Medical Decision Making最新文献

{"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":"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":"775-793"},"PeriodicalIF":3.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12413505/pdf/","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":"OA","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":"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":"849-861"},"PeriodicalIF":3.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12413504/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to Report Research on the Communication of Health-Related Numbers: The Research on Communicating Numbers (ReCoN) Guidelines.","authors":"Natalie C Benda, Brian J Zikmund-Fisher, Jessica S Ancker","doi":"10.1177/0272989X251346799","DOIUrl":"10.1177/0272989X251346799","url":null,"abstract":"&lt;p&gt;&lt;p&gt;BackgroundResearch with lay audiences (e.g., patients, the public) can inform the communication of health-related numerical information. However, a recent systematic review (Making Numbers Meaningful) highlighted several common issues in the literature that impair readers' ability to evaluate and replicate these studies.PurposeTo create a set of guidelines for reporting research regarding the research on communicating numbers to lay audiences for health-related purposes.Reporting RecommendationsWe present 6 common reporting issues from research on communicating numbers that pertain to the background motivating the study, experimental design and analysis reporting, description of the outcomes, and reporting of the data presentation formats. To address these issues, we propose a set of 7 reporting guidelines including 1) specifying how study objectives address a gap in evidence on research on communicating numbers, 2) clearly reporting all combinations of data presentation formats (experimental conditions) compared, 3) providing verbatim examples of the data that were presented to the audience, 4) describing whether or not participants had access to the data presentation formats while outcomes were assessed, 5) reporting the wording of all outcome measures, 6) using standardized terms for both outcomes and data presentation formats, and 7) ensuring that broad outcome concepts such as gist, comprehension, or knowledge are concretely defined.ConclusionsFuture studies involving research on communicating health-related numbers should use these guidelines to improve the quality of reporting and ease of evidence synthesis in future efforts.HighlightsOur systematic review allowed us to exhaustively identify and enumerate several common reporting issues from research on communicating numbers that make it challenging to synthesize evidence.Reporting issues involved not including the background motivating the gap the study addresses, insufficiently describing experimental designs and analyses, and failing to report information regarding the outcomes measured.We propose 7 reporting guidelines for future research on communicating numbers to address the issues detected:1. Specification of how study objectives address a gap in evidence on research communicating numbers2. Clearly reporting all combinations of data presentation format elements compared3. Providing verbatim examples of the data presentation formats4. Describing whether participants had access to the data presentation formats while outcomes were assessed5. Reporting the wording of all outcome measures6. Using standardized terms for both outcomes and data presentation formats7. Ensuring that broad outcome concepts such as gist, comprehension, or knowledge are concretely definedImplementation of these guidelines will facilitate knowledge synthesis of research on communicating numbers and support creating evidence-based guidelines of best practices for communicating health-related numbers to lay ","PeriodicalId":49839,"journal":{"name":"Medical Decision Making","volume":" ","pages":"826-833"},"PeriodicalIF":3.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12353949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477625","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":"Hospital Adoption of Diversity, Equity, and Inclusion (DEI) Disaggregated Data for Organizational Decision Making.","authors":"Tran T Doan, Bradley E Iott","doi":"10.1177/0272989X251346844","DOIUrl":"10.1177/0272989X251346844","url":null,"abstract":"<p><p>IntroductionHospitals are interested in improving the quality of data disaggregation and collection to advance diversity, equity, and inclusion (DEI) goals. We evaluated the extent to which hospitals are adopting DEI disaggregated data to inform organizational decisions and the characteristics associated with this adoption.MethodsWe analyzed data from the 2022 American Hospital Association Annual Survey, which included the final iteration of a new survey item about hospital DEI disaggregated data adoption for decision making. Descriptive statistics, logistic regression, and negative binomial regression were used to evaluate this survey item.ResultsAmong hospitals adopting DEI disaggregated data (<i>n</i> = 2,596, 41.9%), two-thirds used these data to inform decisions about patient outcomes, half about training or professional development, and one-third about supply chain or procurement. Larger, tax-exempt, Veteran Affairs, or metropolitan hospitals are significantly more likely to adopt DEI disaggregated data for decision making.LimitationsOur work is limited by the reporting of 1-y cross-sectional results.ConclusionsMost hospitals adopt DEI disaggregated data to inform decisions about patient outcomes. Future research should explore whether hospital decisions or disaggregated data adoption have advanced DEI and health equity for underserved communities.ImplicationsAnalysis of disaggregated data adoption could reveal how hospitals make decisions and funding allocations to advance DEI goals and health equity.HighlightsThere is a limited understanding of the extent to which hospitals adopt diversity, equity, and inclusion (DEI) disaggregated data to inform organizational decision making, highlighting a knowledge gap at the intersection of data equity and health care management.Among hospitals that adopt DEI disaggregated data, two-thirds use them to inform organizational decisions about patient outcomes, and half about professional development.Larger, tax-exempt, Veteran Affairs, or metropolitan hospitals are more likely to adopt DEI disaggregated data for organizational decision making.Future research is needed to explore whether hospital adoption of DEI disaggregated data has advanced DEI organizational goals and health equity for underserved populations.</p>","PeriodicalId":49839,"journal":{"name":"Medical Decision Making","volume":" ","pages":"917-922"},"PeriodicalIF":3.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477624","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":"<p><p>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":"794-810"},"PeriodicalIF":3.1,"publicationDate":"2025-10-01","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":"Forewarning Artificial Intelligence about Cognitive Biases.","authors":"Jonathan Wang, Donald A Redelmeier","doi":"10.1177/0272989X251346788","DOIUrl":"10.1177/0272989X251346788","url":null,"abstract":"<p><p>Artificial intelligence models display human-like cognitive biases when generating medical recommendations. We tested whether an explicit forewarning, \"Please keep in mind cognitive biases and other pitfalls of reasoning,\" might mitigate biases in OpenAI's generative pretrained transformer large language model. We used 10 clinically nuanced cases to test specific biases with and without a forewarning. Responses from the forewarning group were 50% longer and discussed cognitive biases more than 100 times more frequently compared with responses from the control group. Despite these differences, the forewarning decreased overall bias by only 6.9%, and no bias was extinguished completely. These findings highlight the need for clinician vigilance when interpreting generated responses that might appear seemingly thoughtful and deliberate.HighlightsArtificial intelligence models can be warned to avoid racial and gender bias.Forewarning artificial intelligence models to avoid cognitive biases does not adequately mitigate multiple pitfalls of reasoning.Critical reasoning remains an important clinical skill for practicing physicians.</p>","PeriodicalId":49839,"journal":{"name":"Medical Decision Making","volume":" ","pages":"913-916"},"PeriodicalIF":3.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12413502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477583","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":"Influence of Anecdotes of IVF Success on Treatment Decision Making: An Online Randomized Controlled Trial.","authors":"Verity Chadwick, Micah B Goldwater, Tom van Laer, Jenna Smith, Erin Cvejic, Kirsten J McCaffery, Tessa Copp","doi":"10.1177/0272989X251367783","DOIUrl":"https://doi.org/10.1177/0272989X251367783","url":null,"abstract":"<p><p>BackgroundAlthough in vitro fertilization (IVF) has enhanced fertility opportunities for many people, it also comes with considerable burden. Concerns have been raised about patients holding unrealistic expectations and continuing treatment indefinitely. This study aimed to investigate whether anecdotes of IVF success affect hypothetical intentions to continue treatment despite very low chances of success.DesignOnline randomized controlled trial with a parallel 3-arm design, conducted in May 2022. After viewing a clinical vignette depicting 6 unsuccessful IVF cycles with less than 5% chance of subsequent treatment success, 606 females aged 18 to 45 years in Australia were randomized to receive either 1) an anecdote of IVF success despite limited chances, 2) the anecdote of success and an anecdote of failure, or 3) no anecdote. Outcomes were intention to undergo another IVF cycle, worry, likelihood of success, and narrative transportation.ResultsThere was a main effect of anecdote condition on intention to have another IVF cycle, with participants randomized to the positive and negative anecdote having higher intention than those given no additional information (mean difference = 0.65, 95% confidence interval [CI] = 0.12-1.18, <i>P</i> = 0.017). There were no differences between conditions regarding worry, likelihood of success, or narrative transportation. In adjusted analyses accounting for prior IVF experience, the main effect of anecdotes on intention was no longer statistically significant. Those with prior IVF experience reported a statistically higher likelihood of success and narrative transportation than those without prior IVF experience (mean difference [MD] = 34.28, 95% CI = 27.26-41.30, <i>P</i> < 0.001, and MD = 1.35, 95% CI = 0.96-1.74, <i>P</i> < 0.001, respectively).ConclusionHearing anecdotes may encourage continuation of IVF despite extremely low chances of success. These findings, along with our sample's overestimation of IVF success, illustrate the importance of frequent and frank discussions about expected treatment outcomes.Trial registration:ACTRN12622000576729.HighlightsThe presence of IVF anecdotes increased the intention to undergo another IVF cycle despite extremely low chances of success.Balancing an anecdote of success with an anecdote of failure had no attenuating effect on intention.IVF providers should be wary of the potential impact of success stories on patients' decision making.In the vignette depicting overuse of IVF, participants with previous IVF experience greatly overestimated the likelihood of success with another IVF cycle, supporting previous research finding that patients often have unrealistically high expectations about their own chance of success.</p>","PeriodicalId":49839,"journal":{"name":"Medical Decision Making","volume":" ","pages":"272989X251367783"},"PeriodicalIF":3.1,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187417","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":"Does Messaging for Reducing Breast Cancer Overscreening in Older Women Have Differential Responses among Medical Minimizers and Maximizers?","authors":"Nancy L Schoenborn, Sarah E Gollust, Rebekah H Nagler, Mara A Schonberg, Cynthia M Boyd, Qian-Li Xue, Yaldah M Nader, Craig E Pollack","doi":"10.1177/0272989X251377458","DOIUrl":"https://doi.org/10.1177/0272989X251377458","url":null,"abstract":"<p><p>BackgroundMessaging strategies hold promise to reduce breast cancer overscreening. However, it is not known whether they may have differential effects among medical maximizers who prefer to take action about their health versus medical minimizers who prefer to wait and see.MethodsIn a randomized controlled survey experiment that included 2 sequential surveys with 3,041 women aged 65+ y from a US population-based online panel, we randomized participants to 1) no messages, 2) single exposure to a screening cessation message, or 3) 2 exposures over time to the screening cessation message. We assessed support for stopping screening in a hypothetical patient and intention to stop screening oneself on 7-point scales, where higher values indicated stronger support and intentions to stop screening. We conducted stratified analyses by medical-maximizing preference and moderation analysis.ResultsOf the women, 40.7% (<i>n</i> = 1,238) were medical maximizers; they had lower support and intention for screening cessation in all groups compared with the medical minimizers. Two message exposures increased support for screening cessation among medical maximizers, with a mean score of 3.68 (95% confidence interval [CI] 3.51-3.85) compared with no message (mean score 2.20, 95% CI 2.00-2.39, <i>P</i> < 0.001). A similar pattern was seen for screening intention. Linear regression models showed no differential messaging effect by medical-maximizing preference.ConclusionsMedical maximizers, although less likely to support screening cessation, were nonetheless responsive to messaging strategies designed to reduce breast cancer overscreening.HighlightsIt is not known if a message on rationales for stopping breast cancer screening would have differential effects among medical maximizers who prefer to take action when it comes to their health versus medical minimizers who prefer to wait and see.In a 2-wave randomized controlled survey experiment with 3,041 older women, we found that medical maximizers, although less likely to support screening cessation compared with medical minimizers, were nonetheless responsive to the messaging intervention, and the magnitude of the intervention effect was similar between maximizers and minimizers.Medical maximizers reported higher levels of worry and annoyance after reading the message compared with the minimizers, but the absolute levels of worry and annoyance were low.Our findings suggest that messaging can be a useful tool for reducing overscreening even in a highly reluctant population.</p>","PeriodicalId":49839,"journal":{"name":"Medical Decision Making","volume":" ","pages":"272989X251377458"},"PeriodicalIF":3.1,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187329","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":"Effects of Prior Diagnosis on Second Opinions and Pathologist Viewing Behaviors: Results from a Randomized Trial in Breast Pathology.","authors":"Kathleen F Kerr, Megan M Eguchi, Hannah Shucard, Trafton Drew, Donald L Weaver, Joann G Elmore, Tad T Brunyé","doi":"10.1177/0272989X251368886","DOIUrl":"https://doi.org/10.1177/0272989X251368886","url":null,"abstract":"<p><p>ObjectiveTo study the effects of exposure to a prior diagnosis (PD) on second opinions in breast pathology.Materials and MethodsPathologists interpreted digital breast biopsy cases in 2 phases separated by a washout. Phase 2 interpretations were randomly assigned to PD or no PD. When presented, PD was always more or less severe than a participant's phase 1 diagnosis. Viewing behaviors, including zoom level, were recorded during all interpretations. Twenty pathologists yielded 556 interpretations of 32 different cases.ResultsPathologists were 71% more likely to give a less severe diagnosis when exposed to a less severe PD than with no PD (RR 1.71, 95% CI 1.33-2.20, <i>P</i> < 0.001). In comparison, when exposed to a more severe PD than with no PD, pathologists were 27% more likely to give a more severe diagnosis, but the effect was not significant (RR 1.27, 95% CI 0.87-1.86, <i>P</i> = 0.223). Compared with no PD, viewing behavior shifted toward more focus on critical image regions with exposure to a less severe PD and toward higher zoom levels with exposure to a more severe PD.DiscussionResults indicate anchoring and confirmation biases from PD exposure, such that second opinions after PD exposure are not independent assessments. Viewing behaviors illustrated how PD alters the interpretive process, including increased zooming when exposed to a more severe PD. Results have implications for best practices for computer-aided diagnosis tools.ImplicationsWhen giving a second opinion, exposure to a PD can sway diagnostic classifications and alter interpretive behavior, highlighting a need for protocols that encourage independent assessments.HighlightsIn pathology diagnosis, second opinions are systematically influenced by prior diagnostic information.Less severe prior diagnoses shift pathologists' visual attention toward clinically critical regions of a pathology image, whereas more severe prior diagnoses tend to elicit increased magnification during case interpretation.Specific viewing behaviors partially mediate the effect of prior diagnoses on second opinion diagnoses.When prior diagnoses are disclosed to pathologists, anchoring and confirmation biases undermine the independence of second opinion decisions.</p>","PeriodicalId":49839,"journal":{"name":"Medical Decision Making","volume":" ","pages":"272989X251368886"},"PeriodicalIF":3.1,"publicationDate":"2025-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145187374","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":"Lottery or Triage? Controlled Experimental Evidence from the COVID-19 Pandemic on Public Preferences for Allocation of Scarce Medical Resources.","authors":"Rhys Llewellyn Thomas, Laurence Sj Roope, Raymond Duch, Thomas Robinson, Alexei Zakharov, Philip Clarke","doi":"10.1177/0272989X251367777","DOIUrl":"https://doi.org/10.1177/0272989X251367777","url":null,"abstract":"<p><p>BackgroundBioethicists have advocated lotteries to distribute scarce health care resources, highlighting the benefits that make them attractive amid growing health care challenges. During the COVID-19 pandemic, lotteries were used to distribute vaccines within priority groups in some settings, notably in the United States. Nonetheless, limited evidence exists on public attitudes toward lotteries.MethodsTo assess public support for vaccine allocation by lottery versus expert committee, we conducted a survey-based experiment during the pandemic. Between November 2020 and May 2021, data were collected from 15,380 respondents across 14 diverse countries. Respondents were randomly allocated (1:1) to 1 of 2 hypothetical scenarios involving COVID-19 vaccine allocation among nurses: 1) by lottery and 2) prioritization by a committee of expert physicians. The outcome was agreement on the appropriateness of the allocation mechanism on a scale ranging from 0 (<i>strongly disagree</i>) to 100 (<i>strongly agree</i>), with differences stratified by a range of covariates. Two-sided <i>t</i> tests were used to test for overall differences in mean agreement between lottery and expert committee.FindingsMean agreement with lottery allocation was 37.25 (95% confidence interval [CI] 34.86-39.65), ranging from 21.1 (95% CI 15.07-27.13) in Chile to 62.33 (95% CI 54.45-70.21) in India. In every country, expert committee allocation received higher support, with mean agreement of 61.19 (95% CI: 60.04-62.35), varying from 51.25 in Chile to 69.77 in India. Greater agreement with lotteries was observed among males, higher-income individuals, those with lower education, and those identifying as politically right leaning.ConclusionsDespite arguments for lottery-based allocation of medical resources, we found low overall public support, albeit with substantial variation across countries. Successful implementation of lottery allocation will require targeted public engagement and clear communication of potential benefits.HighlightsThis study surveyed 15,380 respondents from 14 diverse countries during the COVID-19 pandemic, analyzing international agreement with the appropriateness of using lottery allocation for scarce health care resources.There was universal preference for allocating vaccines by expert committee rather than by lotteries, but there was significant variation in agreement between countries, indicating the need for region-specific policy approaches.Successful implementation of lottery allocation requires targeted public engagement and communication of their benefits, especially with groups less supportive of lotteries.</p>","PeriodicalId":49839,"journal":{"name":"Medical Decision Making","volume":" ","pages":"272989X251367777"},"PeriodicalIF":3.1,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145180105","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}