270 research outputs found
What Makes a Tumor Diagnosis a Call to Action? On the Preference for Action versus Inaction
No full textBackground. Many studies have shown an omission bias, but when the context is cancer, people seem to prefer active treatments to watchful waiting. Objective. First, to investigate whether the preference for active treatment for cancer could depend on the associations attached to the inaction option, and second, to explore the kind of diagnosis that gives rise to the preference for action, by comparing scenarios differing in the status of the illness (already present v. could arise in the future), the kind of diagnosis (malign tumor, benign tumor, or nontumor), and the possible development of the tumor (growth v. degeneration). Design. Between-subjects design with 8 hypothetical scenarios. Participants. A total of 735 students participated in an Internet survey. Measurements. Choice between watchful waiting and surgery, perceived severity of the diagnosis. Results. Active treatment was preferred only when the scenario described watchful waiting as excluding surgery in the future. The critical aspect for participants’ preference for active treatment was the malignancy of the tumor currently diagnosed. Perceived severity was also a significant predictor of treatment choice. Limitations. Inability to infer causation in the relationship between choice and perceived severity. Conclusions. Action is preferred to inaction when a malignant tumor is currently diagnosed and active treatments are not allowed in the future; under other conditions, participants prefer inaction (e.g., when active treatments are allowed in the future, or when the tumor is benign) or exhibit no preference (e.g., when it is not specified whether active treatments are allowed in the future)
What makes a tumor diagnosis a call to action? on the preference for action versus inaction
No full textBackground. Many studies have shown an omission bias, but when the context is cancer, people seem to prefer active treatments to watchful waiting. Objective. First, to investigate whether the preference for active treatment for cancer could depend on the associations attached to the inaction option, and second, to explore the kind of diagnosis that gives rise to the preference for action, by comparing scenarios differing in the status of the illness (already present v. could arise in the future), the kind of diagnosis (malign tumor, benign tumor, or nontumor), and the possible development of the tumor (growth v. degeneration). Design. Between-subjects design with 8 hypothetical scenarios. Participants. A total of 735 students participated in an Internet survey. Measurements. Choice between watchful waiting and surgery, perceived severity of the diagnosis. Results. Active treatment was preferred only when the scenario described watchful waiting as excluding surgery in the future. The critical aspect for participants' preference for active treatment was the malignancy of the tumor currently diagnosed. Perceived severity was also a significant predictor of treatment choice. Limitations. Inability to infer causation in the relationship between choice and perceived severity. Conclusions. Action is preferred to inaction when a malignant tumor is currently diagnosed and active treatments are not allowed in the future; under other conditions, participants prefer inaction (e.g., when active treatments are allowed in the future, or when the tumor is benign) or exhibit no preference (e.g., when it is not specified whether active treatments are allowed in the future)
One decision at a time or the whole path at once? When the way information is provided affect prostate cancer decision making
No full textIntegers are better: Adding decimals to risk estimates makes them less believable and harder to remember
No full textPurpose: To determine whether the number of decimal places in a personal health risk estimate influences the extent to which people believe and remember the estimate.
Methods: 3422 adults in a demographically diverse US-based online sample (mean age 50, 52% female, 74% white, 56% no college degree) were asked to imagine they were visiting an online risk calculator hosted by a prominent university’s medical school. We designed a mock calculator similar to existing calculators available online. The calculator asked a series of health questions relevant to kidney cancer and returned a hypothetical estimate of lifetime risk of kidney cancer. In this between-subjects experiment, participants were assigned one of seven risk estimates close to the average lifetime risk of kidney cancer in the US. Participants who were randomized to the no decimals condition received an estimate of 2%. Those in the one, two or three decimals conditions received an estimate of 2.1% or 1.9% (one decimal), 2.13% or 1.87% (two decimals), or 2.133% or 1.867% (three decimals). Participants were asked to indicate how believable they found the estimate to be on a six-point scale anchored by labels, “not at all,” and, “extremely.” Then, after completing a second, unrelated survey (median time for this task was 8 minutes), they were asked to recall to the best of their ability the kidney cancer lifetime risk estimate they had been given earlier.
Results: Risk estimates expressed as integers were judged as the most believable (F(3, 3384)=2.94, p=.03). Compared to estimates with decimal places, integer estimates were judged as highly believable (defined as the top two points of the six-point scale) by 7 to 10% more participants (Chi-squared(3)=17.82, p<.001). Recall was highest for integer estimates. Odds ratios for correct approximate recall (defined generously as being within 50% of the original estimate) were, for one decimal place, OR=0.65 (95% CI 0.49, 0.86), for two decimal places, OR=0.70 (95% CI 0.53, 0.94), and for three decimal places, 0.61 (95% CI 0.45, 0.81). Exact recall showed a similar pattern, with larger effects.
Conclusions: Using decimals in risk calculators offers no benefit and some cost. Rounding to the nearest integer is likely preferable for communicating risk estimates so that they might be remembered correctly and judged as believable
Clarifying values: An updated review
No full textBackground: Consensus guidelines have recommended that decision aids include a process for helping patients clarify their values. We sought to examine the theoretical and empirical evidence related to the use of values clarification methods in patient decision aids. Methods. Building on the International Patient Decision Aid Standards (IPDAS) Collaboration's 2005 review of values clarification methods in decision aids, we convened a multi-disciplinary expert group to examine key definitions, decision-making process theories, and empirical evidence about the effects of values clarification methods in decision aids. To summarize the current state of theory and evidence about the role of values clarification methods in decision aids, we undertook a process of evidence review and summary. Results: Values clarification methods (VCMs) are best defined as methods to help patients think about the desirability of options or attributes of options within a specific decision context, in order to identify which option he/she prefers. Several decision making process theories were identified that can inform the design of values clarification methods, but no single "best" practice for how such methods should be constructed was determined. Our evidence review found that existing VCMs were used for a variety of different decisions, rarely referenced underlying theory for their design, but generally were well described in regard to their development process. Listing the pros and cons of a decision was the most common method used. The 13 trials that compared decision support with or without VCMs reached mixed results: some found that VCMs improved some decision-making processes, while others found no effect. Conclusions: Values clarification methods may improve decision-making processes and potentially more distal outcomes. However, the small number of evaluations of VCMs and, where evaluations exist, the heterogeneity in outcome measures makes it difficult to determine their overall effectiveness or the specific characteristics that increase effectiveness. © 2013 Fagerlin et al; licensee BioMed Central Ltd
Risk estimates from an online risk calculator are more believable and recalled better when expressed as integers
No full textBackground
Online risk calculators offer different levels of precision in their risk estimates. People interpret numbers in varying ways depending on how they are presented, and we do not know how the number of decimal places displayed might influence perceptions of risk estimates.
Objective
The objective of our study was to determine whether precision (ie, number of decimals) in risk estimates offered by an online risk calculator influences users’ ratings of (1) how believable the estimate is, (2) risk magnitude (ie, how large or small the risk feels to them), and (3) how well they can recall the risk estimate after a brief delay.
Methods
We developed two mock risk calculator websites that offered hypothetical percentage estimates of participants’ lifetime risk of kidney cancer. Participants were randomly assigned to a condition where the risk estimate value rose with increasing precision (2, 2.1, 2.13, 2.133) or the risk estimate value fell with increasing precision (2, 1.9, 1.87, 1.867). Within each group, participants were randomly assigned one of the four numbers as their first risk estimate, and later received one of the remaining three as a comparison.
Results
Participants who completed the experiment (N = 3422) were a demographically diverse online sample, approximately representative of the US adult population on age, gender, and race. Participants whose risk estimates had no decimal places gave the highest ratings of believability (F 3,3384 = 2.94, P = .03) and the lowest ratings of risk magnitude (F 3,3384 = 4.70, P = .003). Compared to estimates with decimal places, integer estimates were judged as highly believable by 7%–10% more participants (χ2 3 =17.8, P < .001). When comparing two risk estimates with different levels of precision, large majorities of participants reported that the numbers seemed equivalent across all measures. Both exact and approximate recall were highest for estimates with zero decimals. Odds ratios (OR) for correct approximate recall (defined as being within 50% of the original estimate) were, for one decimal place, OR = 0.65 (95% CI 0.49–0.86), for two decimal places, OR = 0.70 (95% CI 0.53–0.94), and for three decimal places, 0.61 (95% CI 0.45–0.81). Exact recall showed a similar pattern, with larger effects.
Conclusions
There are subtle but measurable differences in how people interpret risk estimates of varying precision. Adding decimal places in risk calculators offers little to no benefit and some cost. Rounding to the nearest integer is likely preferable for communicating risk estimates via risk calculators so that they might be remembered correctly and judged as believable
To have or not to have PSA test? Is the decision affected by whether information is presented sequentially vs. all-at-once?
No full textPurpose: An essential prerequisite of patient decision making is that the patient must be fully informed, especially when the decision is a preference-sensitive one, such as whether to undergo prostate cancer screening. However, the way information is provided to individuals might affect their decision. In the present studies, we examined the effect of two information presentation methods on people’s willingness to undergo screening depending on whether the information was presented all-at-once or as a series of sequential decisions.
Method: Participants indicated their willingness to engage in each behavior either right after reading each piece of information (sequential) or after reading all information.
Result: Study 1 examined decision making for a generic cancer on a sample of 336 participants (n = 218 females; age 25 to 71, M = 38.06, SD = 11.24). Relative to when the information was presented all at once, when the presentation was sequential, individuals showed a higher willingness to undergo the screening tests, both blood test (M = 4.07 vs. 4.52, t (334) = -2.52, p = .012) and biopsy (M = 3.66 vs. 4.07, t (334) = -2.09, p = .037), but also a stronger preference for watchful waiting (M = 3.29 vs. 2.65, t (334) = 3.33, p = .001). Study 2 investigated specifically prostate cancer, with a bigger ( N = 1541) and more specific sample (only male participants; age 40 to 71, M = 54.51, SD = 8.27), providing detailed and longer information, similarly to a patient decision aid. The effect of the two presentation methods disappeared (i.e., the differences between conditions were no longer significant) when the complexity of the information provided was increased, the target cancer was identified, and the respondents were in the age range to which the screening is usually proposed.
Conclusion: The results from Study 1 suggest that presenting information sequentially or all at once can affect decision making, in line with previous findings highlighting the potential effect of the way in which information is provided on people’s decision. However, in Study 2 the way in which information was presented did not affect prostate cancer screening decisions. Possible explanations are discussed, among which: a) limited vs. extensive information; b) generic vs. specific topic; and c) gender and age restrictions on the sample
Veterans Experiences during the COVID-19 pandemic (VISION-19)
No full textThis project was funded by the VA (award VA C-19-20-205 to Drs Fagerlin and Scherer for recruitment of Veterans) and Dr. Fagerlin’s Jon M. Huntsman Presidential Endowed Chair (for recruitment of non-Veterans). The design for the project was a longitudinal survey study of Veterans and non-Veterans (~1:1 ratio for the first survey) conducted using Qualtrics between December 2020 and March 2021. This page includes the surveys and the project outputs (e.g., manuscripts and reports). For any further enquiries please contact Drs. Angela Fagerlin [[email protected]] and Laura Scherer [[email protected]]
Use of decision AIDS for shared decision making in venous thromboembolism: A systematic review
No full textBackground Optimal care of patients with venous thromboembolism requires the input of patient preferences into clinical decision-making. However, the availability and impact of decision aids to facilitate shared decision making in care of venous thromboembolism is not well known. Objectives To assess the availability, clinical impact and outcomes associated with the use of decision aids in patients with or at risk for venous thromboembolism. Patients/methods A systematic review of the literature was performed exploring the use of decision aids in patients with venous thromboembolism. Criteria for primary inclusion required use of patient values clarification in the decision aid. A secondary review without the requirement of a patient values clarification was performed to be more inclusive. The data was summarized such that knowledge gaps and opportunities for enquiry were identified. Results The primary review identified one study that explored the decision to extend anticoagulation in patients with a recent venous thromboembolism beyond the stipulated 3-month duration. The secondary review identified an additional study exploring the decision to undergo computer tomography testing in patients at low risk for pulmonary embolism in an emergency department setting. Both studies were of modest quality given a lack of control group for comparison analysis. Conclusions Despite numerous calls to increase use of shared decision-making, a paucity of data exists to help patients engage in the treatment decisions for venous thromboembolism. Future studies of additional VTE clinical decisions with longer-term clinical outcomes appear necessary.No Full Tex
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