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IMPORTANCE: Despite guideline recommendations, clinicians do not systematically use prior screening or health history to guide colorectal cancer (CRC) screening decisions in older adults. OBJECTIVE: To evaluate the effect of a personalized multilevel intervention on screening orders in older adults due for average-risk CRC screening. DESIGN, SETTING, AND PARTICIPANTS: Interventional 2-group parallel unmasked cluster randomized clinical trial conducted from November 2015 to February 2019 at 2 US Department of Veterans Affairs (VA) facilities: 1 academic VA medical center and 1 of its connected outpatient clinics. Randomization at the primary care physician/clinician (PCP) level, stratified by study site and clinical full-time equivalency. Participants were 431 average-risk, screen-due US veterans aged 70 to 75 years attending a primary care visit. Data analysis was performed from August 2018 to August 2023. INTERVENTION: The intervention group received a multilevel intervention including a decision-aid booklet with detailed information on screening benefits and harms, personalized for each participant based on age, sex, prior screening, and comorbidity. The control group received a multilevel intervention including a screening informational booklet. All participants received PCP education and system-level modifications to support personalized screening. MAIN OUTCOMES AND MEASURES: The primary outcome was whether screening was ordered within 2 weeks of clinic visit. Secondary outcomes were concordance between screening orders and screening benefit and screening utilization within 6 months. RESULTS: A total of 436 patients were consented, and 431 were analyzed across 67 PCPs. Patients had a mean (SD) age of 71.5 (1.7) years; 424 were male (98.4%); 374 were White (86.8%); 89 were college graduates (21.5%); and 351 (81.4%) had undergone prior screening. A total of 258 (59.9%) were randomized to intervention, and 173 (40.1%) to control. Screening orders were placed for 162 of 258 intervention patients (62.8%) vs 114 of 173 control patients (65.9%) (adjusted difference, −4.0 percentage points [pp]; 95% CI, −15.4 to 7.4 pp). In a prespecified interaction analysis, the proportion receiving orders was lower in the intervention group than in the control group for those in the lowest benefit quartile (59.4% vs 71.1%). In contrast, the proportion receiving orders was higher in the intervention group than in the control group for those in the highest benefit quartile (67.6% vs 52.2%) (interaction P = .049). Fewer intervention patients (106 of 256 [41.4%]) utilized screening overall at 6 months than controls (96 of 173 [55.9%]) (adjusted difference, −13.4 pp; 95% CI, −25.3 to −1.6 pp). CONCLUSIONS AND RELEVANCE: In this cluster randomized clinical trial, patients who were presented with personalized information about screening benefits and harms in the context of a multilevel intervention were more likely to receive screening orders concordant with benefit and were less likely to utilize screening. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02027545

Genetic researchers’ selection of a database can have scientific, regulatory, and ethical implications. It is important to understand what is driving database selection such that database stewards can be responsive to user needs while balancing the interests of communities in equitably benefiting from advances.

Background: Factors underlying failure to intensify therapy in response to elevated blood pressure have not been systematically studied. Objective: To examine the process of care for diabetic patients with elevated triage blood pressure ([greater than or equal to] 140/90 mm Hg) during routine primary care visits to assess whether a treatment change occurred and to what degree specific patient and provider factors correlated with the likelihood of treatment change. Design: Prospective cohort study. Setting: 9 Veterans Affairs facilities in 3 midwestern states. Participants: 1169 diabetic patients with scheduled visits to 92 primary care providers from February 2005 to March 2006. Measurements: Proportion of patients who had a change in a blood pressure treatment (medication intensification or planned follow-up within 4 weeks). Predicted probability of treatment change was calculated from a multilevel logistic model that included variables assessing clinical uncertainty, competing demands and prioritization, and medication-related factors (controlling for blood pressure). Results: Overall, 573 (49%) patients had a blood pressure treatment change at the visit. The following factors made treatment change less likely: repeated blood pressure by provider recorded as less than 140/90 turn Hg versus 140/90 mm Hg or greater or no recorded repeated blood pressure (13% vs. 61%; P< 0.001); home blood pressure reported by patients as less man 140/90 mm Hg versus 140/90 turn Hg or greater or no recorded home blood pressure (18% vs. 52%; P < 0.001); provider systolic blood pressure goal greater than 130 mm Hg versus 130 mm Hg or less (33% vs. 52%; P = 0.002); discussion of conditions unrelated to hypertension and diabetes versus no discussion (44% vs. 55%; P = 0.008); and discussion of medication issues versus no discussion (23% vs. 52%; P < 0.001). Limitation: Providers knew that the study pertained to diabetes and hypertension, and treatment change was assessed for 1 visit per patient. Conclusion: Approximately 50% of diabetic patients presenting with a substantially elevated triage blood pressure received treatment change at the visit. Clinical uncertainty about the true blood pressure value was a prominent reason that providers did not intensify therapy.

To predict the association between demographic, psychological, and medication-specific characteristics and the level of concern about stopping medications among older adults.

ABSTRACTCompared to many other countries, China offers fewer pediatric vaccines. Future attempts to add mandatory vaccines may run counter to parents’ preferences for shot-limiting. The aim of this study was to assess Chinese parents’ preferences and willingness-to-pay (WTP) for programmatic attributes of vaccination services. Parents of young infants ≤3 months of age presenting at immunization clinics in Shanghai, China, in 2017 completed a discrete choice experiment (DCE) on vaccination program attributes: waiting time at the clinic, number of shots before 7 months, number of injections per visit, cost per visit, and location of the shot. We estimated preference utilities and WTP using logistic regression. In total, 590 completed the DCE. Caregivers expressed greater utility for less waiting time, fewer office visits, lower cost of vaccines, and fewer injections co-administered. Over the course of their child’s first 6 months, parents were willing to pay 113 RMB ($17) to avoid an additional 10 minutes of waiting at each appointment (95% confidence interval [CI]: 213, 929), 474 RMB ($70) to avoid an additional office visit (95% CI: 241, 707), and 703 RMB ($104) to avoid an additional injection at each appointment (95% CI: 337, 1068). As China expands its list of publicly funded vaccines, public health officials will have to counter Chinese parents’ strong preferences for limiting the total number of office visits and the number of injections administered at each visit, potentially through the use of combination vaccines.

Balancing risks of immune suppressive medications against risk of chronic disease is challenging for clinicians and families. Available aids commonly lack comparative information needed to inform treatment decisions. We developed a simple video aid to illustrate competing risks associated with medications and underlying disease in context of pediatric inflammatory bowel disease. Those who viewed the video aid had more realistic risk perceptions than those who did not view it. The video aid is adaptable for other conditions. It required only commonly accessible software and little cost, thereby making an aid of this style an attractive option for health care professionals interested in communicating comparative risk data to patients.

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajog.2007.03.076 Byline: Brian J. Zikmund-Fisher (1)(2)(3), Angela Fagerlin (1)(2)(3), Kristie Keeton (4), Peter A. Ubel (1)(2)(3)(5) Keywords: amniocentesis; decision-making; prenatal screening; risk Abstract: We tested whether adding interpretive labels (eg, 'negative test') to prenatal genetic screening test results changes perceived risk and preferences for amniocentesis. Author Affiliation: (1) Center for Practice Management & Outcomes Research, Health Services Research & Development Service, VA Ann Arbor Healthcare System, University of Michigan School of Medicine, Ann Arbor, MI (2) Center for Behavioral and Decision Sciences in Medicine, University of Michigan School of Medicine, Ann Arbor, MI (3) Division of General Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI (4) Department of Obstetrics and Gynecology, University of Michigan School of Medicine, Ann Arbor, MI (5) Department of Psychology, University of Michigan School of Medicine, Ann Arbor, MI. Article History: Received 13 October 2006; Accepted 26 March 2007 Article Note: (footnote) Supported in part by the National Institutes for Health (R01 CA87595 and P50 CA101451), by a career development award from the American Cancer Society (MRSG-06-130-01-CPPB [B.J.Z-F.]), and by a Merit Review Entry Program early career award from the Department of Veterans Affairs (A.F.)., The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs., Cite this article as: Zikmund-Fisher BJ, Fagerlin A, Keeton K, Ubel PA. Does labeling prenatal screening test results as negative or positive affect women's responses? Am J Obstet Gynecol 2007;197:528.e1-528.e6.

People living with HIV (PLWHIV) can reasonably expect near-normal longevity, yet many express a willingness to assume significant risks to be cured. We surveyed 200 PLWHIV who were stable on antiretroviral therapy (ART) to quantify associations between the benefits they anticipate from a cure and their risk tolerance for curative treatments. Sixty-five per cent expected their health to improve if cured of HIV, 41% predicted the virus would stop responding to medications over the next 20 years and 54% predicted experiencing serious medication side effects in the next 20 years. Respondents’ willingness to risk death for a cure varied widely (median 10%, 75th percentile 50%). In multivariate analyses, willingness to risk death was associated with expected long-term side effects of ART, greater financial resources and being employed (all P < 0.05) but was not associated with perceptions of how their health would improve if cured.

Patients, policy makers, and the public have access to many types of health and scientific data relevant to various individual and societal decisions. Yet, these audiences often struggle with the meaning and the potential usefulness of those data, so they may choose not to engage with the data at all. Scientific and health data are generally difficult to interpret, yet presentations often implicitly assume that the recipient has the necessary contextual knowledge to identify the data’s meaning. To address this problem, designers of data communications should go beyond considering audience characteristics (e.g., numeracy) and focus more on increasing information evaluability (a concept from the judgment and decision-making literatures). The challenge is understanding which data characteristics guide people’s ability to extract meaning from data in a given situation. Prioritizing use-relevant contextual information (e.g., by defining action thresholds, comparison standards, meaningful categories, and/or significant differences) is the single best thing experts can do to improve data communication effectiveness. Doing so increases the chances that the patient, public, or policy maker audience does not just know what their numbers are but also what they mean.

abstract:Behavioral policy to improve health and health care often relies on interventions, such as nudges, which target individual behaviors. But the most promising applications of behavioral insights in this area involve more far-reaching and systemic interventions. In this article, we propose a series of policies inspired by behavioral research that we believe offer the greatest potential for success. These include interventions to improve health-related behaviors, health insurance access, decisions about insurance plans, end-of-life care, and rates of medical (for example, organ and blood) donation. We conclude with a discussion of new technologies, such as electronic medical records and web- or mobile-based decision apps, which can enhance doctor and patient adherence to best medical practices. These technologies, however, also pose new challenges that can undermine the effectiveness of medical care delivery.

To determine whether older adults would avoid going to the pharmacy (e.g., by restricting medications or requesting delivery) due to the risk of coronavirus disease (COVID-19). Our secondary objectives were to determine the types of medications that the older adults are more likely to restrict and to determine the factors that influence these decisions.