MDM Policy and Practice最新文献

{"title":"Estimating Utility Values for Health States of Nigerian Individuals with Stroke or Epilepsy Using the SF-36: A Brief Report on the Results of a Cross-Sectional Survey.","authors":"T Gebrye, C O Akosile, E C Okoye, U V Okoli, F Fatoye","doi":"10.1177/23814683241266193","DOIUrl":"10.1177/23814683241266193","url":null,"abstract":"<p><p><b>Background.</b> Stroke and epilepsy are the most common neurologic conditions affecting individuals. The Short Form Six-Dimension Health Index (SF-6D) is a preference-based measure of health developed to estimate utility values from the SF-36. This study estimated utility values for health states of Nigerian individuals with stroke or epilepsy using the SF-36. <b>Methods.</b> SF-36 responses from 125 and 69 individuals with stroke and persons with epilepsy, respectively, were transformed into health state utility values using the SF-6D algorithm. The Excel program developed by Brazier and colleagues was used to generate the SF-6D utility score estimated using a set of parametric preference weights. The health state utility values were determined using ordinal health state and standard gamble valuation techniques. <b>Results.</b> Mean (<i>s</i>) ages of the stroke and epilepsy participants were 63.1 (11) and 39.6 (16) y, respectively. The mean (<i>s</i>) utility scores for stroke and epilepsy were 0.52 (0.10) and 0.65 (0.1) for standard gamble and 0.48 (0.13) and 0.68 (0.11), respectively, using the ordinal health state paradigm. The mean (<i>s</i>) utility of stroke (female = 0.46 [0.15]; male = 0.50 [0.12]) and epilepsy (female = 0.65 [0.13], male = 0.69 [0.11]) participants were reported. The mean (<i>s</i>) annual episodes of seizure was 18.7 (39). <b>Conclusions.</b> To our knowledge, this is the first study to suggest that females with stroke and those with epilepsy considered their health to be poorer than that of their male counterparts. The significance of our findings is that they may be helpful for researchers, policy makers, and clinicians by providing input into economic evaluations to facilitate resource allocation for stroke survivors and people living with epilepsy to improve their health outcomes and reduce the huge burden associated with the conditions.</p><p><strong>Highlight: </strong>We estimated a health state utility value for stroke and epilepsy to aid researchers and public health policy makers in conducting health economic analysis and outcomes research.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"9 2","pages":"23814683241266193"},"PeriodicalIF":1.9,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11297505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141894520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modeling the Impact of COVID-19 Mitigation Strategies in Pennsylvania, USA.","authors":"Mary G Krauland, Mark S Roberts","doi":"10.1177/23814683241260744","DOIUrl":"10.1177/23814683241260744","url":null,"abstract":"<p><p><b>Purpose.</b> To estimate the impact on mortality of nonpharmaceutical interventions (NPIs) implemented early in the COVID-19 pandemic. <b>Methods.</b> We implemented an agent-based modified SEIR model of COVID-19, calibrated to match death numbers reported in Pennsylvania from January 2020 to April 2021 and including representations of NPIs implemented in Pennsylvania. To investigate the impact of these strategies, we ran the calibrated model with no interventions and with varying combinations, timings, and levels of interventions. <b>Results.</b> The model closely replicated death outcomes data for Pennsylvania. Without NPIs, deaths in the early months of the pandemic were estimated to be much higher (67,718 deaths compared to actual 6,969). Voluntary interventions alone were relatively ineffective at decreasing mortality. Delaying implementation of interventions led to higher deaths (∼9,000 more deaths with just a 1-week delay). School closure was insufficient as a single intervention but was an important part of a combined intervention strategy. <b>Conclusions.</b> NPIs were effective at reducing deaths early in the COVID-19 pandemic. Agent-based models can incorporate substantial detail on infectious disease spread and the impact of mitigations. <b>Policy Implications.</b> The model supports the importance and effectiveness of NPIs to decrease morbidity from respiratory pathogens. This is particularly important for emerging pathogens for which no vaccines or treatments exist, but such strategies are applicable to a variety of respiratory pathogens.</p><p><strong>Highlights: </strong>Nonpharmaceutical interventions were used extensively during the early period of the COVID-19 pandemic, but their use has remained controversial.Agent-based modeling of the impact of these mitigation strategies early in the COVID-19 pandemic supports the effectiveness of nonpharmaceutical interventions at decreasing mortality.Since such interventions are not specific to a particular pathogen, they can be used to protect against any respiratory pathogen, known or emerging. They can be applied rapidly when conditions warrant.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"9 1","pages":"23814683241260744"},"PeriodicalIF":1.9,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11191394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141443476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening and Treatment of Posttraumatic Stress Disorder in Wildfire Evacuees: A Cost-Utility Analysis.","authors":"Michael Lebenbaum, S Ahmed Hassan","doi":"10.1177/23814683241260423","DOIUrl":"10.1177/23814683241260423","url":null,"abstract":"<p><p><b>Background.</b> Global climate change is resulting in dramatic increases in wildfires. Individuals exposed to wildfires experience a high burden of posttraumatic stress disorder (PTSD), and the cost-effectiveness of the treatment options to address PTSD from wildfires has not been studied. The objective of this study was to conduct a cost-utility analysis comparing screening followed by treatment with paroxetine or trauma-focused cognitive behavioral therapy (TF-CBT) versus no screening in Canadian adult wildfire evacuees. <b>Methods.</b> Using a Markov model, quality-adjusted life-years (QALYs) and costs were evaluated over a 5-y time horizon using health care and societal perspectives. All costs and utilities in the model were discounted at 1.5%. Probabilistic and deterministic sensitivity analyses examined the uncertainty in the incremental net monetary benefit (INMB) under a willingness-to-pay threshold of $50,000. <b>Results.</b> From a societal perspective, no screening (NMB = $177,641) was dominated by screening followed by treatment with paroxetine (NMB = $180,733) and TF-CBT (NMB = $181,787), with TF-CBT having the highest likelihood of being cost-effective at a willingness-to-pay threshold of $50,000 per QALY (probability = 0.649). The initial prevalence of PTSD, probability of acceptance of treatment, and costs of productivity had the largest impact on the INMB of both paroxetine or TF-CBT versus no screening. Neither intervention was cost-effective at a willingness-to-pay threshold of $50,000 per QALY from a health care perspective. <b>Interpretation.</b> Screening followed by treatment with paroxetine or TF-CBT compared with no screening was found to be cost-saving while providing additional QALYs in wildfire evacuees. Governments should consider funding screening programs for PTSD followed by treatment with TF-CBT for wildfire evacuees.</p><p><strong>Highlights: </strong>Two prior studies examined the cost-effectiveness of screening followed by treatment for PTSD among individuals exposed to other disaster-type events (i.e., terrorist attack and Hurricane Sandy) and found screening followed by treatment (i.e., cognitive behavioral therapy [CBT]) to be highly cost-effective.Among wildfire evacuees, screening followed by treatment with paroxetine or trauma-focused (TF)-CBT provides additional quality-adjusted life-years (QALYs) and is cost-saving from a societal perspective. TF-CBT was the treatment option found most likely to be cost-effective.Neither treatment option was cost-effective at a willingness-to-pay threshold of $50,000 per QALY from a health care perspective.Screening programs for PTSD should be considered for wildfire evacuees, and individuals diagnosed with PTSD could be prescribed either TF-CBT or paroxetine depending on their preference and resources availability.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"9 1","pages":"23814683241260423"},"PeriodicalIF":1.9,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11189003/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141433048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Economic and Chronologic Optimization of Fecal Donors Screening Process.","authors":"Bar Levy, Naomi Fliss Isakov, Tomer Ziv-Baran, Moshe Leshno, Nitsan Maharshak, Lael Werner","doi":"10.1177/23814683241254809","DOIUrl":"10.1177/23814683241254809","url":null,"abstract":"<p><p><b>Background.</b> Fecal microbial transplantation (FMT) is the delivery of fecal microbiome, isolated from healthy donors, into a patient's gastrointestinal tract. FMT is a safe and efficient treatment for recurrent <i>Clostridioides difficile</i> infection. Donors undergo strict screening to avoid disease transmission. This consists of several blood and stool tests, which are performed in a multistage, costly process. We performed a cost-minimizing analysis to find the optimal order in which the tests should be performed. <b>Methods.</b> An algorithm to optimize the order of tests in terms of cost was defined. Performance analysis for disqualifying a potential healthy donor was carried out on data sets based on either the published literature or our real-life data. For both data sets, we calculated the total cost to qualify a single donor according to the optimal order of tests, suggested by the algorithm. <b>Results.</b> Applying the algorithm to the published literature revealed potential savings of 94.2% of the cost of screening a potential donor and 7.05% of the cost to qualify a single donor. In our cohort of 87 volunteers, 53 were not eligible for donation. Of 34 potential donors, 10 were disqualified due to abnormal lab tests. Applying our algorithm to optimize the order of tests, the average cost for screening a potential donor resulted in potential savings of 49.9% and a 21.3% savings in the cost to qualify a single donor. <b>Conclusions.</b> Improving the order and timing of the screening tests of potential FMT stool donors can decrease the costs by about 50% per subject.</p><p><strong>Highlights: </strong>What is known:Fecal microbial transplantation (FMT) is the transfer of microbiome from healthy donors to patients.Fecal donors undergo multiple strict screening tests to exclude any transmissible disease.Screening tests of potential fecal donors is expensive and time consuming.FMT is the most efficient treatment for recurrent <i>C difficile</i> infection.What is new here:An algorithm to optimize the order of donors' screening tests in terms of cost was defined.Optimizing the order tests can save nearly 50% in costs of screening a potential donor.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"9 1","pages":"23814683241254809"},"PeriodicalIF":0.0,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11171430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141318566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinician Perceptions on Using Decision Tools to Support Prediction-Based Shared Decision Making for Lung Cancer Screening.","authors":"Sarah E Skurla, N Joseph Leishman, Angela Fagerlin, Renda Soylemez Wiener, Julie Lowery, Tanner J Caverly","doi":"10.1177/23814683241252786","DOIUrl":"10.1177/23814683241252786","url":null,"abstract":"<p><strong>Background: </strong>Considering a patient's full risk factor profile can promote personalized shared decision making (SDM). One way to accomplish this is through encounter tools that incorporate prediction models, but little is known about clinicians' perceptions of the feasibility of using these tools in practice. We examined how clinicians react to using one such encounter tool for personalizing SDM about lung cancer screening (LCS).</p><p><strong>Design: </strong>We conducted a qualitative study based on field notes from academic detailing visits during a multisite quality improvement program. The detailer engaged one-on-one with 96 primary care clinicians across multiple Veterans Affairs sites (7 medical centers and 6 outlying clinics) to get feedback on 1) the rationale for prediction-based LCS and 2) how to use the DecisionPrecision (DP) encounter tool with eligible patients to personalize LCS discussions.</p><p><strong>Results: </strong>Thematic content analysis from detailing visit data identified 6 categories of clinician willingness to use the DP tool to personalize SDM for LCS (adoption potential), varying from \"Enthusiastic Potential Adopter\" (<i>n</i> = 18) to \"Definite Non-Adopter\" (<i>n</i> = 16). Many clinicians (<i>n</i> = 52) articulated how they found the concept of prediction-based SDM highly appealing. However, to varying degrees, nearly all clinicians identified challenges to incorporating such an approach in routine practice.</p><p><strong>Limitations: </strong>The results are based on the clinician's initial reactions rather than longitudinal experience.</p><p><strong>Conclusions: </strong>While many primary care clinicians saw real value in using prediction to personalize LCS decisions, more support is needed to overcome barriers to using encounter tools in practice. Based on these findings, we propose several strategies that may facilitate the adoption of prediction-based SDM in contexts such as LCS.</p><p><strong>Highlights: </strong>Encounter tools that incorporate prediction models promote personalized shared decision making (SDM), but little is known about clinicians' perceptions of the feasibility of using these tools in practice.We examined how clinicians react to using one such encounter tool for personalizing SDM about lung cancer screening (LCS).While many clinicians found the concept of prediction-based SDM highly appealing, nearly all clinicians identified challenges to incorporating such an approach in routine practice.We propose several strategies to overcome adoption barriers and facilitate the use of prediction-based SDM in contexts such as LCS.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"9 1","pages":"23814683241252786"},"PeriodicalIF":0.0,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11110512/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141082604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Longer Life or a Quality Death? A Discrete Choice Experiment to Estimate the Relative Importance of Different Aspects of End-of-Life Care in the United Kingdom.","authors":"Chris Skedgel, David John Mott, Saif Elayan, Angela Cramb","doi":"10.1177/23814683241252425","DOIUrl":"10.1177/23814683241252425","url":null,"abstract":"<p><p><b>Background.</b> Advocates argue that end-of-life (EOL) care is systematically disadvantaged by the quality-adjusted life-year (QALY) framework. By definition, EOL care is short duration and not primarily intended to extend survival; therefore, it may be inappropriate to value a time element. The QALY also neglects nonhealth dimensions such as dignity, control, and family relations, which may be more important at EOL. Together, these suggest the QALY may be a flawed measure of the value of EOL care. To test these arguments, we administered a stated preference survey in a UK-representative public sample. <b>Methods.</b> We designed a discrete choice experiment (DCE) to understand public preferences over different EOL scenarios, focusing on the relative importance of survival, conventional health dimensions (especially physical symptoms and anxiety), and nonhealth dimensions such as family relations, dignity, and sense of control. We used latent class analysis to understand preference heterogeneity. <b>Results.</b> A 4-class latent class multinomial logit model had the best fit and illustrated important heterogeneity. A small class of respondents strongly prioritized survival, whereas most respondents gave relatively little weight to survival and, generally speaking, prioritized nonhealth aspects. <b>Conclusions.</b> This DCE illustrates important heterogeneity in preferences within UK respondents. Despite some preferences for core elements of the QALY, we suggest that most respondents favored what has been called \"a good death\" over maximizing survival and find that respondents tended to prioritize nonhealth over conventional health aspects of quality. Together, this appears to support arguments that the QALY is a poor measure of the value of EOL care. We recommend moving away from health-related quality of life and toward a more holistic perspective on well-being in assessing EOL and other interventions.</p><p><strong>Highlights: </strong>Advocates argue that some interventions, including but not limited to end-of-life (EOL) care, are valued by patients and the public but are systematically disadvantaged by the quality-adjusted life-year (QALY) framework, leading to an unfair and inefficient allocation of health care resources.Using a discrete choice experiment, we find some support for this argument. Only a small proportion of public respondents prioritized survival in EOL scenarios, and most prioritized nonhealth aspects such as dignity and family relations.Together, these results suggest that the QALY may be a poor measure of the value of EOL care, as it neglects nonhealth aspects of quality and well-being that appear to be important to people in hypothetical EOL scenarios.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"9 1","pages":"23814683241252425"},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11100281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141065916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Practical Realities of Local-Level Economic Evaluations: Toward Informed Decision Making in Health Care.","authors":"Todd H Wagner, Alayna Carrandi","doi":"10.1177/23814683241247151","DOIUrl":"https://doi.org/10.1177/23814683241247151","url":null,"abstract":"","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"9 1","pages":"23814683241247151"},"PeriodicalIF":0.0,"publicationDate":"2024-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11025424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140858494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Scoping Review of Personalized, Interactive, Web-Based Clinical Decision Tools Available for Breast Cancer Prevention and Screening in the United States.","authors":"Dalya Kamil, Kaitlyn M Wojcik, Laney Smith, Julia Zhang, Oliver W A Wilson, Gisela Butera, Jinani Jayasekera","doi":"10.1177/23814683241236511","DOIUrl":"10.1177/23814683241236511","url":null,"abstract":"<p><p><b>Introduction.</b> Personalized web-based clinical decision tools for breast cancer prevention and screening could address knowledge gaps, enhance patient autonomy in shared decision-making, and promote equitable care. The purpose of this review was to present evidence on the availability, usability, feasibility, acceptability, quality, and uptake of breast cancer prevention and screening tools to support their integration into clinical care. <b>Methods.</b> We used the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews Checklist to conduct this review. We searched 6 databases to identify literature on the development, validation, usability, feasibility, acceptability testing, and uptake of the tools into practice settings. Quality assessment for each tool was conducted using the International Patient Decision Aid Standard instrument, with quality scores ranging from 0 to 63 (lowest-highest). <b>Results.</b> We identified 10 tools for breast cancer prevention and 9 tools for screening. The tools included individual (e.g., age), clinical (e.g., genomic risk factors), and health behavior (e.g., alcohol use) characteristics. Fourteen tools included race/ethnicity, but no tool incorporated contextual factors (e.g., insurance, access) associated with breast cancer. All tools were internally or externally validated. Six tools had undergone usability testing in samples including White (median, 71%; range, 9%-96%), insured (99%; 97%-100%) women, with college education or higher (60%; 27%-100%). All of the tools were developed and tested in academic settings. Seven (37%) tools showed potential evidence of uptake in clinical practice. The tools had an average quality assessment score of 21 (range, 9-39). <b>Conclusions.</b> There is limited evidence on testing and uptake of breast cancer prevention and screening tools in diverse clinical settings. The development, testing, and integration of tools in academic and nonacademic settings could potentially improve uptake and equitable access to these tools.</p><p><strong>Highlights: </strong>There were 19 personalized, interactive, Web-based decision tools for breast cancer prevention and screening.Breast cancer outcomes were personalized based on individual clinical characteristics (e.g., age, medical history), genomic risk factors (e.g., BRCA1/2), race and ethnicity, and health behaviors (e.g., smoking). The tools did not include contextual factors (e.g., insurance status, access to screening facilities) that could potentially contribute to breast cancer outcomes.Validation, usability, acceptability, and feasibility testing were conducted mostly among White and/or insured patients with some college education (or higher) in academic settings. There was limited evidence on testing and uptake of the tools in nonacademic clinical settings.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"9 1","pages":"23814683241236511"},"PeriodicalIF":1.9,"publicationDate":"2024-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10946080/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140159173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the Impact of Different Modes of Information Provision on Preferences for a Newborn Bloodspot Screening Program in the United Kingdom.","authors":"Stuart J Wright, Caroline M Vass, Fiona Ulph, Katherine Payne","doi":"10.1177/23814683241232935","DOIUrl":"10.1177/23814683241232935","url":null,"abstract":"<p><p><b>Introduction.</b> This study aimed to understand the impact of alternative modes of information provision on the stated preferences of a sample of the public for attributes of newborn bloodspot screening (NBS) in the United Kingdom. <b>Methods.</b> An online discrete choice experiment survey was designed using 4 attributes to describe NBS (effect of treatment on the condition, time to receive results, whether the bloodspot is stored, false-positive rate). Survey respondents were randomized to 1 of 2 survey versions presenting the background training materials using text from a leaflet (leaflet version) or an animation (animation version). Heteroskedastic conditional logistic regression was used to estimate the effect of mode of information provision on error variance. <b>Results.</b> The survey was completed by 1,000 respondents (leaflet = 525; animation = 475). Preferences for the attributes in the DCE were the same in both groups, but the group receiving the animation version had 9% less error variance in their responses. Respondents completing the animation version gave higher ratings compared with the leaflet version in terms of ease of perceived understanding. Subgroup analysis suggested that the animation was particularly effective at reducing error variance for women (20%), people with previous children (16.5%), and people between the ages of 35 and 45 y (11.8%). <b>Limitations.</b> This study used simple DCE with 4 attributes, and the results may vary for more complex choice questions. <b>Conclusion.</b> This study provides evidence that that supplementing the information package offered to parents choosing to take part in NBS with an animation may aid them their decision making. Further research would be needed to test the animation in the health system. <b>Implications.</b> Researchers designing DCE should carefully consider the design of their training materials to improve the quality of data collected.</p><p><strong>Highlights: </strong>Prior to completing a discrete choice experiment about newborn bloodspot screening, respondents were shown information using either a leaflet-based or animated format.Respondents receiving information using an animation version reported that the information was slightly easier to understand and exhibited 9% less error variance in expressing their preferences for a newborn screening program.Using the animation version to present information appeared to have a larger impact in reducing the error variance of responses for specific respondents including women, individuals with children, individuals between the ages of 35 and 45 y, and individuals educated to degree level.</p>","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"9 1","pages":"23814683241232935"},"PeriodicalIF":0.0,"publicationDate":"2024-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10913504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140040565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Affects Perceived Trustworthiness of Online Medical Information and Subsequent Treatment Decision Making? Randomized Trials on the Role of Uncertainty and Institutional Cues.","authors":"Gabriel Recchia, Karin S Moser, Alexandra L J Freeman","doi":"10.1177/23814683241226660","DOIUrl":"10.1177/23814683241226660","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background.&lt;/b&gt; Online, algorithmically driven prognostic tools are increasingly important in medical decision making. Institutions developing such tools need to be able to communicate the precision and accuracy of the information in a trustworthy manner, and so many attempt to communicate uncertainties but also use institutional logos to underscore their trustworthiness. Bringing together theories on trust, uncertainty, and psychological distance in a novel way, we tested whether and how the communication of uncertainty and the presence of institutional logos together affected trust in medical information, the prognostic tool itself, and treatment decisions. &lt;b&gt;Methods.&lt;/b&gt; A pilot and 2 online experiments in which UK (experiment 1) and worldwide (experiment 2) participants (N&lt;sub&gt;total&lt;/sub&gt; = 4,724) were randomized to 1 of 12 arms in a 3 (uncertainty cue) × 4 (institutional cue) between-subjects design. The stimulus was based on an existing medical prognostic tool. &lt;b&gt;Results.&lt;/b&gt; Institutional trust was consistently associated with trust in the prognostic tool itself, while uncertainty information had no consistent effect. Institutional trust predicted the amount of weight participants reported placing on institutional endorsements in their decision making and the likelihood of switching from passive to active treatment in a hypothetical scenario. There was also a significant effect of psychological distance to (perceived hypotheticality of) the scenario. &lt;b&gt;Conclusions/Implications.&lt;/b&gt; These results underline the importance of institutions demonstrating trustworthiness and building trust with their users. They also suggest that users tend to be insensitive to communications of uncertainty and that communicators may need to be highly explicit when attempting to warn of low precision or quality of evidence. The effect of the perceived hypotheticality of the scenario underscores the importance of realistic decision-making scenarios for studies and the role of familiarity with the decision dilemma generally.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Highlights: &lt;/strong&gt;In a world where information for medical decision making is increasingly going to be provided through digital, online tools, institutions providing such tools need guidance on how best to communicate about their trustworthiness and precision.We find that people are fairly insensitive to cues designed to communicate uncertainty around the outputs of such tools. Even putting \"ATTENTION\" in bold font or explicitly pointing out the weaknesses in the data did not appear to affect people's decision making using the tool's outputs. Institutions should take note, and further work is required to determine how best to communicate uncertainty in a way that elicits appropriate caution in lay users.People were much more sensitive to institutional logos associated with the outputs. Generalized institutional trust (rather than trust in the specific institution whose logo was shown) was associated with how trustw","PeriodicalId":36567,"journal":{"name":"MDM Policy and Practice","volume":"9 1","pages":"23814683241226660"},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10870812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139900595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}