reports on health care utilization in the past year and responses to the validated Medical Maximizer-Minimizer Scale were linked to SEER data in the 2,183 disease-free patients. Ordered logistic regression was performed using a cumulative logit with nonproportional odds. RESULTS Of disease-free patients, 31.6% were classified as minimizers, 42.5% as moderate maximizers, and 25.9% as strong maximizers. In the past year, 25.2%, 27.3%, and 38.5% of minimizers, moderate maximizers, and strong maximizers, respectively, had ≥ 4 doctor visits, and 18.3%, 24.9%, and 29.5%, respectively, had ≥ 2 neck ultrasounds. When controlling for age, sex, race and ethnicity, comorbidity, stage, and SEER site, strong maximizers (compared with minimizers) were significantly more likely to report ≥ 4 doctor visits (odds ratio [OR], 1.45; 95% CI, 1.10-1.92), ≥ 2 neck ultrasounds (OR, 1.58; 95% CI, 1.17-2.14), ≥ 1 radioactive iodine scan (OR, 1.73; 95% CI, 1.19-2.50), and ≥ 1 additional imaging study (OR, 2.06; 95% CI, 1.56-2.72). CONCLUSION Among patients with thyroid cancer who have been declared disease free, preference for a more maximal versus minimal approach to medical care is associated with increased number of physician visits and imaging tests. Because increased surveillance does not clearly correlate with improved outcomes, poses potential risks to patients, and contributes to increased healthcare costs, stronger consideration of the role of patient preferences is necessary when framing discussions on surveillance.
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Affiliation(s)
| | | | | | | | | | - Ann S Hamilton
- Keck School of Medicine, University of Southern California, Los Angeles, CA
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49
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Abstract
People are increasingly able to access their laboratory results via patient portals. The potential benefits provided by such access, such as reductions in patient burden and improvements in patient satisfaction, disease management, and medical decision making, also come with potentially valid concerns about such results causing confusion or anxiety among patients. However, it is possible to clearly convey the meaning of results and, when needed, indicate required action by designing systems to present laboratory results adapted to the people who will use them. Systems should support people in converting the potentially meaningless data of results into meaningful information and actionable knowledge. We offer 10 recommendations toward this goal: (1) whenever possible, provide a clear takeaway message for each result. (2) Signal whether differences are meaningful or not. (3) When feasible, provide thresholds for concern and action. (4) Individualize the frame of reference by allowing custom reference ranges. (5) Ensure the system is accessible. (6) Provide conversion tools along with results. (7) Design in collaboration with users. (8) Design for both new and experienced users. (9) Make it easy for people use the data as they wish. (10) Collaborate with experts from relevant fields. Using these 10 methods and strategies renders access to laboratory results into meaningful and actionable communication. In this way, laboratories and medical systems can support patients and families in understanding and using their laboratory results to manage their health.
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Affiliation(s)
- Holly O Witteman
- Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry, Québec City, QC, G1V 0A6, Canada
- Office of Education and Professional Development, Laval University, Quebec City, QC, Canada
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Quebec City, QC, Canada
- Research Centre of the CHU de Québec, Public Health and Optimal Health Practices Axis, Quebec City, QC, Canada, Phone: +418.656.2131 x3981, Fax: 418-656.2465
| | - Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, USA
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA
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50
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Shaffer VA, Focella ES, Hathaway A, Scherer LD, Zikmund-Fisher BJ. On the Usefulness of Narratives: An Interdisciplinary Review and Theoretical Model. Ann Behav Med 2019; 52:429-442. [PMID: 29684135 DOI: 10.1093/abm/kax008] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background How can we use stories from other people to promote better health experiences, improve judgments about health, and increase the quality of medical decisions without introducing bias, systematically persuading the listeners to change their attitudes, or altering behaviors in nonoptimal ways? More practically, should narratives be used in health education, promotion, or behavior change interventions? Method In this article, we address these questions by conducting a narrative review of a diverse body of literature on narratives from several disciplines to gain a better understanding about what narratives do, including their role in communication, engagement, recall, persuasion, and health behavior change. We also review broad theories about information processing and persuasion from psychology and more specific models about narrative messaging found in the health communication and marketing literatures to provide insight into the processes by which narratives have their effect on health behavior. Results To address major gaps in our theoretical understanding about how narratives work and what effects they will have on health behavior, we propose the Narrative Immersion Model, whose goal is to identify the parameters that predict the specific impact of a particular narrative (e.g. persuade, inform, comfort, etc.) based on the type of narrative message (e.g. process, experience, or outcome narrative). Further, the Narrative Immersion Model describes the magnitude of the effect as increasing through successive layers of engagement with the narrative: interest, identification, and immersion. Finally, the Narrative Immersion Model identifies characteristics of the narrative intervention that encourage greater immersion within a given narrative. Conclusions We believe there are important communication gaps in areas areas of behavioral medicine that could be addressed with narratives; however, more work is needed in order to employ narrative messaging systematically. The Narrative Immersion Model advances our theoretical understanding about narrative processing and its subsequent effects on knowledge, attitudes, and behavior.
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Affiliation(s)
- Victoria A Shaffer
- Department of Psychological Sciences, University of Missouri, Columbia, MO
| | | | - Andrew Hathaway
- Department of Psychological Sciences, University of Missouri, Columbia, MO
| | - Laura D Scherer
- Department of Psychological Sciences, University of Missouri, Columbia, MO
| | - Brian J Zikmund-Fisher
- Department of Health Education and Health Behavior, Department of Internal Medicine, Center for Bioethics and Social Sciences in Medicine (CBSSM), University of Michigan, Ann Arbor, MI
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