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Background: Older adults and Hispanic individuals are increasingly turning to social media platforms to access health-related information. The purpose of this project was to evaluate a social media campaign to disseminate information from decision aids (DAs) on hip and knee osteoarthritis to Spanish-speaking adults., Methods: A social media marketing team helped create an 8-mo campaign posted across 3 social media platforms to promote visits to a Web site offering free multilingual DAs for treatment of hip or knee osteoarthritis. Eight videos featuring Spanish-speaking actors discussing DAs were boosted (i.e., money was paid so posts landed on user's feeds). In this observational study, metrics tracked reach, extended engagement, and number of users accessing the Web site. Videos were qualitatively coded for themes, including pain and benefits of treatment options; biserial correlations assessed relationships between the presence of a code and the metrics. We calculated cost per visitor using the total campaign cost and number of users accessing the Web site., Results: During the campaign, boosted videos reached 83,937 users. Of the users, 22,777 had extended engagement with the videos, and 1,835 users visited our Web site with access to the DAs. Videos that included themes of pain tended to reach more users ( r  = 0.88) and have higher engagement ( r  = 0.70). When videos included the theme of benefits of treatment, more users tended to visit our Web site ( r  = 0.78). The total campaign cost was $25,950, making the cost per Web site visitor $14.14., Conclusions: Social media was a useful, inexpensive tool for disseminating health care information on hip and knee osteoarthritis DAs to predominantly Spanish-speaking adults. Further work should identify how exposure to such social media content affects a viewer's health care attitudes, health care behaviors, and surgical decision making., Highlights: An 8-mo social media campaign was able to reach more than 83,000 users and result in almost 2,000 users accessing a Web site with multilingual decision aids.Social media may be an inexpensive tool for disseminating health care information such as decision aids to Spanish-speaking adults., Competing Interests: The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: KS, KDV, and FM report receiving support from the Patrick and Catherine Weldon Donaghue Medical Research Foundation for the project. AFC reports royalties from Stryker; is a paid consultant for Adaptive Phage Therapeutics, Avanos, BICMD, Convatec, Ethicon, Heraeus, IrriMax, Osteal Therapeutics, Peptilogics, Pfizer, Smith and Nephew, Stryker, and TrialSpark; holds stock or stock options in Hyalex, Irrimax, Osteal Therapeutics, Sonoran, IlluminOss; received research support (outside of this project) from Adaptive Phage Therapeutics, Elute, Peptilogics, Sectra; received support from SLACK Incorporated, UpToDate, Taylor & Francis Group, and Journal of Bone and Joint Surgery; engaged in editorial participation at the Journal of Arthroplasty, Journal of Bone and Joint Infection, Journal of Bone and Joint Surgery, and Arthroplasty Today; and has board appointments at the American Joint Replacement Registry and American Association of Hip and Knee Surgeons. KS reports research funding to her institution from the Patient-Centered Outcomes Research Institute, National Institute on Aging, National Cancer Institute, and Agency for Healthcare Research and Quality, outside the submitted work. LS reports no conflicts of interest. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The study was funded through an R3 mechanism from the Patrick and Catherine Weldon Donaghue Medical Research Foundation. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report., (© The Author(s) 2025.)

Background: The American College of Cardiology, American Heart Association, and Centers for Medicare and Medicaid Services recommend shared decision-making (SDM) for patients with severe aortic stenosis choosing between transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). Although tools such as patient decision aids (DAs) and training in SDM have been shown to improve SDM, implementation of SDM and DAs is limited. The IMproving treatment decisions for Patients with AortiC stenosis Through Shared Decision Making (IMPACT SDM) study aims to (1) determine the effectiveness of the interventions (a DA and clinician SDM training) in achieving SDM (primary outcome) and improving the quality of decisions about aortic valve replacement, (2) determine the reach of the DAs and adoption of training, and (3) explore potential mechanisms of effectiveness and implementation at the patient-, clinician-, and clinic-level., Methods: The study is a hybrid type II effectiveness-implementation study using a cluster randomized batched stepped wedge trial with 8 sites across the USA. Eligible patients will be surveyed before and after visits with the heart valve team; clinicians will be surveyed after visits. Reach of DAs and adoption of training will be tracked. Clinicians will be interviewed regarding barriers and facilitators to implementation., Discussion: The IMPACT SDM Study seeks to provide evidence of the ability of the interventions to improve SDM and decision quality, and also to shed light on barriers and facilitators to SDM implementation to promote future implementation efforts., Trial Registration: ClinicalTrials.gov NCT06171737. Registered on December 15, 2023., Competing Interests: Declarations. Ethics approval and consent to participate {24}: Ethical approval for the study will be provided by each site individually. The majority of sites approved waiver of written consent to participate in this minimal risk trial, and consent is implied by completion of the survey. Consent for publication {32}: At 6 sites, participants will receive an information sheet reviewing options, benefits, and risks of the trial and consent will be implied by return of the pre-visit survey. At one site, research staff will obtain written consent and at one site research staff will obtain and document verbal consent. Competing interests {28}: NL reports being a consultant for Edwards Lifesciences. CK reports a K23 from NHLBI (K23HL153892). CD reports paid consulting fees from Medtronic and Record Medical. EK reports receiving honoraria from Abbott, Boston Scientific, Edwards, and Medtronic. ND receives research support from the American Heart Association, NIH, AHRQ, and Merck and research funding and consulting for Abiomed. KS reports receiving funding for shared decision-making research from PCORI, AHRQ, and NIH, outside submitted work. KS developed the Shared Decision-Making Process scale (copyright Massachusetts General Hospital) that is being used as an outcome measure in the study. KV reports receiving support for shared decision-making research from PCORI and AHRQ outside submitted work and receiving research funding from Google LLC outside the submitted work. SE reports receiving research funding and consulting fees from Edwards Lifesciences and Medtronic. VT reports advising and research with Artivion, AtriCure, Boston Scientific, Abbott Vascular, CroiValve, Edwards Lifesciences, Medtronic, JenaValve, HighLife, Innovalve, and DASI Simulations. JM reports institutional grant support from the University of Colorado School of Medicine: Philips Medical Systems, Medtronic Corporation. SS reports travel sponsored by the ACC, Global Heart Hub, TCT, and Heart Valve Collaboratory and significant financial interests in Heart Valve Voice US. AN has received institutional research funding and speaker fees from Edwards Lifesciences, which is involved in products for the treatment of aortic stenosis. AB reports receiving honoraria for teaching a course at Edwards Lifesciences. DM, MC, YC, KG, NQ, and DK report no conflicts of interest., (© 2024. The Author(s).)

Importance: Decisions about whether to stop colorectal cancer (CRC) screening tests in older adults can be difficult and may benefit from shared decision-making (SDM)., Objective: To evaluate the effect of physician training in SDM and electronic previsit reminders (intervention) vs reminders only (comparator) on receipt of the patient-preferred approach to CRC screening and on overall CRC screening rates of older adults at 12 months., Design, Setting, and Participants: This was a secondary analysis of the Promoting Informed Decisions About Colorectal Cancer Screening in Older Adults (PRIMED) cluster randomized clinical trial. In the PRIMED trial, primary care physicians (PCPs) from 36 primary care practices in Massachusetts and Maine were enrolled between May 1 and August 30, 2019, and were randomized to the intervention group or the comparator group. Patients aged 76 to 85 years who were overdue for CRC screening and did not have a prior diagnosis of CRC enrolled between October 21, 2019, and April 8, 2021. Data analysis was performed between May 24, 2022, and May 10, 2023., Interventions: Primary care physicians in the intervention group completed an SDM training course and received previsit reminders of patients eligible for CRC testing discussion, whereas PCPs in the comparator group received reminders only., Main Outcomes and Measures: The primary outcome was concordance, or the percentage of patients who received their preferred screening approach. Postvisit surveys were administered to assess patient preference for testing, and electronic health record review was used to assess CRC testing at 12 months. Heterogeneity of treatment effect analyses examined interaction between study groups and different factors on concordance rates., Results: This study included 59 physicians and 466 older adults. Physicians had a mean (SD) age of 52.7 (9.4) years and a mean (SD) of 21.6 (10.2) years in practice; 30 (50.8%) were women and 16 (27.1%) reported prior training in SDM. Patients had a mean (SD) age of 80.3 (2.8) years; 249 (53.4%) were women and 238 (51.1%) reported excellent or very good overall health. Patients preferred stool-based tests (161 [34.5%]), followed by colonoscopy (116 [24.8%]) or no further screening (97 [20.8%]); 75 (16.1%) were not sure. The distribution of patient preferences was similar across groups (P = .36). At 12 months, test uptake was also similar for both the intervention group (29 [12.3%] for colonoscopy, 62 [26.3%] for stool-based tests, and 145 [61.4%] for no testing) and the comparator group (32 [13.9%] for colonoscopy, 35 [15.2%] for stool-based tests, and 163 [70.9%] for no testing; P = .08). Approximately half of patients in the intervention group received their preferred approach vs the comparator group (115 of 226 [50.9%] vs 103 of 223 [46.2%]; P = .47). Heterogeneity of treatment effect analyses found significantly higher rates with the intervention vs the comparator for patients with a strong intention to follow through with the preferred approach (adjusted odds ratio [AOR], 1.79 [95% CI, 1.11-2.89]; P = .02, P = .05 for interaction) and for patients who reported more than 5 minutes (AOR, 3.27 [95% CI, 1.25-8.59]; P = .02, P = .05 for interaction) of discussion with their PCP regarding screening. Higher rates were also observed among patients who reported 2 to 5 minutes of discussion with their PCP, although this finding was not significant (AOR, 1.89 [95% CI, 0.93-3.84]; P = .08, P = .05 for interaction)., Conclusions and Relevance: In this secondary analysis of a cluster randomized clinical trial, approximately half of older patients received their preferred approach to CRC screening. Physician training in SDM did not result in higher concordance rates overall but may have benefitted some subgroups. Future work to refine and evaluate clinical decision support (in the form of an electronic advisory or reminder) as well as focused SDM skills training for PCPs may promote high-quality, preference-concordant decisions about CRC testing for older adults., Trial Registration: ClinicalTrials.gov Identifier: NCT03959696.

Objective: Adapt and test a measure of knowledge for caregivers of children with attention-deficit/hyperactivity disorder (ADHD) and evaluate the impact of the information component of a decision aid (DA) on participant knowledge., Methods: A set of seven knowledge items were created based on prior knowledge measures and clinical guidelines. As part of a larger cross-sectional survey study of caregivers of children diagnosed with ADHD, caregivers were randomized to one of two arms: 1) a DA arm, where participants reviewed the information component of the Cincinnati Children's Hospital's DA, and 2) a control arm, where participants were not shown a DA. All participants completed the seven knowledge items. Knowledge items were assessed for difficulty, quality of distractors, acceptability, and redundancy. Total knowledge scores (0-100) for the DA and control arm were compared., Results: Caregivers were assigned to the DA arm (n = 243) or the control arm (n = 260). All 7 knowledge items were retained as no items were too difficult or too easy, all response options were used, there were little missing data, and no items were redundant. The overall knowledge score was normally distributed, and almost covered the full range of scores (5-100). Those who received the DA component had higher knowledge scores (M=68, SD=23) than those who did not receive the DA component (M=60, SD=19, P < .01, d=0.4)., Conclusions: The Caregiver ADHD Knowledge (CAKe) measure was acceptable and demonstrated construct validity as those who were assigned to review the DA component demonstrated greater knowledge than those who were not assigned to review the DA component., Competing Interests: Declaration of Competing Interest Financial support for this study was provided entirely by a grant from the Agency for Health Research and Quality (grant number R01HSO25718). The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report. With regards to potential conflicts of interest for this study. Dr. Lipstein reports previously receiving an institutional grant from Pfizer, Inc. Dr. Brinkman has common stock in the following publicly traded companies: Pfizer, Merck, Abbott Laboratories, Viatris, and Johnson & Johnson. Dr. Sepucha has received consulting income from Blue Cross Blue Shield of Massachusetts. All authors (sans Dr. Brinkman) report support from the Agency for Health Research and Quality., (Copyright © 2024 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Objective: To compare results of three preference elicitation methods for a cancer screening test., Methods: Participants (undergraduate students) completed a discrete choice experiment (DCE) and a threshold technique (TT) task. Accuracy (false positives, false negatives), benefits (lives saved), and cost for a cancer screening test were used as attributes in the DCE and branching logic for the TT. Participants were also asked a direct elicitation question regarding a hypothetical screening test for breast (women) or prostate (men) cancer without mortality benefit. Correlations assessed the relationship between DCE and TT thresholds. Thresholds were standardized and ranked for both methods to compare. A logistic regression used the thresholds to predict results of the direct elicitation., Results: DCE and TT estimates were not meaningfully correlated (max ρ = 0.17). Participant rankings of attributes matched only 20% of the time (58/292). Neither method predicted preference for being screened (ps > 0.21)., Conclusions: The DCE and TT yielded different preference estimates (and rank orderings) for the same participant. Neither method predicted patients' desires for a screening test., Practice Implications: Clinicians, patients, policy makers, and researchers should be aware that patient preference results may be sensitive to the method of eliciting preferences., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to disclose., (Copyright © 2023 Elsevier B.V. All rights reserved.)

This study aimed to evaluate feasibility, acceptability, reliability, and validity of the existing four-item Shared Decision Making (SDM) Process Scale for use in evaluating genetic testing decisions. Patients from a large hereditary cancer genetics practice were invited to participate in a two-part survey after completing pre-test genetic counseling. The online survey included the SDM Process Scale and the SURE scale, a measure of decisional conflict. SDM Process scores were compared to SURE scores to test convergent validity, and respondents were sent a second survey 1 week later to assess retest reliability. The response rate was 65% (n = 259/398) and missing data was low (<1%). SDM scores ranged from zero to four with a mean of 2.3 (SD = 1.1). Retest reliability was good, with intraclass correlation of 0.84, 95% confidence interval (0.79, 0.88). No relationship was found between SDM Process scores and decisional conflict (p = 0.46), likely because 85% of participants reported no decisional conflict. The four-item SDM Process Scale demonstrated feasibility, acceptability, and retest reliability, but not convergent validity with decisional conflict. These findings provide initial evidence for use of this scale to measure patient perceptions of SDM in pre-test counseling for hereditary cancer genetic testing., (© 2023 National Society of Genetic Counselors.)

Purpose: Older adults are prone to cognitive impairment, which may affect their ability to engage in aspects of shared decision making (SDM) and their ability to complete surveys about the SDM process. This study examined the surgical decision-making processes of older adults with and without cognitive insufficiencies and evaluated the psychometric properties of the SDM Process scale., Methods: Eligible patients were 65 y or older and scheduled for a preoperative appointment before elective surgery (e.g., arthroplasty). One week before the visit, staff contacted patients via phone to administer the baseline survey, including the SDM Process scale (range 0-4), SURE scale (top scored), and the Montreal Cognitive Assessment Test version 8.1 BLIND English (MoCA-blind; score range 0-22; scores < 19 indicate cognitive insufficiency). Patients completed a follow-up survey 3 mo after their visit to assess decision regret (top scored) and retest reliability for the SDM Process scale., Results: Twenty-six percent (127/488) of eligible patients completed the survey; 121 were included in the analytic data set, and 85 provided sufficient follow-up data. Forty percent of patients ( n  = 49/121) had MoCA-blind scores indicating cognitive insufficiencies. Overall SDM Process scores did not differ by cognitive status (intact cognition x ¯  = 2.5, s  = 1.0 v. cognitive insufficiencies x ¯  = 2.5, s  = 1.0; P  = 0.80). SURE top scores were similar across groups (83% intact cognition v. 90% cognitive insufficiencies; P  = 0.43). While patients with intact cognition had less regret, the difference was not statistically significant (92% intact cognition v. 79% cognitive insufficiencies; P  = 0.10). SDM Process scores had low missing data and good retest reliability (intraclass correlation coefficient = 0.7)., Conclusions: Reported SDM, decisional conflict, and decision regret did not differ significantly for patients with and without cognitive insufficiencies. The SDM Process scale was an acceptable, reliable, and valid measure of SDM in patients with and without cognitive insufficiencies., Highlights: Forty percent of patients 65 y or older who were scheduled for elective surgery had scores indicative of cognitive insufficiencies.Patient-reported shared decision making, decisional conflict, and decision regret did not differ significantly for patients with and without cognitive insufficiencies.The Shared Decision Making Process scale was an acceptable, reliable, and valid measure of shared decision making in patients with and without cognitive insufficiencies.

Objectives: Examine reliability and validity of the Shared Decision-Making (SDM) Process scale for cancer screening and medication decisions., Methods: Secondary data analysis from 6174 participants who made decisions about cancer screening (breast, colon or prostate) or medication (menopause, depression, hypertension or high cholesterol). Key measures included the SDM Process scale, decisional conflict, decision regret, and decision quality. Construct validity was examined by testing whether higher SDM Process scores were associated with lower regret, lower decisional conflict and higher decision quality. Meta-analyses summarized data across studies. Some studies assessed the scale's reliability., Results: Average SDM Process scores ranged from 1.2 to 2.5. There was a moderate-to-large, positive association between scores and lack of decisional conflict (cancer screening: d=0.61, CI(0.38, 0.84), p < .001; medications: d=0.36, CI(0.29, 0.44), p < .001). High scores were associated with lower decision regret (cancer screening: d=-0.24, CI(-0.37, -0.11), p < .001; medications: d=-0.30, CI(-0.40,-0.20), p < .001). There was no relationship with decision quality. Retest reliability was acceptable (ICC>0.7) for seven of eight clinical samples., Conclusions: The SDM Process scale demonstrated construct validity and retest reliability in cancer screening and medication decisions., Practice Implications: The validated SDM Process scale is a short, patient reported metric to evaluate the current state of SDM., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Thousands of colonoscopies were canceled during the initial surge of the COVID-19 pandemic. As facilities resumed services, some patients were hesitant to reschedule. The purpose of this study was to determine whether a decision aid plus telephone coaching would increase colorectal cancer (CRC) screening and improve patient reports of shared decision making (SDM). A randomized controlled trial assigned adults aged 45-75 without prior history of CRC who had a colonoscopy canceled from March to May 2020 to intervention (n = 400) or usual care control (n = 400) arms. The intervention arm received three-page decision aid and call from decision coach from September 2020 through November 2020. Screening rates were collected at 6 months. A subset (n = 250) in each arm was surveyed 8 weeks after randomization to assess SDM (scores range 0-4, higher scores indicating more SDM), decisional conflict, and screening preference. The sample was on average, 60 years old, 53% female, 74% White, non-Hispanic, and 11% Spanish speaking. More intervention arm patients were screened within 6 months (35% intervention vs 23% control, p < 0.001). The intervention respondents reported higher SDM scores (mean difference 0.7 [0.4, 0.9], p < 0.001) and less decisional conflict than controls (-21% [-35%, -7%], p = 0.003). The majority in both arms preferred screening versus delaying (68% intervention vs. 65% control, p = 0.75). An SDM approach that offered alternatives and incorporated patients' preferences resulted in higher screening rates. Patients who are overdue for CRC screening may benefit from proactive outreach with SDM support., (© 2022 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.)

Background: For adults aged 76-85, guidelines recommend individualizing decision-making about whether to continue colorectal cancer (CRC) testing. These conversations can be challenging as they need to consider a patient's CRC risk, life expectancy, and preferences., Objective: To promote shared decision-making (SDM) for CRC testing decisions for older adults., Design: Two-arm, multi-site cluster randomized trial, assigning physicians to Intervention and Comparator arms. Patients were surveyed shortly after the visit to assess outcomes. Analyses were intention-to-treat., Participants and Setting: Primary care physicians affiliated with 5 academic and community hospital networks and their patients aged 76-85 who were due for CRC testing and had a visit during the study period., Interventions: Intervention arm physicians completed a 2-h online course in SDM communication skills and received an electronic reminder of patients eligible for CRC testing shortly before the visit. Comparator arm received reminders only., Main Measures: The primary outcome was patient-reported SDM Process score (range 0-4 with higher scores indicating more SDM); secondary outcomes included patient-reported discussion of CRC screening, knowledge, intention, and satisfaction with the visit., Key Results: Sixty-seven physicians (Intervention n=34 and Comparator n=33) enrolled. Patient participants (n=466) were on average 79 years old, 50% with excellent or very good self-rated overall health, and 66% had one or more prior colonoscopies. Patients in the Intervention arm had higher SDM Process scores (adjusted mean difference 0.36 (95%CI (0.08, 0.64), p=0.01) than in the Comparator arm. More patients in the Intervention arm reported discussing CRC screening during the visit (72% vs. 60%, p=0.03) and had higher intention to follow through with their preferred approach (58.0% vs. 47.1, p=0.03). Knowledge scores and visit satisfaction did not differ significantly between arms., Conclusion: Physician training plus reminders were effective in increasing SDM and frequency of CRC testing discussions in an age group where SDM is essential., Trial Registration: The trial is registered on clinicaltrials.gov (NCT03959696)., (© 2022. The Author(s).)

Background. Early in the COVID-19 pandemic colonoscopies for colorectal cancer (CRC) screening were canceled. Patient perceptions of the benefits and risks of routine screening relative to health concerns associated with the COVID-19 pandemic were unknown. Purpose. Assess patient anxiety, worry, and interest in CRC screening during the COVID-19 pandemic. Methods. A random sample of 200 patients aged 45 to 75 y with colonoscopy cancellation due to COVID-19 in March to May 2020 were surveyed. Anxiety, COVID-19 and CRC risk perceptions, COVID-19 and CRC worry, likelihood of following through with colonoscopy in the next month, and interest in alternatives to colonoscopy were assessed. Subsequent screening was tracked for 12 mo. Results. Respondents ( N  = 127/200, 63.5%) were on average 60 y old, female (59%), college educated (62% college degree or more), and White (91%). A substantial portion of patients (46%) stated they may not follow through with a colonoscopy in the next month. There was greater interest in stool-based testing than in delaying screening (48% v. 26%). Women, older patients, and patients indicating tolerance of uncertainty due to complexity reported they were less likely to follow through with colonoscopy in the next month. Greater interest in stool-based testing was related to lower perceptions of CRC risk. Greater interest in delaying screening was related to less worry about CRC and less tolerance of risk. Over 12 mo, 60% of participants completed screening. Patients who stated they were more likely to screen in the next month were more likely to complete CRC screening ( P  = 0.01). Conclusions. Respondents who had a colonoscopy canceled during the COVID-19 pandemic varied in interest in rescheduling the procedure. A shared decision-making approach may help patients address varying concerns and select the best approach to screening for them., Highlights: In the wake of the first wave of the COVID-19 pandemic, almost half of patients stated they were not likely to follow through with a colonoscopy in the short term, about half were interested in screening with a stool-based test, and only one-quarter were interested in delaying screening until next year.Patients who perceived themselves at higher risk of colorectal cancer were less interested in stool-based testing, and patients who were more worried about colorectal cancer were less interested in delaying screening.A shared decision-making approach may be necessary to tailor screening discussions for patients during subsequent waves of the pandemic, other occasions where resources are limited and patient preferences vary, or where patients hold conflicting views of screening., Competing Interests: With regard to potential conflicts of interest for this study, Dr. Atlas reports a grant from the National Cancer Institute, and Dr. Richter reports approximately 25% income derived from performing colonoscopy. All other authors report no conflicts outside receiving grant funding through their institution from PCORI for this study., (© The Author(s) 2022.)

Background: This study examined the performance of the shared decision-making (SDM) Process scale in patients with depression, compared alternative wording of two items in the scale and explored performance in younger adults., Methods: A web-based non-probability panel of respondents with depression aged 18-39 (younger) or 40-75 (older) who talked with a health-care provider about starting or stopping treatment for depression in the past year were surveyed. Respondents completed one of two versions of the SDM Process scale that differed in the wording of pros and cons items and completed measures of decisional conflict, decision regret and who made the decision (mainly the respondent, mainly the provider or together). A subset of respondents completed a retest survey by 1 week. We examined how version and age group impacted SDM Process scores and calculated construct validity and retest reliability. We hypothesized that patients with higher SDM Process scores would show less decisional conflict using the SURE scale (range = 0-4); top score = no conflict versus other and less regret (range 1-4; higher scores indicated more regret)., Results: The sample (N = 494) was majority White, non-Hispanic (82%) and female (72%), 48% were younger and 23% had a high school education or less. SDM Process scores did not differ by version (P = 0.09). SDM Process scores were higher for younger respondents (M = 2.6, SD = 1.0) than older respondents (M = 2.3, SD = 1.1; P = 0.001). Higher SDM Process scores were also associated with no decisional conflict (M = 2.6, SD = 0.99 vs. M = 2.1, SD = 1.2; P < 0.001) and less decision regret (r = -0.18, P < 0.001). Retest reliability was intraclass correlation coefficient = 0.81., Conclusions: The SDM Process scale demonstrated validity and retest reliability in younger adults, and changes to item wording did not impact scores. Although younger respondents reported more SDM, there is room for improvement in SDM for depression treatment decisions., (© The Author(s) 2022. Published by Oxford University Press on behalf of International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: To assess the impact of patient health literacy, numeracy, and graph literacy on perceptions of hypertension control using different forms of data visualization., Materials and Methods: Participants (Internet sample of 1079 patients with hypertension) reviewed 12 brief vignettes describing a fictitious patient; each vignette included a graph of the patient's blood pressure (BP) data. We examined how variations in mean systolic blood pressure, BP standard deviation, and form of visualization (eg, data table, graph with raw values or smoothed values only) affected judgments about hypertension control and need for medication change. We also measured patient's health literacy, subjective and objective numeracy, and graph literacy., Results: Judgments about hypertension data presented as a smoothed graph were significantly more positive (ie, hypertension deemed to be better controlled) then judgments about the same data presented as either a data table or an unsmoothed graph. Hypertension data viewed in tabular form was perceived more positively than graphs of the raw data. Data visualization had the greatest impact on participants with high graph literacy., Discussion: Data visualization can direct patients to attend to more clinically meaningful information, thereby improving their judgments of hypertension control. However, patients with lower graph literacy may still have difficulty accessing important information from data visualizations., Conclusion: Addressing uncertainty inherent in the variability between BP measurements is an important consideration in visualization design. Well-designed data visualization could help to alleviate clinical uncertainty, one of the key drivers of clinical inertia and uncontrolled hypertension., (© The Author(s) 2022. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Importance: Following the recent expansion of telemedicine during the COVID-19 pandemic, this remote model of care in female pelvic medicine and reconstructive surgery will likely remain and continue to evolve., Objective: This study was conducted to assess patients' perceptions of and willingness to participate in a synchronous telemedicine visit beyond the COVID-19 pandemic for women with pelvic floor disorders., Study Design: We conducted a cross-sectional study of women who completed a synchronous telemedicine visit from March 16 through May 22, 2020, at a urogynecology practice in an academic medical center. An electronic survey was distributed to women after all telemedicine visits. Demographic data, visit type, and survey responses were analyzed., Results: Two hundred two women received the survey, and 135 women completed it (response rate of 66.8%). The mean age of the respondents was 62.9 ± 16.4 years, and the 3 most common visit diagnoses were overactive bladder (43.7%), stress urinary incontinence (22.2%), and pelvic organ prolapse (21.4%). Most survey participants (88.9%) found that the quality of their telemedicine visits was better than expected, and 89.6% reported that they would like to continue telemedicine care. Our survey showed that 19.4% of women reported difficulty with technology., Conclusions: We found that most women presenting for synchronous telemedicine urogynecology care had a positive visit experience and would continue to use telemedicine for their care. Further developmental work needs to be done on improving the ease of technology as well as availability of telemedicine in the care of women affected by pelvic floor disorders., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2022 American Urogynecologic Society. All rights reserved.)

Objective: To develop and validate a short measure of trust in the surgical decision making process., Summary of Background Data: Having a reliable and valid measure of trust is important to assess the quality of the patient-surgeon relationship when decisions about surgical procedures are made., Methods: A previously published 10-item trust scale was qualitatively tested with patients, and a revised set of 14 items was tested using a web-based survey of 300 people who had hip, knee or back surgery in the past 2 years. The 14 items were evaluated using patterns of correlations and relevance to medical decision making to create a 5-item version. A 5-item subset was compared to the 14-item version to assess reliability and validity of patient's trust in the surgical decision making process., Results: Of the 300 participants, 32% had hip surgery, 33% had knee surgery, and 34% back surgery. Mean age was 53 years, 45% female, 80% White, and 36% had a high school degree or less. The item intercorrelations for the 14 items were 0.43-0.72 and 0.58-0.71 for the 5 items. Correlation between the versions was 0.96 (P < 0.01). The 14- and 5-item versions were positively correlated with participants' shared decision making process scores (0.42 and 0.41, both P = 0.01), internal consistency reliability scores were 0.95 and 0.89, respectively, and were negatively correlated with their Decision Regret scores (-0.51 and -0.48, both P = 0.01)., Conclusion: The 5-item Trust in the Surgical Decision Scale has strong evidence of validity and reliability for patients who underwent common orthopedic procedures., Competing Interests: SB and MB were supported in part by a grant from the CRICO/Risk Management Foundation of the Harvard Medical Institutions. For the remaining authors, no conflicts of interest were declared., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Clinical guidelines recommend patients with aortic stenosis (AS) being considered for transcatheter aortic valve implantation or surgical aortic valve replacement to participate in shared decision-making (SDM) with a heart valve team (HVT). Data supporting these recommendations are limited. This project gathered data on feasibility and preliminary efficacy of a decision aid (DA) in decision-making for patients with severe AS deciding between transcatheter aortic valve implantation and surgical aortic valve replacement., Methods: This institutional review board-approved randomized pilot trial assigned eligible patients to receive either the American College of Cardiology's DA for patients with AS or usual care. Patients were surveyed after their visit regarding knowledge, treatment-preference concordance, SDM (SDM process and CollaboRATE Scales), and decisional conflict. Patients were followed for 3 months to collect data on treatment received., Results: Of 62 patients approached, 59 (95%) consented and participated. The average age of participants was 72 years, they were 100% white, and 32% of them were female. Intervention patients had higher knowledge scores (75.6 vs 65.5) and more frequently reported CollaboRATE top scores (67% vs 33%) than usual care patients. No other group comparisons reached significance. Patients who saw both members of the HVT before survey completion reported higher SDM process scores than those who saw only 1 specialist (3.1 vs 2.4)., Conclusions: The study exceeded enrollment targets, indicating feasibility. Results suggest the American College of Cardiology's DA improved patient knowledge and communication scores. Patients who met with both members of the HVT reported higher SDM. These observations highlight the importance of SDM and multidisciplinary HVT assessment in the management of severe AS., (© 2022 The Authors.)

Purpose: The US Preventive Services Task Force has changed their screening recommendations, encouraging informed patient choice and shared decision making as a result of emerging evidence. We aimed to compare the impact of a didactic intervention, a descriptive harms intervention, a narrative intervention, and a new risk communication strategy titled Aiding Risk Information learning through Simulated Experience (ARISE) on preferences for a hypothetical beneficial cancer screening test (one that reduces the chance of cancer death or extends life) versus a hypothetical screening test with no proven physical benefits., Method: A total of 3386 men and women aged 40 to 70 completed an online survey about prostate or breast cancer screening. Participants were randomly assigned to either an unbeneficial test condition (0 lives saved due to screening) or a beneficial test condition (1 life saved due to screening). Participants then reviewed 4 informational interventions about either breast (women) or prostate (men) cancer screening. First, participants were provided didactic information alongside an explicit recommendation. This was followed by a descriptive harms intervention in which the possible harms of overdetection were explained. Participants then viewed 2 additional interventions: a narrative and ARISE (an intervention in which participants learned about probabilities by viewing simulated outcomes). The order of these last 2 interventions was randomized. Preference for being screened with the test and knowledge about the test were measured., Results: With each successive intervention, preferences for screening tests decreased an equivalent amount for both a beneficial and unbeneficial test. Knowledge about the screening tests was largely unimpacted by the interventions., Conclusions: Presenting detailed risk and benefit information, narratives, and ARISE reduced preferences for screening regardless of the net public benefit of screening.

Patient-clinician interactions require an interpersonal exchange of information, preferences, expectations, values, and priorities. Given the brief interaction patients and clinicians are allowed, many barriers to effective communication exist, resulting in patients and clinicians leaving an interaction with discordant perceptions of what has occurred and what is to come. We review literature on concordance and lack thereof, between patient and clinician perceptions, reasons why discordance may occur, how to decrease discordance as well as how dischordance impacts patient care and outcomes., Competing Interests: Conflict of interest statement The authors declare the following financial interests/personal relationships which may be considered as potential competing interests. L.D.S. reports receiving funding from the National Institutes of Health, Agency for Healthcare Research and Quality, and the Patient-Centered Outcomes Research Institute. K.D.V. reports receiving funding from the Patrick and Catherine Weldon Donaghue Medical Research Foundation, the Agency for Healthcare Research and Quality, and the Patient-Centered Outcomes Research Institute., (Published by Elsevier Ltd.)

Background: The Shared Decision Making (SDM) Process scale is a brief, patient-reported measure of SDM with demonstrated validity in surgical decision making studies. Herein we examine the validity of the scores in assessing SDM for cancer screening and medication decisions through standardized videos of good-quality and poor-quality SDM consultations., Method: An online sample was randomized to a clinical decision-colon cancer screening or high cholesterol-and a viewing order-good-quality video first or poor-quality video first. Participants watched both videos, completing a survey after each video. Surveys included the SDM Process scale and the 9-item SDM Questionnaire (SDM-Q-9); higher scores indicated greater SDM. Multilevel linear regressions identified if video, order, or their interaction predicted SDM Process scores. To identify how the SDM Process score classified videos, area under the curve (AUC) was calculated. The correlation between SDM Process score and SDM-Q-9 assessed construct validity. Heterogeneity analyses were conducted., Results: In the sample of 388 participants (68% white, 70% female, average age 45 years) good-quality videos received higher SDM Process scores than poor-quality videos ( P s < 0.001), and those who viewed the good-quality high cholesterol video first tended to rate the videos higher. SDM Process scores were related to SDM-Q-9 scores ( r s > 0.58; P s < 0.001). AUC was poor (0.69) for the high cholesterol model and fair (0.79) for the colorectal cancer model. Heterogeneity analyses suggested individual differences were predictive of SDM Process scores., Conclusion: SDM Process scores showed good evidence of validity in a hypothetical scenario but were lacking in ability to classify good-quality or poor-quality videos accurately. Considerable heterogeneity of scoring existed, suggesting that individual differences played a role in evaluating good- or poor-quality SDM conversations.

Background: Clinical guidelines recommend engaging patients in shared decision making for common orthopedic procedures; however, limited work has assessed what is occurring in practice. This study assessed the quality of shared decision making for elective hip and knee replacement and spine surgery at four network-affiliated hospitals., Methods: A cross-sectional sample of 875 adult patients undergoing total hip or knee joint replacement (TJR) for osteoarthritis or spine surgery for lumbar herniated disc or lumbar spinal stenosis was selected. Patients were mailed a survey including measures of Shared Decision Making (SDMP scale) and Informed, Patient-Centered (IPC) decisions. We examined decision-making across sites, surgeons, and conditions, and whether the decision-making measures were associated with better health outcomes. Analyses were adjusted for clustering of patients within surgeons., Results: Six hundred forty-six surveys (74% response rate) were returned with sufficient responses for analysis. Patients who had TJR reported lower SDMP scores than patients who had spine surgery (2.2 vs. 2.8; p < 0.001). Patients who had TJR were more likely to make IPC decisions (OA = 70%, Spine = 41%; p < 0.001). SDMP and IPC scores varied widely across surgeons, but the site was not predictive of SDMP scores or IPC decisions (all p > 0.09). Higher SDMP scores and IPC decisions were associated with larger improvements in global health outcomes for patients who had TJR, but not patients who had spine surgery., Conclusions: Measures of shared decision making and decision quality varied among patients undergoing common elective orthopedic procedures. Routine measurement of shared decision making provides insight into areas of strength across these different orthopedic conditions as well as areas in need of improvement., (© 2021. The Author(s).)

Background: This article evaluates the evidence for the inclusion of patient narratives in patient decision aids (PtDAs). We define patient narratives as stories, testimonials, or anecdotes that provide illustrative examples of the experiences of others that are relevant to the decision at hand., Method: To evaluate the evidence for the effectiveness of narratives in PtDAs, we conducted a narrative scoping review of the literature from January 2013 through June 2019 to identify relevant literature published since the last International Patient Decision Aid Standards (IPDAS) update in 2013. We considered research articles that examined the impact of narratives on relevant outcomes or described relevant theoretical mechanisms., Results: The majority of the empirical work on narratives did not measure concepts that are typically found in the PtDA literature (e.g., decisional conflict). Yet, a few themes emerged from our review that can be applied to the PtDA context, including the impact of narratives on relevant outcomes (knowledge, behavior change, and psychological constructs), as well as several theoretical mechanisms about how and why narratives work that can be applied to the PtDA context., Conclusion: Based on this evidence update, we suggest that there may be situations when narratives could enhance the effectiveness of PtDAs. The recent theoretical work on narratives has underscored the fact that narratives are a multifaceted construct and should no longer be considered a binary option (include narratives or not). However, the bottom line is that the evidence does not support a recommendation for narratives to be a necessary component of PtDAs.

Background: A high quality treatment decision means patients are informed and receive treatment that matches their goals. This research examined the reliability and validity of the Depression Decision Quality Instrument (DQI), a survey to measure the extent to which patients are informed and received preferred treatment for depression., Methods: Participants were aged 18 and older from 17 US cities who discussed medication or counseling with a physician in the past year, and physicians who treated patients with depression who practiced in the same cities. Participants were mailed a survey that included the Depression-DQI, a tool with 10 knowledge and 7 goal and concern items. Patients were randomly assigned to either receive a patient decision aid (DA) on treatment of depression or no DA. A matching score was created by comparing the patient's preferred treatment to their self-reported treatment received. Concordant scores were considered matched, discordant were not. We examined the reliability and known group validity of the Depression-DQI., Results: Most patients 405/504 (80%) responded, 79% (320/405) returned the retest survey, and 60% (114/187) of physicians returned the survey. Patients' knowledge scores on the 10-item scale ranged from 14.6 to 100% with no evidence of floor or ceiling effects. Retest reliability for knowledge was moderate and for goals and concerns ranged from moderate to good. Mean knowledge scores differentiated between patients and physicians (M = 63 [SD = 15] vs. M = 81 [SD = 11], p < 0.001), and between patients who did and didn't receive a DA (M = 64 [SD = 16] vs. M = 61 [SD = 14], p = 0.041). 60.5% of participants received treatment that matched their preference. Based on the multivariate logistic regression, 'avoiding taking anti-depressants' was the only goal that was predictive of taking mediation (OR = 0.73 [0.66, 0.80], p < 0.01). Shared Decision Making Process scores were similar for those who matched their preference and those who didn't (M = 2.18 [SD = 0.97] vs. M = 2.06 [SD = 1.07]; t(320) =  - 1.06, p = 0.29). Those who matched had lower regret scores (matched M = 1.72 [SD = 0.74] vs. unmatched M = 2.32 [SD = 0.8]; t(301) =  - 6.6, p < .001)., Conclusions: The Depression DQI demonstrated modest reliability and validity. More work is needed to establish validity of the method to determine concordance., Trial Registration: NCT01152307., (© 2021. The Author(s).)

Background: Home blood pressure measurements have equal or even greater predictive value than clinic blood pressure measurements regarding cardiovascular outcomes. With advances in home blood pressure monitors, we face an imminent flood of home measurements, but current electronic health record systems lack the functionality to allow us to use this data to its fullest. We designed a data visualization display for blood pressure measurements to be used for shared decision making around hypertension., Methods: We used an iterative, rapid-prototyping, user-centred design approach to determine the most appropriate designs for this data display. We relied on visual cognition and human factors principles when designing our display. Feedback was provided by expert members of our multidisciplinary research team and through a series of end-user focus groups, comprised of either hypertensive patients or their healthcare providers required from eight academic, community-based practices in the Midwest of the United States., Results: A total of 40 participants were recruited to participate in patient (N = 16) and provider (N = 24) focus groups. We describe the conceptualization and development of data display for shared decision making around hypertension. We designed and received feedback from both patients and healthcare providers on a number of design elements that were reported to be helpful in understanding blood pressure measurements., Conclusions: We developed a data display for substantial amounts of blood pressure measurements that is both simple to understand for patients, but powerful enough to inform clinical decision making. The display used a line graph format for ease of understanding, a LOWESS function for smoothing data to reduce the weight users placed on outlier measurements, colored goal range bands to allow users to quickly determine if measurements were in range, a medication timeline to help link recorded blood pressure measurements with the medications a patient was taking. A data display such as this, specifically designed to encourage shared decision making between hypertensive patients and their healthcare providers, could help us overcome the clinical inertia that often results in a lack of treatment intensification, leading to better care for the 35 million Americans with uncontrolled hypertension., (© 2021. The Author(s).)

Purpose: To validate the Impact Index, a short, publicly available scale that measures the extent to which a respondent's health problem adversely impacts their quality of life., Methods: Secondary analysis of patients with hip or knee osteoarthritis surveyed after visiting a surgeon at baseline (N = 322) and about 6 months after the visit (N = 283). Patients responded to the Impact Index and previously validated questionnaires about overall health, pain, and function. The Impact Index includes four questions that ask how much the respondent is bothered, worried, limited, or in pain due to their health condition over the past 30 days. Total scores range from 0 to 12; higher scores indicate more deleterious impact., Results: Patients were mostly female (55%), majority white (95%), had an average age of 65 (SD = 9), and most had surgery (64%). The baseline Impact Index score was 9.48 (SD = 2.63); at follow up 4.75 (SD = 3.54). Impact Index was related to overall health at baseline (r =  - 0.49). For knee patients at baseline, Impact Index was negatively related to their knee symptoms (r =  - 0.49) and knee pain (r =  - 0.67). For hip patients at baseline, Impact Index was negatively related to the Harris Hip score (r =  - 0.62). Scale directions varied; however, the signs of all correlations were as hypothesized. The Impact Index was predictive of surgical choice (p < .001, OR = 1.45), however, overall health (p = .88) and comorbidity (p = .24) measures were not. Reliability was acceptable (α = 0.85). Responsiveness statistics suggested overall health, pain, function, and Impact Index measures reflected improvement patients experienced from surgery. The Impact Index had the largest effect sizes (> - 3.4) and Guyatt Responsiveness Statistics (> - 2.3)., Conclusions: The Impact Index demonstrated strong evidence of validity, reliability, and responsiveness in hip or knee osteoarthritis patients.

Importance: Thresholds for initiating statin therapy should be informed by patients' preferences., Objective: To define the preference distribution for statin therapy across the spectrum of cardiovascular disease (CVD) risk after participants were informed about the benefits and harms of statin therapy., Design, Setting, and Participants: A cross-sectional survey was conducted from May 13 to June 2, 2020. Participants included 304 individuals aged 40 to 75 years drawn from a nonprobability opt-in panel who had not taken a statin or proprotein convertase subtilisin/kexin type 9 inhibitor in the past 3 years and knew the results of their total cholesterol, high-density lipoprotein cholesterol, and blood pressure measurements., Exposures: Personalized 10-year CVD risk with and without statin therapy and potential harms of statins., Main Outcomes and Measures: The primary outcome was self-reported preference for statin therapy., Results: The 304 participants had a mean (SD) age of 54.8 (9.9) years; 152 were women (50.0%), 130 (42.8%) non-White, 50 (16.6%) had a high school degree or less education, and 153 (50.8%) reported never needing help reading health materials. When asked their preference for using statin therapy after reviewing their benefit and risk information, 45% of the participants reported they would definitely or probably choose statin therapy. As the risk increased, the proportion who would choose statin therapy generally increased (from 31.1% for a risk <5% to 82.6% for a risk >50%). The minimum risk threshold had to increase to 20% before 75% of respondents in that risk group would want statin therapy. For participants with a risk greater than 10%, the desire to use statin therapy decreased as participants' health literacy, subjective numeracy, and knowledge scores increased., Conclusions and Relevance: In this study, preferences for statin therapy for primary prevention of CVD appeared to vary across the spectrum of 10-year cardiovascular risk, but they were relatively flat at intermediate levels of risk. This preference distribution suggests a broad risk range for shared decision-making.

Background: The Shared Decision Making (SDM) Process scale is a short patient-reported measure of the amount of SDM that occurs around a medical decision. SDM Process items have been used previously in studies of surgical decision making and exhibited discriminant and construct validity., Method: Secondary data analysis was conducted across 8 studies of 11 surgical conditions with 3965 responses. Each study contained SDM Process items that assessed the discussion of options, pros and cons, and preferences. Item wording, content, and number of items varied, as did inclusion of measures assessing decision quality, decisional conflict (SURE scale), and regret. Several approaches for scoring, weighting, and the number of items were compared to identify an optimal approach. Optimal SDM Process scores were compared with measures of decision quality, conflict, and regret to examine construct validity; meta-analysis generated summary results., Results: Although all versions of the scale were highly correlated, a short, partial credit, equally weighted version of the scale showed favorable properties. Overall, higher SDM Process scores were related to higher decision quality ( d = 0.18, P = 0.029), higher SURE scale scores ( d = 0.57, P < 0.001), and lower decision regret ( d = -0.34, P < 0.001). Significant heterogeneity was present in all validity analyses., Limitations: Included studies all focused on surgical decisions, several had small sample sizes, and many were retrospective., Conclusion: SDM Process scores showed resilience to coding changes, and a scheme using the short, partial credit, with equal weights was adopted. The SDM Process scores demonstrated a small, positive relationship with decision quality and were consistently related to lower decision conflict and less regret, providing evidence of validity across several surgical decisions.

Background: Nearly half of US adults with diagnosed hypertension have uncontrolled blood pressure. Clinical inertia may contribute, including patient-physician uncertainty about how variability in blood pressures impacts overall control. Better information display may support clinician-patient hypertension decision making through reduced cognitive load and improved situational awareness., Methods: A multidisciplinary team employed iterative user-centered design to create a blood pressure visualization EHR prototype that included patient-generated blood pressure data. An attitude and behavior survey and 10 focus groups with patients (N = 16) and physicians (N = 24) guided iterative design and confirmation phases. Thematic analysis of qualitative data yielded insights into patient and physician needs for hypertension management., Results: Most patients indicated measuring home blood pressure, only half share data with physicians. When receiving home blood pressure data, 88% of physicians indicated entering gestalt averages as text into clinical notes. Qualitative findings suggest that including a data visualization that included home blood pressures brought this valued data into physician workflow and decision-making processes. Data visualization helps both patients and physicians to have a fuller understanding of the blood pressure 'story' and ultimately promotes the activated engaged patient and prepared proactive physician central to the Chronic Care Model. Both patients and physicians expressed concerns about workflow for entering and using home blood pressure data for clinical care., Conclusions: Our user-centered design process with physicians and patients produced a well-received blood pressure visualization prototype that includes home blood pressures and addresses patient-physician information needs. Next steps include evaluating a recent EHR visualization implementation, designing annotation functions aligned with users' needs, and addressing additional stakeholders' needs (nurses, care managers, caregivers). This significant innovation has potential to improve quality of care for hypertension through better patient-physician understanding of control and goals. It also has the potential to enable remote monitoring of patient blood pressure, a newly reimbursed activity, and is a strong addition to telehealth efforts.

Objective . Uncontrolled hypertension is driven by clinical uncertainty around blood pressure data. This research sought to determine whether decision support-in the form of enhanced data visualization-could improve judgments about hypertension control. Methods . Participants (Internet sample of patients with hypertension) in 3 studies ( N = 209) viewed graphs depicting blood pressure data for fictitious patients. For each graph, participants rated hypertension control, need for medication change, and perceived risk of heart attack and stroke. In study 3, participants also recalled the percentage of blood pressure measurements outside of the goal range. The graphs varied by systolic blood pressure mean and standard deviation, change in blood pressure values over time, and data visualization type. Results . In all 3 studies, data visualization type significantly affected judgments of hypertension control. In studies 1 and 2, perceived hypertension control was lower while perceived need for medication change and subjective perceptions of stroke and heart attack risk were higher for raw data displays compared with enhanced visualization that employed a smoothing function generated by the locally weighted smoothing algorithm. In general, perceptions of hypertension control were more closely aligned with clinical guidelines when data visualization included a smoothing function. However, conclusions were mixed when comparing tabular presentations of data to graphical presentations of data in study 3. Hypertension was perceived to be less well controlled when data were presented in a graph rather than a table, but recall was more accurate. Conclusion . Enhancing data visualization with the use of a smoothing function to minimize the variability present in raw blood pressure data significantly improved judgments about hypertension control. More research is needed to determine the contexts in which graphs are superior to data tables.

Background: Patients' behaviors play a key role in chronic disease management, but how effective they are may depend on how engaged they feel. The objective was to develop a short measure of how much patients felt engaged in self-managing a chronic condition. Online test of a three-question series followed by a survey of physicians and their eligible diabetic patients. Physicians answered: 1) how well the physician thought the patient was managing his/her diabetes, and 2) how much effort the physician thought the patient was putting in. Each patient was mailed a survey that included three questions on self-management. Six hundred six patients from a national online consumer panel with diabetes or obesity, and 35 physicians from 3 primary care practices and a sample of 243 of their diabetic patients. Respondents were asked three questions about how much they thought their behavior could affect their health condition, how confident they were that they could do what was needed, and how involved they were in decisions about managing their condition. These items were summed to create a WELL score. Descriptive statistics and correlation coefficients were used to describe item relationships. Generalized Estimating Equations were used to predict how well the physician thought the patient was managing their diabetes and patient effort., Results: Correlations among the three patient-reported items ranged from - 0.01 to 0.45. The WELL score was correlated with an existing measure of patient activation commitment (r = .43, p < 0.001) and found to be a significant predictor of physicians' ratings of how much effort patients devoted to condition management (b = 0.02, p = 0.001, OR = 1.02) after adjusting for confounders. The WELL score didn't predict physicians' ratings of how effective patients were (b = 0.003, p = .526, OR = 1.004) after their A1c score had been taken into account., Conclusion: Patients' WELL scores predicted physicians' ratings of patient effort in diabetes self-management.

Background: Despite recommendations to screen adults for depression in primary care, little is known about how people across education levels decide to treat their depression and factors that influence their decision., Methods: We conducted a secondary analysis of a national, probability-based web survey in English-speaking adults aged 40 or older living in the United States who reported they discussed starting or continuing an antidepressant with their clinician in the past 2 years. Respondents answered questions about knowledge, decision-making process, and demographics. Education level was analyzed using 5 ordered categories. The Shared Decision Making (SDM) Process score was used to assess patient involvement. Descriptive statistics, χ 2 tests, analysis of variance, and regression models were used to describe the data and test associations., Results: Of the 5682 people invited, 3396 answered questions about health decisions (59.8% response rate) and 385 reported discussing antidepressants. The mean percentage of knowledge questions answered correctly increased as education level increased ( P = .008). The mean SDM Process score also increased with education ( P = .001). There was an association between education and who made the treatment decision, suggesting that for respondents with less education, the clinician was more likely to decide ( P = .001). Respondents with less education were less likely to report they would definitely make the same decision again ( P = .000)., Conclusions: Those with less education were even less informed, had lower SDM Process scores and were less likely to think they made the right decision about antidepressants. There is a need to ensure patients are better informed about and involved in treatment for depression., Competing Interests: Conflict of interest: none., (© Copyright 2020 by the American Board of Family Medicine.)

A limiting factor in understanding memory and language is often the availability of large numbers of stimuli to use and explore in experimental studies. In this study, we expand on three previous databases of concepts to over 4000 words including nouns, verbs, adjectives, and other parts of speech. Participants in the study were asked to provide lists of features for each concept presented (a semantic feature production task), which were combined with previous research in this area. These feature lists for each concept were then coded into their root word form and affixes (i.e., cat and s for cats) to explore the impact of word form on semantic similarity measures, which are often calculated by comparing concept feature lists (feature overlap). All concept features, coding, and calculated similarity information is provided in a searchable database for easy access and utilization for future researchers when designing experiments that use word stimuli. The final database of word pairs was combined with the Semantic Priming Project to examine the relation of semantic similarity statistics on semantic priming in tandem with other psycholinguistic variables.

This article presents the Linguistic Annotated Bibliography (LAB) as a searchable Web portal to quickly and easily access reliable database norms, related programs, and variable calculations. These publications were coded by language, number of stimuli, stimuli type (i.e., words, pictures, symbols), keywords (i.e., frequency, semantics, valence), and other useful information. This tool not only allows researchers to search for the specific type of stimuli needed for experiments but also permits the exploration of publication trends across 100 years of research. Details about the portal creation and use are outlined, as well as various analyses of change in publication rates and keywords. In general, advances in computational power have allowed for the increase in dataset size in the recent decades, in addition to an increase in the number of linguistic variables provided in each publication.

Research that has explored public enthusiasm for cancer screening has suggested that the public may be overly enthusiastic about being screened with certain tests, and this has been attributed, in part, to lack of knowledge about the risks and benefits. In this article the authors considered the possibility that some people may be enthusiastic about screening even when they are informed and also accept that the test unquestionably does not save lives. Two studies were conducted, one that involved a nationally representative U.S. sample and another that involved an online convenience sample. All participants were asked whether they would want to receive a hypothetical screening test for breast (women) or prostate (men) cancer that does not reduce the chance of cancer death or extend the length of life. Over half of participants wanted to receive the described screening test. Many people did not believe that cancer screening might not save lives, yet screening preferences were not due to disbelief alone. Results further suggested that cancer worry, reassurance, and a desire for health information explained variance in preferences for unbeneficial screening, adjusting for beliefs about screening benefits, perceptions of screening risks, family history, perceptions of cancer risk, and demographics. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Human judgment often violates normative standards, and virtually no judgment error has received as much attention as the conjunction fallacy. Judgment errors have historically served as evidence for dual-process theories of reasoning, insofar as these errors are assumed to arise from reliance on a fast and intuitive mental process, and are corrected via effortful deliberative reasoning. In the present research, three experiments tested the notion that conjunction errors are reduced by effortful thought. Predictions based on three different dual-process theory perspectives were tested: lax monitoring, override failure, and the Tripartite Model. Results indicated that participants higher in numeracy were less likely to make conjunction errors, but this association only emerged when participants engaged in two-sided reasoning, as opposed to one-sided or no reasoning. Confidence was higher for incorrect as opposed to correct judgments, suggesting that participants were unaware of their errors.

Objectives: This retrospective study evaluates infant bed-sharing at a Missouri family practice with OB care., Methods: After Institutional Review Board (IRB) approval, data were extracted from the first four well-child visits of 2374 infants between Sept. 2003 and Dec. 20 11., Results: Bed-sharing decreased after 2005 (25%, 39%, respectively, p = 0.000). For infants who bed-shared, the frequency of bed-sharing did not decline., Conclusions: Nearly 20% of infants bed-share before the first visit; safe sleep prenatal education is warranted.