Medical Decision Making最新文献

{"title":"Relative Survival Modeling for Appraising the Cost-Effectiveness of Life-Extending Treatments: An Application to Tafamidis for the Treatment of Transthyretin Amyloidosis with Cardiomyopathy.","authors":"Robert Young, Jack Said, Sam Large","doi":"10.1177/0272989X251342459","DOIUrl":"10.1177/0272989X251342459","url":null,"abstract":"<p><p>BackgroundEconomic evaluations for life-extending treatments frequently require clinical trial data to be extrapolated beyond the trial duration to estimate changes in life expectancy. Conventional survival models often display hazard profiles that do not rise as expected in an aging population and require the incorporation of external data to ensure plausibility. Relative survival (RS) models can enable the incorporation of external data at model fitting. A comparison was performed between RS and \"standard\" all-cause survival (ACS) in modeling outcomes from the tafamidis for the treatment of transthyretin amyloid cardiomyopathy (ATTR-ACT) trial.MethodsPatient-level data from the 30-mo ATTR-ACT trial were used to develop survival models based on parametric ACS and RS models. The latter was composed of an expected hazard and an independent excess hazard. Models were selected according to statistical goodness of fit and clinical plausibility, with extrapolation up to 72 mo validated against ATTR-ACT long-term extension (LTE) data.ResultsInformation criteria were too similar to discriminate between RS or ACS models. Several ACS models were affected by capping with general population mortality rates and considered implausible. Selected RS models matched the empirical hazard function, could not fall below general population hazards, and predicted well compared with the LTE data. The preferred RS model predicted the restricted mean survival (RMST) to 72 mo of 51.0 mo (95% confidence interval [CI]: 46.1, 55.3); this compared favorably to the LTE RMST of 50.9 mo (95% CI: 47.7, 53.9).DiscussionRS models can improve the accuracy for modeling populations with high background mortality rates (e.g., the ATTR-CM trial). RS modeling enforces a plausible long-term hazard profile, enables flexibility in medium-term hazard profiles, and increases the robustness of medical decision making.HighlightsTo inform survival extrapolations for health technology assessment, a relative survival model incorporating external data per the recommendations of the National Institute for Health and Care Excellence (NICE) Decision Support Unit was used in support of the NICE evaluation of tafamidis for treatment of transthyretin amyloid cardiomyopathy (ATTR-CM).Relative survival modeling allowed selection of a broader range of hazard profiles compared with all-cause survival modeling by ensuring plausible long-term predictions.Predictions from plausible relative survival models of overall survival in patients with ATTR-CM, extrapolated from the ATTR-ACT trial, validated very well to outcomes after a doubling of follow-up and demonstrated improved precision and accuracy versus parametric all-cause survival models.</p>","PeriodicalId":49839,"journal":{"name":"Medical Decision Making","volume":" ","pages":"726-739"},"PeriodicalIF":3.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12304488/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Notes Contain Limited Documentation of Shared Decision Making for Colorectal Cancer Screening Decisions.","authors":"Brittney Mancini, Joshua Siar, Kathrene Diane Valentine, Leigh Simmons, Lauren Leavitt, Karen Sepucha","doi":"10.1177/0272989X251340704","DOIUrl":"10.1177/0272989X251340704","url":null,"abstract":"<p><p>BackgroundEffective shared decision making (SDM) in health care involves thorough discussions of options, pros, cons, and patient preferences. While SDM is recommended for engaging adults aged 76 to 85 y in colorectal cancer (CRC) screening decisions, the extent of SDM documentation in clinical notes remains unclear.ObjectiveThis study aimed to evaluate the current state of SDM documentation in clinical notes regarding CRC screening discussions for adults aged 76 to 85 y. It also sought to assess the impact of an SDM training intervention on documentation quality and compare documented SDM elements with physician- and patient-reported SDM.MethodsData from 465 patient participants and 58 primary care physicians in a multisite cluster randomized trial were analyzed. Physicians in the intervention arm underwent a 2-h SDM skills training and received support tools, including an electronic health record SmartPhrase. Coders analyzed clinical notes using content analysis to identify SDM elements. Linear multilevel models and multilevel partial correlations were used for analysis.ResultsOverall, SDM Note scores were low (<math><mrow><mover><mrow><mi>x</mi></mrow><mo>¯</mo></mover></mrow></math> = 0.80, <i>s</i> = 0.99). The intervention arm exhibited higher SDM Note scores than the comparator arm did (adjusted mean 1.02 v. 0.66; <i>P</i> = 0.006), with more frequent documentation of stool-based tests (52% v. 33%; <i>P</i> = 0.02) and colonoscopy cons (28% v. 8%; <i>P</i> = 0.001). No significant differences were observed in patient preference documentation. SDM Note scores correlated moderately with patient- and physician-reported SDM.ConclusionDocumentation of CRC screening discussions with older adults lacks comprehensive SDM elements. The intervention improved SDM documentation, particularly regarding alternative screening options and potential cons. Given the limited documentation of SDM even after a training intervention, attention to more robust SDM documentation, including patient preferences and discussion of stopping CRC screening, is needed.HighlightsShared decision-making (SDM) documentation in clinical notes is limited for discussions on colon cancer screening among older adults.SDM training improves SDM documentation of screening options for colorectal cancer, specifically documentation of stool-based testing and the downsides of screening options.SDM documentation in clinical notes is related to patient and provider reports of SDM.</p>","PeriodicalId":49839,"journal":{"name":"Medical Decision Making","volume":" ","pages":"665-674"},"PeriodicalIF":3.1,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Process for Rapid Co-development of a Decision Aid Prototype for Population-wide Cancer Screening.","authors":"Odilon Quentin Assan, Claude Bernard Uwizeye, Hervé Tchala Vignon Zomahoun, Oscar Nduwimana, Wilhelm Dubuisson, Guillaume Sillon, Danielle Bergeron, Stéphane Groulx, Wilber Deck, Anik Giguère, France Légaré","doi":"10.1177/0272989X251346894","DOIUrl":"https://doi.org/10.1177/0272989X251346894","url":null,"abstract":"<p><p>Decision aids (DA) are more likely to be adopted if co-developed with stakeholders and culturally adapted. Using the DEVELOPTOOLS Reporting Checklist, we describe a process for rapid co-development of a culturally adapted DA prototype for population-wide cancer-screening programs. Our systematic, collaborative, and iterative methodology had 7 phases: 1) set up the process by adopting best governance practices (e.g., identify and engage stakeholders, adapt our collaborative DA design process, validate development process), with governance comprising 20 individuals from a wide range of sectors including at least 2 citizens; 2) identify and analyze existing DAs relevant to the cancerscreening of interest by conducting a systematic review; 3) share results with stakeholders and make recommendations; 4) formulate Quebec-specific DA content and consult stakeholders including users by conducting e-Delphi surveys; 5) co-design a prototype with stakeholders, including users, following international DA standards; 6) translate the DA using translation-back translation approaches and deploy; and 7) knowledge mobilization (KMb) using end-of-grant and integrated KMb activities. Using the User-Centred Design 11-Item Measure (UCD-11), our proposed process scored 10 of 11 on the UCD-11. Overall, we expect this new co-developed process to ensure that good-quality, user-centered, and culturally adapted DAs for cancer screening are produced within reasonable timeframes. We also expect it to foster the adoption of the DAs.HighlightsWe report on a 7-step process for collaborating with various stakeholders to create a culturally adapted decision aid (DA) prototype for deciding about cancer screening in Quebec, Canada.The process includes: ○ Making sure the DA prototype design includes users and other interested parties and reflects their needs, perceptions, values, and preferences.○ Finding and analyzing existing DAs on cancer screening to decide what ours should include○ Respecting international standards and criteria for DA design○ Repeated rounds of expert consensus about the exact content, with revisions between each roundThis method could help the rapid creation of DAs shaped by users' interests and will ultimately encourage shared decision making.</p>","PeriodicalId":49839,"journal":{"name":"Medical Decision Making","volume":" ","pages":"272989X251346894"},"PeriodicalIF":3.1,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do Caregivers of Asian Patients with Advanced Cancer Help or Hinder Patient Understanding of Illness and Involvement in Decision Making?","authors":"Semra Ozdemir, Isha Chaudhry, Chetna Malhotra, Courtney Van Houtven, Eric Andrew Finkelstein","doi":"10.1177/0272989X251347303","DOIUrl":"https://doi.org/10.1177/0272989X251347303","url":null,"abstract":"<p><p>PurposeIt is unclear whether caregivers help or hinder patients' involvement in decision making and understanding of illness. We thus investigated the extent to which caregivers' preferred level of patient involvement in decision making and understanding of treatment goals are associated with those of patients.MethodsWe used survey data from 229 patients with metastatic cancer and their family caregivers living in Singapore spanning 2 y prior to the patient's death. We used mixed-effects regressions to investigate the associations between 1) caregiver-preferred level of patient involvement (<i>t_-1</i>) and patient preferred and perceived level of involvement in decision making at subsequent assessments (<i>t₁</i>) and 2) patient and caregiver understanding of treatment goals at the same assessments (<i>t₁</i>).ResultsCaregivers who preferred higher levels of patient involvement in decision making at <i>t</i>_-1 were more likely to have patients who also preferred higher levels of involvement (odds ratio [OR] = 1.19; <i>P</i> = 0.03) and who perceived experiencing higher levels of involvement in decision making (OR = 1.24; <i>P</i> < 0.01) at <i>t₁</i>. Compared with an uncertain understanding of treatment goals, caregivers who had an inaccurate understanding at <i>t₁</i> were more likely to have patients who had an inaccurate understanding (relative risk ratio [RRR] = 8.56; <i>P</i> = 0.03), and caregivers who had an accurate understanding at <i>t₁</i> were more likely to have patients with an accurate understanding (RRR = 3.02; <i>P</i> = 0.01) at <i>t₁</i>.ConclusionOur findings suggest that caregiver preferences for patient involvement in decision making and understanding of treatment goals are significantly associated with those of patients. Enhancing caregiver education and involvement may be pivotal in improving patient participation and comprehension in the context of metastatic cancer care.HighlightsPatients of caregivers who preferred higher levels of patient involvement in decision making at earlier time points were more likely to prefer and experience higher levels of involvement in decision making at subsequent assessments.Patients of caregivers with an inaccurate understanding of treatment goals were more likely to have an inaccurate understanding, while patients of caregivers with an accurate understanding were also more likely to have an accurate understanding.</p>","PeriodicalId":49839,"journal":{"name":"Medical Decision Making","volume":" ","pages":"272989X251347303"},"PeriodicalIF":3.1,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Weight Status Transitions and Validation of an Obesity Model for Aboriginal and Torres Strait Islander Children and Adolescents.","authors":"Thomas Lung, Anagha Killedar, Kirsten Howard, Li Ming Wen, Patrick Kelly, Michelle Dickson, Simone Sherriff, Louise Baur, Alison Hayes","doi":"10.1177/0272989X251351030","DOIUrl":"https://doi.org/10.1177/0272989X251351030","url":null,"abstract":"<p><p>ObjectivesAboriginal and Torres Strait Islander children and adolescents are at higher risk of overweight and obesity, highlighting an inequitable public health concern. The aim of this study was to estimate transition probabilities and validate a model predicting the epidemiologic trajectory of overweight and obesity in Australian Aboriginal and Torres Strait Islander children.MethodsAn individual-level state-transition Markov model was developed to model transitions between healthy weight, overweight, and obesity for Aboriginal and Torres Strait Islander children aged between 2 and 14 y. Age-specific annual transition probabilities were derived from semi-parametric survival analyses using the Longitudinal Study of Indigenous Children. The model used annual cycles over a 12-y time horizon, and the epidemiological predictions of the model were validated using both internal and external data, according to best practice guidelines. The starting age of the model was 2 to 4 y and 4 to 5 y for the internal and external validation, respectively. Aboriginal and Torres Strait Islander children from the Longitudinal Study of Australian Children were used as the external validation cohort.ResultsA total of 1,643 children with 11,514 complete anthropometric measurements were used to estimate transition probabilities. The model predictions showed both good internal and external validity, with most predictions falling within the 95% confidence intervals of measured data. The model was able to reliably capture the epidemiology of overweight and obesity prevalence in early childhood.ConclusionsOur model predictions showed good internal and external validity, ensuring our model is fit for purpose to use to evaluate Aboriginal and Torres Strait Islander-led programs to achieve a healthy weight.HighlightsAboriginal and Torres Strait Islander children experience high rates of overweight and obesity; hence, there is a need for high-quality evidence on both effectiveness and cost-effectiveness of Aboriginal and Torres Strait Islander-led childhood obesity prevention programs to ensure they offer value for money.This is the first study to develop and validate a predictive model using anthropometric data from Aboriginal and Torres Strait Islander children to inform decision making on childhood obesity programs.Our model predictions showed good internal and external validity, ensuring our model is fit for purpose to use to evaluate Aboriginal and Torres Strait Islander-led programs to achieve a healthy weight.The model provides a framework to assist policy makers in identifying when best to intervene in childhood as well as the most effective approaches for maintaining a healthy weight for Aboriginal and Torres Strait Islander children.</p>","PeriodicalId":49839,"journal":{"name":"Medical Decision Making","volume":" ","pages":"272989X251351030"},"PeriodicalIF":3.1,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Population Preferences for Treatment in Life-Limiting Illness: Valuing the Way Time Is Spent at the End of Life.","authors":"Patricia Kenny, Deborah J Street, Jane Hall","doi":"10.1177/0272989X251346203","DOIUrl":"https://doi.org/10.1177/0272989X251346203","url":null,"abstract":"<p><p>IntroductionSocietal preferences over different health states are used to guide service planning, but there has been little investigation of treatment preferences at the end of life. This study aimed to examine population preferences for active treatment or palliation for cancer patients when life expectancy is limited and the relative importance of time spent in hospital or with functional limitation.MethodsWe used a discrete choice experiment that presented respondents with a series of hypothetical patients who had died, describing their last few months of life. Respondents selected the end-of-life alternative they thought best. Data were collected from 1,502 Australian adults participating in an online survey panel. Latent class analysis was used to identify groups with different preference patterns.ResultsFour preference groups were identified along with an additional group that we termed <i>inattentive</i>, as they appeared to respond at random. Among the 1,070 respondents assigned to 1 of the 4 preference groups, 33.5% favored longer overall survival regardless of how that time was spent; 26.1% were willing to accept a shorter survival time for less time in the hospital or completely incapacitated at home, and they had a stronger preference for palliative care in older patients; 22.5% strongly supported the use of palliative care regardless of the age of the patients, preferring less time in the hospital or time at home with any functional limitations; and 17.9% had a strong preference to not use palliative care.ConclusionsOur results show distinct heterogeneity in population preferences for end-of-life care. Policy goals and service planning should acknowledge this heterogeneity and provide end-of-life support services that offer the flexibility to enhance patient choice. Many current funding approaches are not consistent with the philosophy of patient-centered care. Policy makers can and should be exploring innovative approaches to improve efficiency and equity.HighlightsSocial preferences, based on a general population survey, vary across palliative and active care approaches.Preferences for palliative care and willingness to tolerate time in hospital and time at home with activity limitations varied within the groups willing to trade quality and quantity of life.Policy, resource allocation, and funding methods should accommodate this variability.</p>","PeriodicalId":49839,"journal":{"name":"Medical Decision Making","volume":" ","pages":"272989X251346203"},"PeriodicalIF":3.1,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence on Methods for Communicating Health-Related Probabilities: Comparing the Making Numbers Meaningful Systematic Review to the 2021 IPDAS Evidence Paper Recommendations.","authors":"Brian J Zikmund-Fisher, Natalie C Benda, Jessica S Ancker","doi":"10.1177/0272989X251346811","DOIUrl":"10.1177/0272989X251346811","url":null,"abstract":"&lt;p&gt;&lt;p&gt;PurposeTo summarize the degree to which evidence from our recent Making Numbers Meaningful (MNM) systematic review of the effects of data presentation format on communication of health numbers supports recommendations from the 2021 International Patient Decision Aids Standards (IPDAS) Collaboration papers on presenting probabilities.MethodsThe MNM review generated 1,119 distinct findings (derived from 316 papers) related to communication of probabilities to patients or other lay audiences, classifying each finding by its relation to audience task, type of stimulus (data and data presentation format), and up to 10 distinct sets of outcomes: identification and/or recall, contrast, categorization, computation, probability perceptions and/or feelings, effectiveness perceptions and/or feelings, behavioral intentions or behavior, trust, preference, and discrimination. Here, we summarize the findings related to each of the 35 IPDAS paper recommendations.ResultsStrong evidence exists to support several IPDAS recommendations, including those related to the use of part-to-whole graphical formats (e.g., icon arrays) and avoidance of verbal probability terms, 1-in-X formats, and relative risk formats to prevent amplification of probability perceptions, effectiveness perceptions, and/or behavioral intentions as well as the use of consistent denominators to improve computation outcomes. However, the evidence base appears weaker and less complete for other IPDAS recommendations (e.g., recommendations regarding numerical estimates in context and evaluative labels). The IPDAS papers and the MNM review agree that both communication of uncertainty and use of interactive formats need further research.ConclusionsThe idea that no one visual or numerical format is optimal for every probability communication situation is both an IPDAS panel recommendation and foundational to the MNM project's design. Although no MNM evidence contradicts IPDAS recommendations, the evidence base needed to support many common probability communication recommendations remains incomplete.HighlightsThe Making Numbers Meaningful (MNM) systematic review of the literature on communicating health numbers provides mixed support for the recommendations of the 2021 International Patient Decision Aids Standards (IPDAS) evidence papers on presenting probabilities in patient decision aids.Both the IPDAS papers and the MNM project agree that no single visual or numerical format is optimal for every probability communication situation.The MNM review provides strong evidentiary support for IPDAS recommendations in favor of using part-to-whole graphical formats (e.g., icon arrays) and consistent denominators.The MNM review also supports the IPDAS cautions against verbal probability terms and 1-in-X formats as well as its concerns about the potential biasing effects of relative risk formats and framing.MNM evidence is weaker related to IPDAS recommendations about placing numerical estimates in context","PeriodicalId":49839,"journal":{"name":"Medical Decision Making","volume":" ","pages":"272989X251346811"},"PeriodicalIF":3.1,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12236432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144576775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Experimental Investigation of Treatment Decisions under Ambiguity and Conflict.","authors":"Yiyun Shou, Amelia Gulliver, Louise M Farrer, Amy Dawel, Eryn Newman, Michael Smithson","doi":"10.1177/0272989X251346853","DOIUrl":"https://doi.org/10.1177/0272989X251346853","url":null,"abstract":"<p><p>IntroductionEffective risk communication is essential for medical professionals to assist patients to make informed decisions. However, risk communication can be challenging as patients receive ambiguous and conflicting information.ObjectivesThis study aimed to examine how uncertainty influences individuals' perceptions and preferences and interacts with message framing in a medical treatment decision scenario.MethodsThe present study included a large representative sample of Australians (<i>N</i> = 805). A randomized experiment was conducted presenting a scenario about hypothetical COVID-19 treatment alternatives with varying uncertainty and framing in treatment information.ResultsThe results showed that conflicting information and loss framing had deleterious effects on participants' willingness to take a treatment and trust in the sources providing the information, compared with information that was precise, ambiguous, or in a gain frame. The effects could be stronger among participants who are risk averse, anxious, and native language speakers.ConclusionThe findings highlight that patients may be more averse to a treatment option and reduce their trust in medical professionals when they are provided with ambiguous information and particularly when information that conflicts with other sources including other medical professionals. It is important for medical professionals to be aware of other information patients have sourced that may conflict with information provided by the medical professionals during the consultation and to assist patients with high levels of risk aversion and anxiety in their decision making.HighlightsConflicting information and loss framing had deleterious effects on participants' willingness to take a treatment.Conflicting information and loss framing also reduced participants' trust in the sources of the information.The deleterious effects were stronger among participants who were native language speakers and were risk averse and anxious.</p>","PeriodicalId":49839,"journal":{"name":"Medical Decision Making","volume":" ","pages":"272989X251346853"},"PeriodicalIF":3.1,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Organ Donation Decisions: When Deviating from the Status Quo Heightens Perceived Vulnerability.","authors":"Marina Motsenok, Tehila Kogut","doi":"10.1177/0272989X251346213","DOIUrl":"https://doi.org/10.1177/0272989X251346213","url":null,"abstract":"<p><p>BackgroundResearch suggests that the method used to determine voluntary consent (i.e., opt-in versus opt-out policies) greatly affects the number of registered organ donors in various countries. Although the concept of organ transplantation is broadly supported, the relatively low percentage of registered donors in opt-in countries is puzzling. We suggest that deviating from the status quo (such as signing an organ donor card in opt-in countries or removing oneself from the list of registered donors in opt-out countries) heightens one's sense of vulnerability.DesignWe examined our prediction in 2 online experiments involving participants from the United States (studies 1 and 2), which has an opt-in organ-donation policy, and from the United Kingdom (study 2), a country that has recently changed its policy to opt out.ResultsIn study 1, registered organ donors perceived their vulnerability as greater after being reminded of their decision, but vulnerability perceptions were not affected by such a reminder among nondonors who upheld the status quo. In study 2, imagining oneself making an organ donation decision that deviates from the status quo (signing a commitment under an opt-in policy or removing oneself from the registered donors list under an opt-out policy) increased participants' perceived personal vulnerability.ConclusionsThe decision to become an organ donor may affect individuals' sense of physical vulnerability, depending on their country's donation policy. Potentially, deviating from the status quo may curtail willingness for organ donation. Understanding the psychological barriers to organ donation may help overcome them by presenting the issue in a manner that takes such perceptions into account. We recommend future research to explore whether this heightened sense of vulnerability potentially deters organ donation in opt-in countries.HighlightsThe decision to become an organ donor may affect individuals' sense of physical vulnerability, depending on their country's donation policy (opt in versus opt out).Registered organ donors perceived their vulnerability as greater after being reminded of their decision, but vulnerability perceptions were not affected by such a reminder among nondonors who upheld the status quo.Imagining oneself making an organ donation decision that deviates from the status quo (signing a commitment under an opt-in policy or removing oneself from the registered donors list under an opt-out policy) increased participants' perceived personal vulnerability.Future research is needed to examine whether this heightened sense of vulnerability affects actual organ donation decisions.</p>","PeriodicalId":49839,"journal":{"name":"Medical Decision Making","volume":" ","pages":"272989X251346213"},"PeriodicalIF":3.1,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144561781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Semi-Markov Processes and Other Epidemiological Time-to-Event Models by Computing Disease Sojourn Density as Partial Differential Equations.","authors":"Joachim Worthington, Eleonora Feletto, Emily He, Stephen Wade, Barbara de Graaff, Anh Le Tuan Nguyen, Jacob George, Karen Canfell, Michael Caruana","doi":"10.1177/0272989X251333398","DOIUrl":"10.1177/0272989X251333398","url":null,"abstract":"<p><p>IntroductionEpidemiological models benefit from incorporating detailed time-to-event data to understand how disease risk evolves. For example, decompensation risk in liver cirrhosis depends on sojourn time spent with cirrhosis. Semi-Markov and related models capture these details by modeling time-to-event distributions based on published survival data. However, implementations of semi-Markov processes rely on Monte Carlo sampling methods, which increase computational requirements and introduce stochastic variability. Explicitly calculating the evolving transition likelihood can avoid these issues and provide fast, reliable estimates.MethodsWe present the sojourn time density framework for computing semi-Markov and related models by calculating the evolving sojourn time probability density as a system of partial differential equations. The framework is parametrized by commonly used hazard and models the distribution of current disease state and sojourn time. We describe the mathematical background, a numerical method for computation, and an example model of liver disease.ResultsModels developed with the sojourn time density framework can directly incorporate time-to-event data and serial events in a deterministic system. This increases the level of potential model detail over Markov-type models, improves parameter identifiability, and reduces computational burden and stochastic uncertainty compared with Monte Carlo methods. The example model of liver disease was able to accurately reproduce targets without extensive calibration or fitting and required minimal computational burden.ConclusionsExplicitly modeling sojourn time distribution allows us to represent semi-Markov systems using detailed survival data from epidemiological studies without requiring sampling, avoiding the need for calibration, reducing computational time, and allowing for more robust probabilistic sensitivity analyses.HighlightsTime-inhomogeneous semi-Markov models and other time-to-event-based modeling approaches can capture risks that evolve over time spent with a disease.We describe an approach to computing these models that represents them as partial differential equations representing the evolution of the sojourn time probability density.This sojourn time density framework incorporates complex data sources on competing risks and serial events while minimizing computational complexity.</p>","PeriodicalId":49839,"journal":{"name":"Medical Decision Making","volume":" ","pages":"569-586"},"PeriodicalIF":3.1,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12166149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}