1,721,017 research outputs found
Where are we in shared decision-making in Italy? A brief updated review
No full textThe aim of this paper is to provide an overview of the current state of the art concerning patient-centred care (PCC), shared decision-making (SDM), and patient involvement in health care in Italy, by updating the previous versions of the review. In the past 5 years some progress has been made towards a higher involvement of patients in their health care and patient-centredness into the national health care system. The updated scoping literature search focused on articles reporting primary data collected in Italy and showed a great increase in the number of publications. Nonetheless, the research efforts are still relatively sporadic compared to other countries especially as for evaluations of interventions and, most notably, they are not driven by a consistent effort to promote SDM and PCC in clinical practice
Numbers in Medicine: Ingredients for an effective and transparent risk communication
No full textNowadays, we have much more information about our health than we had in the past, and numerical information is, or should be, commonplace in the communication between doctors and patients. Indeed, evidence-based medicine is the gold standard for public health decisions, for the development of national and international guidelines, as well as for clinical practice on individual patients. In this perspective, risk communication, conveyed mainly through numerical information, need to take into account how people perceive and understand this information. Psychological research on this issue has shown that people are affected by the way information is presented when making judgments and decisions. This paper aims to illustrate some of the main issues to be considered when designing risk communication in the medical domain. By examining some examples of non-transparent risk communication, we will illustrate the effectiveness of different types of numerical information (natural frequencies, 1 in n. percentages) and discuss the concepts of absolute and relative risk, highlighting the importance of making explicit the reference class. Additionally, considering that the same treatment can be described in terms of likelihood of survival or death, and that, although the two information are complementary, people seem to be affected by the communicator's choice, we will examine the various types of frames used in the medical domain and discuss the more recent research findings. Making explicit the reference class to which probabilities refer can also help to understand the results of a clinical test. In a simplistic way, people often think that a positive test result means that a disease is present and that a negative test result means that it is not. Even when it is acknowledged that no test is 100% certain, the margin of error and the extent to which it is affected by the frequency of the disease in the population are difficult to grasp, even by experts. For instance, even with a very precise test, a positive test result is associated with a very low likelihood of having the disease (positive predictive value) when the disease is rare. Research has also shown that people with low numeracy (the ability to reason and to apply simple numerical concepts) are especially susceptible to misunderstanding of numerical information when it is referred to groups of people and that are likely to be affected by stories about single cases (see, for instance, the current debate about childhood vaccinations). Finally, we will discuss about the new frontiers of medical research, resulting in a continuous increase in the complexity of risk communication. For example, with the progress of medical genetics and the possibility to determine the presence of genetic mutations that can be linked to the risk of developing diseases, the complexity of the information to be communicated is clearly increasing. Even if people are driven by the desire to know, we need to remember that it is not always possible to act upon the information obtained (e.g., would you want to know whether you have a genetic predisposition for Alzheimer, considering that at present there is no effective treatment?) and that the decisions made by our «present Self» might not be the same of those that our «future Self» would made for its health
“Patient dies due to hernia: Doctors in trouble” A study on the effect of framing and numerical information format on liability judgments.
No full textQuality of life and functions after chemoradiation for rectal cancer: A review of recent publications
No full textWe have systematically reviewed studies published in the last three years on patients' self-reported evaluations of quality of life (QoL) and functions after chemoradiotherapy (CRT) for rectal cancer. Overall, the findings from 13 studies confirmed that CRT negatively affect functions and, consequently, patients' QoL, especially for bowel, role, and social function. The studies' heterogeneity limited the possibility of comparison among findings. We discuss and comment on the ideal characteristics of studies assessing QoL and function. We emphasise how this type of evidence is relevant to decision-making at all levels of health-care practice. © 2013 Springer Science+Business Media New York
What’s in a name: Drug names convey implicit information about their riskiness and efficacy
No full textThe present research provides empirical evidence that drug names may entail implicit promises about their therapeutic power. We asked people to evaluate the perceived efficacy and risk associated with hypothetical drug names and other secondary related measures. We compared opaque (without meaning), functional (targeting the health issue that the drug is meant to solve) and persuasive (targeting the expected outcome of the treatment) names. Persuasive names were perceived as more efficacious and less risky than both opaque and functional names, suggesting that names that target the expected outcome of the drug may bias the perception of risk and efficacy. Implications for health-related communication are discussed in light of both the increasing use of over-the-counter drugs and the concern about people's low health literac
Patient-reported outcomes after neoadjuvant therapy for rectal cancer: A systematic review
No full textNeoadjuvant therapy followed by total mesorectal excision is standard of care for locally advanced rectal cancer. However, this approach has been previously shown to be associated with high rate of morbidity and it may have a negative effect on patients' reported outcomes (PROs). In order to summarize findings on the effect of the neoadjuvant approach on PROs, we systematically reviewed articles published in the last five years. Thirty-five articles met the inclusion criteria. Ten articles compared the effect of surgery with and without neoadjuvant therapy, six articles compared different neoadjuvant therapies, ten articles reported on patients who were all treated with neoadjuvant therapy, and nine articles examined the effect of neoadjuvant therapy in the analyses. The results are summarized by function investigated and critically commented. © 2014 Informa UK, Ltd
f you were a BRCA mutation carrier what would you do? Factors predicting the choice of prophylactic ovariectomy in a sample of Italian women.
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how framing and numerical information affect people's judgments when reading a newspaper story
No full textA Psychological Perspective on Factors Predicting Prophylactic Salpingo-Oophorectomy in a Sample of Italian Women from the General Population. Results from a Hypothetical Study in the Context of BRCA Mutations
No full textThe aim of this study was to assess attitudes toward ovarian cancer risk management options for BRCA mutation carriers in healthy Italian women, and to identify predictors of the preference for risk reducing salpingo-oophorectomy (RRSO) over surveillance. One hundred eighty-one women aged 30–45 completed a questionnaire about preferences, knowledge, risk perception, and socio-demographic information. Participants were randomly presented with a pamphlet about BRCA1 or BRCA2 mutation-specific testing, consequences of testing and preventive options for carriers, and they were stratified by having children or not and by age group. Surveillance was the preferred option (64.6%), followed by RRSO (24.3%). Although RRSO is the only effective strategy available to BRCA carriers, most healthy women faced for the first time with this option may not consider it as their preferred choice. Predictors associated with a higher likelihood to prefer surgery over surveillance were: knowing that life expectancy is longer with surgery, perceived comprehension of the consequences of testing, previous knowledge about BRCA testing, anticipated worry about developing cancer, and feelings of risk. Childbearing intentions and the effect of childbearing intentions on choice were associated with a lower preference for surgery. Further research is needed to confirm the role of the factors identified in this study in order to promote informed decision-making about RRSO
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