MDM Policy and Practice最新文献

Background. Breast cancer screening via mammography for women younger than 50 y sparks controversy due to balancing benefits and risks. In Israel, specific criteria govern early screening initiation, yet global studies reveal low adherence to guidelines for this demographic. Objectives. This study aims to report on young women's referrals for screening mammography in Israel, assess adherence to guidelines, and identify factors influencing guideline adherence. Design, Setting, and Participants. A cross-sectional study analyzed referral letters for screening mammography issued to women aged 18 to 49 y from March 2019 to February 2020 in 2 districts of Israel's largest health care provider. Exclusions included women with a history of breast cancer or BRCA mutations. Of 9,960 letters, 1,287 were randomly selected for adherence assessment, with 13% of nonadherent cases further reviewed. Main Outcomes and Measures. Primary outcomes included categorizing referrals as adherent or nonadherent to guidelines. Additional measures explored correlations between adherence and patient characteristics (e.g., age, comorbidities) and the referring physician's specialty. Results. A total of 999 referral letters were included in the statistical analysis. Referrals spanned all ages but skewed toward women older than 40 y. Of the referrals, 45% (452) came from general surgeons and 32% (327) from family physicians. Twenty-four percent (303) of referrals were blank, and 1% (4) involved risk-benefit discussions. In total, 109 (10.9%) of the referrals strictly adhered to guidelines; under a lenient approach, 30.6% (307) adhered. General surgeons adhered more frequently than gynecologists did (32.8% [109] v. 14.9% [11], P = 0.014). Conclusions and Relevance. Despite official guidelines, many physicians in Israel did not follow recommendations for breast cancer screening in women younger than 50 y, highlighting a gap between evidence-based medicine and clinical practice.

Highlights: Question Are screening mammography referrals, given to women younger than 50 y of age, adherent to current guidelines? Findings In this cross-sectional study of a randomly selected sample of 1,287 referral letters, given to women aged 18 to 50 y, only 10.9% were adherent with the guidelines when examined with a strict approach and 30.6% with a forgiving approach. Adherence significantly correlated with the field of the referring physician. Meaning Despite known risks of screening mammography, women younger than 50 y are commonly referred to such screening in a deviation from current guidelines.

Background. To develop guidance on the effect of data presentation format on communication of health probabilities, the Making Numbers Meaningful project undertook a systematic review. Purpose. This article, one in a series, covers evidence about "difference tasks," in which a reader examines a stimulus to evaluate differences between probabilities, such as the effect of a risk factor or therapy on the chance of a disease. This article covers the effect of format on 4 outcomes: 1) identifying a probability difference (identification) or recalling it (recall), 2) identifying the largest or smallest of a set of probability differences (contrast outcome), 3) placing a probability difference into a category such as "elevated" or "below average" (categorization outcome), and 4) performing computations (computation outcome). Data Sources. MEDLINE, Embase, CINAHL, the Cochrane Library, PsycINFO, ERIC, ACM Digital Library; hand search of 4 journals. Finding Selection. Pairwise screening to identify experimental/quasi-experimental research comparing 2 or more formats for quantitative health information. This article reports on 53 findings derived from 35 unique studies reported in 32 papers. Data Extraction. Pairwise extraction of information on stimulus (data in a data presentation format), cognitive task, and perceptual, affective, cognitive, or behavioral outcomes. Data Synthesis. Most evidence involving outcomes of difference-level cognitive tasks was weak or insufficient. Evidence was strong that 1) computations involving differences are easier with rates per 10ⁿ than with percentages or 1 in X rates and 2) adding graphics to numbers makes it easier to perform difference-level computations. Limitations. A granular level of evidence syntheses leads to narrow guidance rather than broad statements. Conclusions. Although many studies examined differences between probabilities, few were comparable enough to generate strong evidence.

Highlights: Most evidence about the effect of format on ability to evaluate differences in probabilities was weak or insufficient because of too few comparable studies.Strong evidence showed that computations relevant to differences in probabilities are easier with rates per 10ⁿ than with 1 in X rates.Adding graphics to probabilities helps readers compute differences between probabilities.

Background. To develop guidance on the effect of data presentation format on communication of health probabilities, the Making Numbers Meaningful project undertook a systematic review. Purpose. This article, one in a series, covers evidence about a "synthesis task," in which readers examine stimuli to synthesize information about multiple features of health options, such as chances of both harm and benefit for a treatment. This article presents evidence of the effect of format on perceptual, cognitive, affective, and behavioral outcomes. Data Sources. MEDLINE, Embase, CINAHL, the Cochrane Library, PsycINFO, ERIC, ACM Digital Library; hand search of 4 journals. Finding Selection. Manual pairwise screening to identify experimental and quasi-experimental research comparing 2 or more formats for presenting quantitative health information to lay audiences. This article reports on 91 findings derived from 45 unique studies reported in 42 articles. Data Extraction. Pairwise extraction of information on stimulus (data in a data presentation format), cognitive task, and perceptual, affective, cognitive, or behavioral outcomes. Data Synthesis. Evidence was found about 6 outcomes: identification/recall, contrast, effectiveness perceptions/feelings, behavioral intentions/behavior, trust, and preference. No strong evidence was found. Moderate evidence suggests that for synthesis tasks, behavioral intention is not affected by whether the risk and benefit probabilities are in text or in tables, that people prefer tables to text for presenting this information, and that effectiveness feelings are not affected by whether or not numbers are supplemented by narratives. Limitations. Granular data extraction and evidence syntheses lead to narrow evidence statements. Conclusions. Current evidence on synthesis tasks is moderate strength at best. Future studies should enrich the evidence on how to present information needed to synthesize multiple features of health options, given the importance of this task.

Highlights: This study found a moderate number of studies assessing strategies for evaluating sets of probabilities conveying information such as risks and benefits.Evidence is moderate that although presenting sets of probabilities in table versus sentences may not affect behavioral intentions, people may prefer tables.Contrary to previous studies about probability feelings, moderate evidence suggested that narratives may not affect effectiveness feelings.Evidence was insufficient to draw conclusions regarding contrast, identification, and trust outcomes, and no studies assessed recall, categorization, computation, or discrimination outcomes.

Background. To create guidance on the effect of data presentation format on communication of health numbers, the Making Numbers Meaningful project undertook a systematic review. Purpose. This article (one of a series) covers research studying so-called "point tasks," in which a reader examines stimuli to obtain information about single probabilities. The current article presents the evidence on the effects of data presentation format on multiple outcomes: identification and recall, contrast, categorization, and computation. Data Sources. MEDLINE, Embase, CINAHL, the Cochrane Library, PsycINFO, ERIC, ACM Digital Library; hand search of 4 journals. Finding Selection. Manual pairwise screening to identify experimental and quasi-experimental research comparing 2 or more formats for quantitative health information for patients or other lay audiences. This article reports on 218 findings from 99 articles on single probability communication. Data Extraction. Pairwise extraction of data on stimulus (data in a data presentation format), task, and perceptual/affective/cognitive/behavioral outcomes. Data Synthesis. Most evidence on these outcomes was weak or insufficient. There was moderate to strong evidence that 1) recall was better with icon arrays with human figures than icon arrays with blocks, 2) survival curves make it easier to identify points of highest survival than mortality curves (contrast outcome), 3) adding an average population probability to a message about an individual probability may not affect recall, 4) computation performance is better with bar charts combined with data labels than with either numbers or graphics alone, 5) computation performance with rates is better when denominators match, and 6) framing strongly affects risky choices (contrast). Limitations. Heterogeneous study designs reduced the ability to develop strong evidence. Conclusions. Few findings assessing identification or recall, contrast, categorization, or computation outcomes for point tasks were comparable enough to each other to generate strong evidence.

Highlights: Many researchers have studied the effects of data presentation formats of single probabilities on different outcomes.However, few findings are comparable enough to allow for strong evidence-based conclusions about the impact on identification, recall, contrast, categorization, and computation outcomes.

Background. The Making Numbers Meaningful review is intended to create guidance on the effect of data presentation format on comprehension of numbers in health. Purpose. This article (one of a series) covers research studying so-called "point tasks," in which a reader examines materials to obtain information about single probabilities. The current article presents evidence on the effects of data presentation format on probability perceptions and feelings, health behaviors and behavioral intentions, trust, preference, and discrimination outcomes. Data Sources. MEDLINE, Embase, CINAHL, the Cochrane Library, PsycINFO, ERIC, ACM Digital Library; hand search of 4 journals. Study Selection. Manual pairwise screening to identify experimental and quasi-experimental research that compared 2 or more formats for presenting quantitative health information to patients or other lay audiences. This article reports 466 findings of probability communication from 161 articles. Data Extraction. Pairwise extraction of information on stimulus (data in a data presentation format), task, and outcomes. Data Synthesis. Moderate to strong evidence is available on the effects of several format interventions to influence probability perceptions and feelings, including the 1-in-X number format, foreground-only (numerator-only) icon arrays, bar charts, anecdotes, framing, and verbal probabilities. However, only 3 (the 1-in-X effect, anecdotes, and framing) had moderate to strong evidence of influencing health behaviors and behavioral intentions. Research on patient preferences for numerical, graphical, and verbal formats yielded only weak evidence. Conclusions. The link between probability perceptions/feelings and health behaviors is not strongly reflected in the evidence about communicating numbers because many communication-focused studies measure short-term response rather than longer-term behaviors. Also, research into patient preferences for numerical, graphical, and verbal formats has not yielded strong evidence suggesting stable and predictable preferences.

Highlights: Formatting a probability as 1 in X, using a foreground-only icon array, adding anecdotes to numbers, and gain-loss framing all affect probability perceptions and feelings.The evidence on communicating numbers to influence perceptions is far stronger than the evidence on using it to change health behavior or behavioral intention.Only weak evidence is available on patient preferences for verbal, graphical, and numerical probability formats.

Background. To develop guidance on the effects of format on communication of health probabilities, the Making Numbers Meaningful team conducted a systematic review. Purpose. This article (one of a series) covers research on time-trend tasks, in which participants evaluate stimuli for information about probability trends, such as changing chances of cancer recurrence over time. Data Sources. MEDLINE, Embase, CINAHL, the Cochrane Library, PsycINFO, ERIC, ACM Digital Library; hand search of 4 journals. Study Selection. We conducted independent dual screening to identify experimental or quasi-experimental research comparing 2 or more formats for presenting quantitative health information to lay audiences. This article reports on 11 findings from 6 unique studies. Data Extraction. Independent dual extraction of information on stimulus (data in a data presentation format), task, and perceptual, affective, cognitive, and behavioral outcomes. Data Synthesis. We identified research on the impact of format on the following outcomes: contrast, computation, effectiveness perceptions, health behaviors and behavioral intentions, discrimination, and preference. Strong evidence suggests that graphing probability curves over longer (rather than shorter) time periods increases perceived differences between curves (effectiveness perception outcome). Weak evidence suggested 1) survival versus mortality curves do not affect perceived differences between curves or ability to perform computations, 2) survival curves may help people identify the option with the highest survival, and 3) graphing probabilities over longer time periods may not affect the ability to identify the highest survival. Limitations. Granular data extraction and evidence syntheses lead to narrow conclusions rather than broader statements. Conclusions. The very limited evidence available about probability time-trend tasks is primarily about the effects of framing (survival v. mortality curves) and the effects of using shorter versus longer time periods.

Highlights: This systematic review found that few studies of probability trend data compared similar formats or used comparable outcome measures.The only strong piece of evidence was that graphing probabilities over longer time periods such that the distance between curves widens will tend to increase the perceived difference between the curves.Weak evidence suggests that survival curves (versus mortality curves) may make it easier to identify the option with the highest overall survival.Weak evidence suggests that graphing probabilities over longer (rather than shorter) time periods may increase the ability to distinguish between small survival differences.Evidence was insufficient to determine whether any format influenced behaviors or behavioral intentions.