Medical Decision Making最新文献_第5页

Natural Frequencies Improve Public Understanding of Medical Test Results: An Experimental Study on Various Bayesian Inference Tasks with Multiple Scoring Methods and Non-Bayesian Reasoning Strategies 自然频率提高了公众对医学检验结果的理解：使用多种评分方法和非贝叶斯推理策略完成各种贝叶斯推理任务的实验研究

IF 3.6 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Medical Decision Making

Pub Date : 2024-09-18 DOI: 10.1177/0272989x241275191

Soyun Kim

BackgroundIt is well established that the natural frequencies (NF) format is cognitively more beneficial for Bayesian inference than the conditional probabilities (CP) format. However, empirical studies have suggested that the NF facilitation effect might be limited to specific groups of individuals. Unlike previous studies that focused on a limited number of Bayesian inference problems evaluated by a single scoring method, it was essential to examine multiple Bayesian problems using various scoring metrics. This study also explored the impact of numeracy on Bayesian inference and assessed non-Bayesian cognitive strategies using the numerical information in problem solving.MethodsIn a Web-based experimental survey, 175 South Korean adults were randomly assigned to 1 of 2 format groups (NF v. CP). After completing numeracy scales, participants were asked to estimate 4 Bayesian inference problems and document the numerical information used in their problem-solving process. Four scoring methods—strict rounding, loose rounding, absolute deviation, and 50-Split—were used to evaluate participants’ estimations.ResultsThe NF format generally outperformed the CP format across all problems, except in a chorionic villus sampling test problem when evaluated using the 50-Split method. In addition, numeracy levels significantly influenced Bayesian inference; participants with higher numeracy demonstrated better performance. In addition, participants used various non-Bayesian strategies influenced by the format and the nature of the problems.ConclusionsThe NF facilitation effect was consistently observed across multiple Bayesian problems and scoring methods. Individuals with higher numeracy levels benefited more from the NF format. The use of various non-Bayesian strategies varied with the formats and nature of specific tasks.HighlightsThe natural frequencies (NF) format is known to foster understanding of medical test results compared with the conditional probabilities (CP) format, but some studies have reported that this benefit is either nonexistent or limited to specific groups. This study aims to replicate previous empirical studies using various Bayesian problems using multiple scoring methods. The NF format fosters understanding of medical test results across all Bayesian problems by all scoring methods, except in the CVS problem when using a 50-Split scoring method. Participants with high numeracy perform better Bayesian inference than those with lower numeracy. Particularly, higher numerates benefit more in the NF format than lower numerates do. In addition, the public tend to use various non-Bayesian reasoning strategies depending on the format and the nature of the tasks.

背景众所周知，自然频率（NF）格式比条件概率（CP）格式更有利于贝叶斯推理。然而，实证研究表明，自然频率的促进作用可能仅限于特定人群。以往的研究侧重于用单一评分方法评估数量有限的贝叶斯推理问题，与此不同的是，本研究必须使用各种评分标准考察多个贝叶斯问题。本研究还探讨了计算能力对贝叶斯推理的影响，并评估了在解决问题时使用数字信息的非贝叶斯认知策略。方法在一项基于网络的实验调查中，175 名韩国成年人被随机分配到两种形式组（NF 组和 CP 组）中的一种。在完成计算量表后，参与者被要求估计 4 个贝叶斯推理问题，并记录解决问题过程中使用的数字信息。结果在所有问题上，NF格式的成绩普遍优于CP格式，但在使用50-Split方法评估绒毛取样测试问题时除外。此外，计算能力水平对贝叶斯推理有很大影响；计算能力越高的参与者表现越好。此外，受问题形式和性质的影响，参与者还使用了各种非贝叶斯策略。计算水平较高的人从 NF 形式中获益更多。亮点众所周知，与条件概率（CP）格式相比，自然频率（NF）格式可促进对医学测试结果的理解，但一些研究报告称，这种益处要么不存在，要么仅限于特定群体。本研究旨在利用多种计分方法，使用各种贝叶斯问题，重复以往的实证研究。在所有贝叶斯问题中，NF格式在所有计分方法下都能促进对医学测试结果的理解，但在CVS问题中使用50-Split计分法时除外。计算能力高的学员比计算能力低的学员能更好地进行贝叶斯推理。特别是，高运算能力者比低运算能力者在 NF 形式中获益更多。此外，根据任务的形式和性质，公众倾向于使用各种非贝叶斯推理策略。

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引用次数: 0

How Much Information Is Too Much? An Experimental Examination of How Information Disclosures May Unintentionally Encourage the Withholding of Health Information 多少信息才算多？信息披露如何无意中鼓励隐瞒健康信息的实验研究

IF 3.6 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Medical Decision Making

Pub Date : 2024-09-18 DOI: 10.1177/0272989x241275645

Helen Colby, Deidre Popovich, Tony Stovall

IntroductionInformation disclosures are used in medicine to provide patients with relevant information. This research examines whether patients are less likely to discuss medical conditions with their physicians after seeing an insurance information disclosure.MethodsThree experimental studies with nonprobability online samples (ntotal = 875 US adult participants) examined the impact of information disclosures on patients’ likelihood of disclosing symptoms to providers, using new symptoms and preexisting chronic conditions. The effects of insurance disclosures were also compared to those of pharmaceutical discount disclosures.ResultsThese studies demonstrate that information disclosures can result in unintended consequences for patients and providers. Results showed that information disclosures about insurance claims significantly negatively affected willingness to discuss health information with providers. This effect was consistent for both new health concerns, b = −0.661, P < 0.001 (study 1, n = 250) and b = −0.893, P < 0.001 (study 3, n = 375), as well as chronic conditions, b = −1.175, P < .001 (study 2, n = 250); all studies were conducted in January 2023. Information provided to patients about pharmaceutical savings did not similarly affect willingness to discuss symptoms with providers.LimitationsThese were experimental studies with hypothetical scenarios. Future research is needed to understand how patients react to information disclosures in a physician’s office. Future research is also needed to examine the role of specific wording and tone used in information disclosures.ConclusionsPrior research has shown that patients prefer more information and to be involved in their medical decisions; however, these studies demonstrate that some information disclosures can discourage full communication between patients and physicians.ImplicationsThis research has important implications for the potential consequences of information disclosures in health care settings. Information disclosures should be presented in a way that will not discourage candid discussions of patient symptoms.HighlightsThis research found that information disclosures about insurance claims can negatively affect patient willingness to discuss health information with providers. Information disclosures may sometimes fall short of their intended purpose of aiding patient decisions with the goal of improved well-being. When information disclosures are focused on warning about potential new costs, patients may feel uncomfortable discussing new symptoms with their providers. Findings suggest patients may often be more concerned with costs than with addressing their ongoing health problems.

导言信息披露在医学中被用来为患者提供相关信息。本研究探讨了患者在看到保险信息披露后是否不太可能与医生讨论病情。方法三项非概率在线样本实验研究（总计 = 875 名美国成人参与者）利用新症状和既往慢性疾病，研究了信息披露对患者向医疗服务提供者披露症状的可能性的影响。这些研究表明，信息披露可能会给患者和医疗服务提供者带来意想不到的后果。研究结果表明，保险理赔信息的披露严重影响了患者与医疗服务提供者讨论健康信息的意愿。这种影响对于新的健康问题（b = -0.661，P <0.001，研究 1，n = 250）和 b = -0.893，P <0.001，研究 3，n = 375）以及慢性病（b =-1.175，P <.001，研究 2，n = 250）都是一致的；所有研究都是在 2023 年 1 月进行的。向患者提供有关节省药品的信息并不会同样影响患者与医疗服务提供者讨论症状的意愿。要了解患者在医生办公室对信息披露的反应，还需要今后的研究。结论先前的研究表明，患者更希望获得更多信息并参与医疗决策；然而，这些研究表明，某些信息披露会阻碍患者与医生之间的充分沟通。这项研究发现，有关保险理赔的信息披露会对患者与医疗服务提供者讨论健康信息的意愿产生负面影响。信息披露有时可能达不到其预期目的，即帮助患者做出决定，从而改善其健康状况。当信息披露的重点是警告潜在的新费用时，患者可能会在与医疗服务提供者讨论新症状时感到不自在。研究结果表明，患者往往更关心费用，而不是解决他们当前的健康问题。

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引用次数: 0

General Population Mortality Adjustment in Survival Extrapolation of Cancer Trials: Exploring Plausibility and Implications for Cost-Effectiveness Analyses in HER2-Positive Breast Cancer in Sweden. 癌症试验生存期外推中的普通人群死亡率调整：探索瑞典 HER2 阳性乳腺癌成本效益分析的合理性及其影响。

IF 3.6 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Medical Decision Making

Pub Date : 2024-09-12 DOI: 10.1177/0272989x241275969

Kun Kim,Michael Sweeting,Nils Wilking,Linus Jönsson

BACKGROUNDIn economic evaluations of novel therapies, assessing lifetime effects based on trial data often necessitates survival extrapolation, with the choice of model affecting outcomes. The aim of this study was to assess accuracy and variability between alternative approaches to survival extrapolation.METHODSData on HER2-positive breast cancer patients from the Swedish National Breast Cancer Register were used to fit standard parametric distribution (SPD) models and excess hazard (EH) models adjusting the survival projections based on general population mortality (GPM). Models were fitted using 6-y data for stage I and II, 4-y data for stage III, and 2-y data for stage IV cancer reflecting an early data cutoff while maintaining sufficient events for comparison of model estimates with actual long-term outcomes. We compared model projections of 15-y survival and restricted mean survival time (RMST) to 15-y registry data and explored the variability between models in extrapolations of long-term survival.RESULTSAmong 11,224 patients compared with the observed registry 15-y RMST estimates across the disease stages, EH cure models provided the most accurate estimates in patients with stage I to III cancer, whereas EH models without cure most closely matched survival in patients with stage IV cancer, in which cure assumption was less plausible. The Akaike information criterion-averaged model projections varied as follows: -8.2% to +5.3% for SPD models, -4.9% to +5.2% for the EH model without a cure assumption, and -19.3% to -0.2% for the EH model with a cure assumption. EH models significantly reduced between-model variance in the predicted RMSTs over a 50-y time horizon compared with SPD models.CONCLUSIONSEH models may be considered as alternatives to SPD models to produce more accurate and plausible survival extrapolation that accounts for general population mortality.HIGHLIGHTSExcess hazard (EH) methods have been suggested as an approach to incorporate background mortality rates in economic evaluation using survival extrapolation.We highlight that EH models with or without a cure assumption can produce more accurate survival projections and significantly reduce between-model variability in comparison with standard parametric distribution models across cancer stages.EH models may be a preferred modeling method to reduce model uncertainty in health economic modeling since models that would otherwise have produced implausible extrapolations are constrained by the EH framework.Reduced uncertainty in economic evaluations will enhance the application of evidence-based health care decision making.

背景在对新型疗法进行经济评估时，根据试验数据评估终生疗效往往需要进行生存期外推，而模型的选择会影响结果。方法瑞典国家乳腺癌登记处的 HER2 阳性乳腺癌患者数据被用于拟合标准参数分布 (SPD) 模型和超额危险 (EH) 模型，根据一般人群死亡率 (GPM) 调整生存预测。模型的拟合使用了 I 期和 II 期的 6 年数据、III 期的 4 年数据以及 IV 期癌症的 2 年数据，这些数据反映了早期数据的截止日期，同时也保持了足够的事件数，以便将模型估计值与实际长期结果进行比较。我们将模型预测的 15 年生存期和限制性平均生存时间（RMST）与 15 年登记数据进行了比较，并探讨了不同模型在推断长期生存期方面的差异。结果在 11,224 名患者中，与观察到的各疾病分期登记 15 年 RMST 估计值相比，EH 治愈模型为 I 期至 III 期癌症患者提供了最准确的估计值，而无治愈的 EH 模型与 IV 期癌症患者的生存期最为匹配，在 IV 期癌症患者中，治愈假设不太可信。阿凯克信息准则平均模型预测值变化如下：SPD模型为-8.2%至+5.3%，无治愈假设的EH模型为-4.9%至+5.2%，有治愈假设的EH模型为-19.3%至-0.2%。与 SPD 模型相比，EH 模型大大降低了 50 年时间跨度内预测 RMST 的模型间差异。结论EH 模型可作为 SPD 模型的替代方法，以产生更准确、更合理的生存外推法，并考虑到一般人群的死亡率。我们强调，与癌症各期的标准参数分布模型相比，有无治愈假设的超常危害模型都能产生更准确的生存预测，并显著降低模型间的变异性。超常危害模型可能是降低健康经济建模中模型不确定性的首选建模方法，因为原本会产生难以置信的外推结果的模型受到了超常危害框架的限制。

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引用次数: 0

Adaptation and Validation of the Psychological Consequences of Screening Questionnaire (PCQ) for Cognitive Screening in Primary Care. 改编并验证用于初级保健认知筛查的筛查心理后果问卷 (PCQ)。

IF 3.6 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Medical Decision Making

Pub Date : 2024-09-12 DOI: 10.1177/0272989x241275676

Rebecca M Lovett,Sarah Filec,Jeimmy Hurtado,Mary Kwasny,Alissa Sideman,Stephen D Persell,Katherine Possin,Michael Wolf

BACKGROUNDContext-specific measures with adequate external validity are needed to appropriately determine psychosocial effects related to screening for cognitive impairment.METHODSTwo-hundred adults aged ≥65 y recently completing routine, standardized cognitive screening as part of their Medicare annual wellness visit were administered an adapted version of the Psychological Consequences of Screening Questionnaire (PCQ), composed of negative (PCQ-Neg) and positive (PCQ-Pos) scales. Measure distribution, acceptability, internal consistency, factor structure, and external validity (construct, discriminative, criterion) were analyzed.RESULTSParticipants had a mean age of 73.3 y and were primarily female and socioeconomically advantaged. Most had a normal cognitive screening result (99.5%, n = 199). Overall PCQ scores were low (PCQ-Neg: x¯= 1.27, possible range 0-36; PCQ-Pos: x¯ = 7.63, possible range 0-30). Both scales demonstrated floor effects. Acceptability was satisfactory, although the PCQ-Pos had slightly more item missingness. Both scales had Cronbach alphas >0.80 and a single-factor structure. Spearman correlations between the PCQ-Neg with general measures of psychological distress (Impacts of Events Scale-Revised, Perceived Stress Scale, Kessler Distress Scale) ranged from 0.26 to 0.37 (P's < 0.001); the correlation with the World Health Organization-Five Well-Being Index was -0.19 (P < 0.01). The PCQ-Neg discriminated between those with and without a self-reported subjective cognitive complaint (x¯ = 2.73 v. 0.89, P < 0.001) and was associated with medical visit satisfaction (r = -0.24, P < 0.001) on the Patient Satisfaction Questionnaire. The PCQ-Pos predicted self-reported willingness to engage in future screening (x¯ = 8.00 v. 3.00, P = 0.03).CONCLUSIONSThe adapted PCQ-Neg is an overall valid measure of negative psychological consequences of cognitive screening; findings for the PCQ-Pos were more variable. Future studies should address measure performance among diverse samples and those with abnormal screening results.HIGHLIGHTSThe PCQ scale is an overall valid measure of psychological dysfunction related to cognitive screening in older adults receiving normal screen results.PCQ scale performance should be further validated in diverse populations and those with abnormal cognitive screening results.The adapted PCQ may be useful to both health research and policy stakeholders seeking improved assessment of psychological impacts of cognitive screening.

方法对 200 名年龄≥65 岁、最近完成常规标准化认知筛查（作为医疗保险年度健康检查的一部分）的成年人进行了筛查心理后果问卷 (PCQ) 的改编版测试，该问卷由消极（PCQ-Neg）和积极（PCQ-Pos）两个量表组成。对量表的分布、可接受性、内部一致性、因子结构和外部效度（建构效度、区分效度和标准效度）进行了分析。结果参与者的平均年龄为 73.3 岁，主要为女性，社会经济地位较高。大多数人的认知筛查结果正常（99.5%，n = 199）。PCQ 总分较低（PCQ-Neg：x¯= 1.27，可能范围 0-36；PCQ-Pos：x¯= 7.63，可能范围 0-30）。两个量表均显示出底限效应。可接受性令人满意，但 PCQ-Pos 的缺失项目略多。两个量表的 Cronbach alphas 均大于 0.80，且均为单因素结构。PCQ-Neg与一般心理压力测量（事件影响量表-修订版、感知压力量表、凯斯勒压力量表）之间的斯皮尔曼相关性为0.26至0.37（P<0.001）；与世界卫生组织-五项幸福指数之间的相关性为-0.19（P<0.01）。PCQ-Neg可区分有主观认知主诉和无主观认知主诉的患者（x¯ = 2.73 v. 0.89，P < 0.001），并与患者满意度问卷中的就诊满意度相关（r = -0.24，P < 0.001）。PCQ-Pos预测了自我报告的未来筛查意愿（x¯ = 8.00 v. 3.00, P = 0.03）。结论：改编后的PCQ-Neg是认知筛查负面心理后果的总体有效测量方法；PCQ-Pos的结果变化较大。PCQ量表的性能应在不同人群和认知筛查结果异常的人群中进一步验证。改编后的PCQ可能对寻求改善认知筛查心理影响评估的健康研究和政策利益相关者有用。

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引用次数: 0

Medical Homo Ignorans, Shared Decision Making, and Affective Paternalism: Balancing Emotion and Analysis in Health Care Choices. 医学无知者、共同决策和情感家长制：平衡医疗保健选择中的情感与分析。

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Medical Decision Making

Pub Date : 2024-08-01 Epub Date: 2024-06-25 DOI: 10.1177/0272989X241263001

Gustav Tinghög, Emil Persson, Daniel Västfjäll

引用次数: 0

Using Separate Single-Outcome Risk Presentations Instead of Integrated Multioutcome Formats Improves Comprehension in Discrete Choice Experiments. 在离散选择实验中，使用单独的单一结果风险演示而非综合的多结果形式可提高理解能力。

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Medical Decision Making

Pub Date : 2024-08-01 Epub Date: 2024-06-21 DOI: 10.1177/0272989X241258466

Matthew J Wallace, E Hope Weissler, Jui-Chen Yang, Laura Brotzman, Matthew A Corriere, Eric A Secemsky, Jessie Sutphin, F Reed Johnson, Juan Marcos Gonzalez, Michelle E Tarver, Anindita Saha, Allen L Chen, David J Gebben, Misti Malone, Andrew Farb, Olufemi Babalola, Eva M Rorer, Brian J Zikmund-Fisher, Shelby D Reed

Introduction: Despite decades of research on risk-communication approaches, questions remain about the optimal methods for conveying risks for different outcomes across multiple time points, which can be necessary in applications such as discrete choice experiments (DCEs). We sought to compare the effects of 3 design factors: 1) separated versus integrated presentations of the risks for different outcomes, 2) use or omission of icon arrays, and 3) vertical versus horizontal orientation of the time dimension.

Methods: We conducted a randomized study among a demographically diverse sample of 2,242 US adults recruited from an online panel (mean age 59.8 y, s = 10.4 y; 21.9% African American) that compared risk-communication approaches that varied in the 3 factors noted above. The primary outcome was the number of correct responses to 12 multiple-choice questions asking survey respondents to identify specific numbers, contrast options to recognize dominance (larger v. smaller risks), and compute differences. We used linear regression to test the effects of the 3 design factors, controlling for health literacy, graph literacy, and numeracy. We also measured choice consistency in a subsequent DCE choice module.

Results: Mean comprehension varied significantly across versions (P < 0.001), with higher comprehension in the 3 versions that provided separated risk information for each risk. In the multivariable regression, separated risk presentation was associated with 0.58 more correct responses (P < 0.001; 95% confidence interval: 0.39, 0.77) compared with integrated risk information. Neither providing icon arrays nor using vertical versus horizontal time formats affected comprehension rates, although participant understanding did correlate with DCE choice consistency.

Conclusions: In presentations of multiple risks over multiple time points, presenting risk information separately for each health outcome appears to increase understanding.

Highlights: When conveying information about risks of different outcomes at multiple time points, separate presentations of single-outcome risks resulted in higher comprehension than presentations that combined risk information for different outcomes.We also observed benefits of presenting single-outcome risks separately among respondents with lower numeracy and graph literacy.Study participants who scored higher on risk understanding were more internally consistent in their responses to a discrete choice experiment.

导言：尽管对风险传达方法进行了数十年的研究，但在离散选择实验（DCEs）等应用中，传达不同结果在多个时间点的风险的最佳方法仍然存在问题。我们试图比较 3 个设计因素的效果：1) 不同结果风险的分离与整合呈现；2) 使用或省略图标阵列；3) 时间维度的垂直与水平方向：我们从一个在线小组（平均年龄 59.8 岁，s = 10.4 岁；21.9% 为非洲裔美国人）中招募了 2,242 名美国成年人，对他们进行了一项随机研究，比较了因上述 3 个因素而异的风险传达方法。主要结果是对 12 道多选题的正确回答数，这些多选题要求调查对象识别具体数字、对比选项以识别优势（较大风险与较小风险）并计算差异。我们使用线性回归法检验了 3 个设计因素的影响，并对健康素养、图形素养和计算能力进行了控制。我们还在随后的 DCE 选择模块中测量了选择的一致性：结果：不同版本的平均理解力差异很大（P在介绍多个时间点的多种风险时，分别介绍每种健康结果的风险信息似乎能加深理解：在传达多个时间点不同结果的风险信息时，单独介绍单一结果的风险比综合介绍不同结果的风险信息的理解度更高。我们还观察到，单独介绍单一结果的风险对计算能力和识图能力较低的受访者有好处。

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引用次数: 0

"Sensemaking" to Aid Shared Decision Making in Clinical Practice: A Personal Response to Information Overload and Decision Abdication. 在临床实践中以 "感性决策 "辅助共同决策：对信息过载和放弃决策的个人回应。

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Medical Decision Making

Pub Date : 2024-08-01 Epub Date: 2024-06-06 DOI: 10.1177/0272989X241257941

Andrew J Vickers, Paul Bennett

引用次数: 0

Identifying Strategies to Improve Shared Decision Making for Pregnant Patients' Decisions about Prenatal Genetic Screens and Diagnostic Tests. 确定改进孕妇就产前基因筛查和诊断测试共同决策的策略。

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Medical Decision Making

Pub Date : 2024-08-01 Epub Date: 2024-07-31 DOI: 10.1177/0272989X241259016

Christina Collart, Caitlin Craighead, Meng Yao, Edward K Chien, Susannah Rose, Richard M Frankel, Marissa Coleridge, Bo Hu, Brownsyne Tucker Edmonds, Angela C Ranzini, Ruth M Farrell

Purpose: Prenatal genetic screens and diagnostic tests are vital components of prenatal care. The first prenatal visit is a critical time in the decision-making process when patients decide whether to use these tests in addition to address a series of other essential prenatal care aspects. We conducted this study to examine the role of a shared decision-making (SDM) instrument to support these discussions.

Methods: We conducted a cluster randomized controlled trial of patients allocated to an SDM tool or usual care at their first prenatal visit. Participants completed a baseline survey to measure decision-making needs and preferences. Direct observation was conducted and analyzed using the OPTION scale to measure SDM during prenatal genetic testing discussions.

Results: Levels of SDM were similar across groups (P = 0.081). The highest levels of SDM were observed during screening test discussions (NEST 2.4 ± 0.9 v. control 2.6 ± 1.0). Lowest levels were observed in discussions about patients' preference for risk versus diagnostic information (NEST 1.0 ± 1.1 v. control 1.2 ± 1.3).

Conclusion: Study findings demonstrate the need for targeted patient-focused and provider-focused efforts to improve SDM to enhance patients' informed decision making about these options. Importantly, patients' baseline knowledge and attitudes need to be considered given that patients with less knowledge may need more carefully crafted communication.

Highlights: Choices about whether, when, and how to use prenatal genetic tests are highly preference-based decisions, with patients' baseline attitudes about these options as a major driver in health care discussions.The decision-making process is also shaped by patient preferences regarding a shared or informed decision-making process for medical decisions that are highly personal and have significant ramifications for obstetric outcomes.There is a need to develop targeted efforts to improve decision making and enhance patients' ability to make informed decisions about prenatal genetic tests in early pregnancy.

目的：产前基因筛查和诊断检测是产前保健的重要组成部分。首次产前检查是决策过程中的关键时刻，患者除了要决定是否使用这些检测外，还要解决一系列其他重要的产前保健问题。我们开展了这项研究，以探讨共同决策（SDM）工具在支持这些讨论中的作用：我们对首次产前就诊的患者进行了分组随机对照试验，将其分配给 SDM 工具或常规护理。参与者完成了一项基线调查，以衡量决策需求和偏好。采用 OPTION 量表对产前基因检测讨论期间的 SDM 进行直接观察和分析：各组的 SDM 水平相似（P = 0.081）。筛查测试讨论中的 SDM 水平最高（NEST 2.4 ± 0.9 对对照组 2.6 ± 1.0）。在讨论患者对风险信息和诊断信息的偏好时，观察到的 SDM 水平最低（NEST 1.0 ± 1.1 v. 对照组 1.2 ± 1.3）：研究结果表明，有必要开展以患者为中心和以医疗服务提供者为中心的有针对性的工作，以改善 SDM，从而加强患者对这些选择的知情决策。重要的是，需要考虑患者的基本知识和态度，因为知识较少的患者可能需要更细致的沟通：关于是否、何时及如何使用产前基因检测的选择是高度基于偏好的决策，患者对这些选择的基本态度是医疗讨论的主要驱动力。决策过程还受到患者对医疗决策的共同或知情决策过程的偏好的影响，这些医疗决策是高度个人化的，对产科结果有重大影响。

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引用次数: 0

Withdrawing versus Withholding Treatments in Medical Reimbursement Decisions: A Study on Public Attitudes. 医疗报销决定中的撤回治疗与保留治疗：公众态度研究》。

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Medical Decision Making

Pub Date : 2024-08-01 Epub Date: 2024-06-24 DOI: 10.1177/0272989X241258195

Liam Strand, Lars Sandman, Emil Persson, David Andersson, Ann-Charlotte Nedlund, Gustav Tinghög

Background: The use of policies in medical treatment reimbursement decisions, in which only future patients are affected, prompts a moral dilemma: is there an ethical difference between withdrawing and withholding treatment?

Design: Through a preregistered behavioral experiment involving 1,067 participants, we tested variations in public attitudes concerning withdrawing and withholding treatments at both the bedside and policy levels.

Results: In line with our first hypothesis, participants were more supportive of rationing decisions presented as withholding treatments compared with withdrawing treatments. Contrary to our second prestated hypothesis, participants were more supportive of decisions to withdraw treatment made at the bedside level compared with similar decisions made at the policy level.

Implications: Our findings provide behavioral insights that help explain the common use of policies affecting only future patients in medical reimbursement decisions, despite normative concerns of such policies. In addition, our results may have implications for communication strategies when making decisions regarding treatment reimbursement.

Highlights: We explore public' attitudes toward withdrawing and withholding treatments and how the decision level (bedside or policy level) matters.People were more supportive of withholding medical treatment than of withdrawing equivalent treatment.People were more supportive of treatment withdrawal made at the bedside than at the policy level.Our findings help clarify why common-use policies, which impact only future patients in medical reimbursement decision, are implemented despite the normative concerns associted with thesepolicies.

背景：在医疗报销决策中，只有未来的病人会受到影响，而政策的使用会引发道德困境：撤消治疗和拒绝治疗在道德上是否有区别？通过一项有 1067 人参与的预先登记的行为实验，我们测试了公众在床边和政策层面对撤消和拒绝治疗的态度变化：结果：与我们的第一个假设一致，与撤消治疗相比，参与者更支持暂停治疗的配给决策。与我们的第二个预设假设相反，与在政策层面做出的类似决定相比，参与者更支持在床边做出的撤消治疗决定：我们的研究结果提供了行为学方面的见解，有助于解释为什么在医疗报销决策中普遍使用只影响未来患者的政策，尽管此类政策存在规范性问题。此外，我们的研究结果还可能对治疗报销决策中的沟通策略产生影响：我们探讨了公众对撤消和暂停治疗的态度，以及决策层面（床旁或政策层面）的影响。与撤消同等治疗相比，人们更支持暂停治疗。与政策层面相比，人们更支持在床旁撤消治疗。我们的研究结果有助于澄清为什么在医疗报销决策中只影响未来患者的常用政策会被实施，尽管这些政策存在规范性问题。

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引用次数: 0

Who Makes the Decision, How, and Why: A Fuzzy-Trace Theory Approach. 谁做决定、如何做决定以及为什么做决定：模糊跟踪理论方法。

IF 3.1 3区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Medical Decision Making

Pub Date : 2024-08-01 Epub Date: 2024-07-26 DOI: 10.1177/0272989X241263818

Sarah M Edelson, Valerie F Reyna

引用次数: 0