Why Clinicians Choose Their Language Intervention Approach: An International Perspective on Intervention for Children with Developmental Language Disorder

Purpose: Considerable progress has been made in recent years in generating external evidence underpinning interventions for children with developmental language disorder (DLD), but less is known about the practitioner decision-making process underpinning such interventions and whether such decisions are context specific or are internationally generalizable. Methods: An online survey about clinical practice was developed by members of COST Action IS1406, an EU-funded research network, which included representation from 39 countries. The participants were 2,408 practitioners who answered questions in relation to their decision making for a specific child of their choosing with DLD. Analysis of open-ended questions was undertaken, and data were converted into codes for the purpose of quantitative analysis. Results: Although a wide range of intervention approaches and rationales were reported, the majority of responses referenced a client-centred approach. Level of functioning was used as a rationale only if a child had severe DLD. Practitioners with university level education or above were less likely to report basing intervention on client-centred factors. A number of differently named interventions with variable theoretical and empirical underpinnings were used in different countries. Conclusions: Specific client and practitioner characteristics have an impact on the intervention approaches and rationales adopted across countries. A limited number of practitioners reported use of external scientific evidence, which suggests that there should be more initiatives in basic training of practitioners and continuing professional development to encourage the uptake of scientific evidence-based practice.

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The Cognitive Psychology of Diagnostic Errors

10.2310/neuro.6288 ◽

2015 ◽

Author(s):

Lauren E. Benishek ◽

Sallie J. Weaver ◽

David E. Newman-Toker

Keyword(s):

Decision Making ◽

Cognitive Psychology ◽

Scientific Evidence ◽

Characteristic Curve ◽

Diagnostic Errors ◽

Diagnostic Error ◽

Diagnostic Reasoning ◽

Diagnostic Decision ◽

Context Specific ◽

Diagnostic Decision Making

Health care involves complex decision making, often under uncertain, ambiguous, and time-sensitive conditions. Clinicians typically face the greatest uncertainty when making diagnostic decisions; common, undifferentiated symptoms paired with increasing prevalence of complex comorbidities, continuously and rapidly evolving scientific evidence, and often fragmented information systems are just a few of the hurdles clinicians must navigate as part of daily diagnostic decision making. In this review, the current state of the science concerning the cognitive psychology of diagnostic errors is discussed, including models of diagnostic reasoning, common errors: heuristics and biases, and practical implications and interventions. Figures show a conceptual model for diagnostic errors; diagnostic and therapeutic cycles; relationships among heuristics, biases, premature closure, and diagnostic errors; Reason’s (2000) Swiss cheese model; and tradeoffs versus improvements in diagnostic performance as illustrated by the receiver operating characteristic curve. Tables list important reasons for understanding the foundational cognitive models of diagnostic reasoning; a glossary of key diagnostic error–related definitions; three models of cognitive decision making; a summary of clinical reasoning models; steps of diagnostic decision making; examples of diagnostic errors resulting from representativeness, availability, and anchoring and adjustment; categories of countermeasures for error reduction interventions; examples of cognitively, systems-, and patient-focused countermeasures for selected biases; a summary of cognitively focused countermeasures to cognitive bias; key problem “classes” where problem- or context-specific solutions might be applied; types of system-focused countermeasures; and patient-focused countermeasures to avoid diagnostic error. This review contains 5 highly rendered figures, 12 tables, and 120 references.

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O-215 How common is add-on use and how do patients decide whether to use them? A national survey of IVF patients

Human Reproduction ◽

10.1093/humrep/deab128.026 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

S Lensen ◽

K Hammarberg ◽

A Polyakov ◽

J Wilkinson ◽

S Whyte ◽

...

Keyword(s):

Decision Making ◽

Online Survey ◽

Scientific Evidence ◽

Oocyte Donation ◽

Patient Recall ◽

Effectiveness Factors ◽

Ivf Failure ◽

High Prevalence ◽

Registration Number

Abstract Study question How common is IVF add-on use in Australia, and what drives the use? Summary answer Most women (82%) had used one or more IVF add-ons and more than half (54%) first learned about the add-ons from their fertility specialist. What is known already IVF add-ons are procedures, techniques or medicines which may be considered nonessential to IVF, usually used in attempts to improve the probability of conception and live birth. Despite widespread concern about unproven IVF add-ons, information about the prevalence of their use is limited because these data are not available in national registries or datasets. Study design, size, duration Women who had undergone IVF in Australia since 2017 were recruited via social media. Women were excluded if they were gestational surrogates, had used a surrogate, or underwent IVF for oocyte donation or elective oocyte cryopreservation only. Eligible women completed an online survey which was open from 21st June to 14th July 2020. Participants/materials, setting, methods Survey questions included demographics, IVF and medical history, and questions specifically about IVF add-ons such as: the type of add-ons used, information sources consulted, and where participants first heard about add-ons. Women also responded to questions about the importance of scientific evidence regarding safety and effectiveness, factors considered in decision-making around add-on use and the presence of any decision regret. Main results and the role of chance A total of 1,590 responses were analyzed after excluding 287 ineligible responses. Participants were generally representative of women who undergo IVF in Australia in terms of age, indication for IVF, and use of ICSI for fertilisation. Most women had used at least one add-on (82%), and these were usually associated with an additional fee (72%). It was most common to first learn about IVF add-ons from the fertility specialist (54%), and most women reported that they and their specialist contributed equally to the decision to use add-ons. Women viewed scientific evidence for safety and effectiveness as very important on a scale from 0-100, an importance score over 90 was selected by more than half of the participants. Additionally, many (49%) assumed that add-ons were risk-free. Most women experienced regret at the decision to use IVF add-ons (66%), and this regret was greatest among women who experienced IVF failure when using add-ons (83%) and those who believed that the specialist drove the decision to use the add-ons (75%). Limitations, reasons for caution This was a retrospective survey of IVF patients, therefore it may suffer from bias due to patient recall. It does not consider the perspective of the IVF clinic or fertility specialist. Certain questions may be more prone to biased responses, such as those regarding who contributed to decision making. Wider implications of the findings The high prevalence of add-on use is likely generalizable to other settings where IVF treatment is largely private. Although women viewed scientific evidence as very important, most had used unproven IVF add-ons. This might suggest that women were not aware of the lack of robust evidence to support their use. Trial registration number Not applicable

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Variability of Executive Function Performance in Preschoolers with Developmental Language Disorder

Seminars in Speech and Language ◽

10.1055/s-0039-1692723 ◽

2019 ◽

Vol 40 (04) ◽

pp. 243-255

Author(s):

Leah L. Kapa ◽

Jessie A. Erikson

Keyword(s):

Executive Function ◽

Language Disorder ◽

Large Body ◽

Developmental Language Disorder ◽

Individual Level ◽

Number Of Children ◽

Wide Range ◽

Memory Inhibition ◽

The Individual ◽

Nonverbal Measures

AbstractAlthough results vary across individual studies, a large body of evidence suggests that children with developmental language disorder (DLD) have domain-general deficits in executive function compared with peers with typically developing language. Poorer performance for children with DLD has been reported on verbal and nonverbal measures of sustained selective attention, working memory, inhibition, and shifting. However, examination of the variability of task scores among both children with and without DLD reveals a wide range of executive function performance for both groups. Additionally, using executive function scores to classify children into DLD versus typical groups results in classification accuracy that is not clinically useful. This evidence indicates that group-level differences in executive function abilities between children with and without DLD cannot be applied at the individual level. Many children with DLD appear to have intact executive function abilities, which undermines the possibility that poor executive functioning causes language deficits in this population. However, a substantial number of children with DLD also have executive function deficits, and, therefore, therapy approaches with this population should consider both their language and executive function abilities.

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How Urban Forest Managers Evaluate Management and Governance Challenges in Their Decision-Making

Forests ◽

10.3390/f11090963 ◽

2020 ◽

Vol 11 (9) ◽

pp. 963

Author(s):

Camilo Ordóñez ◽

Dave Kendal ◽

Caragh G. Threlfall ◽

Dieter F. Hochuli ◽

Melanie Davern ◽

...

Keyword(s):

Decision Making ◽

Local Government ◽

Local Governments ◽

Online Survey ◽

Urban Forest ◽

Forest Protection ◽

Regional Strategies ◽

Wide Range ◽

Governance Challenges ◽

Forest Managers

Decisions about urban forests are critical to urban liveability and resilience. This study aimed to evaluate the range of positions held by urban forest managers from local governments in the state of Victoria, Australia, regarding the management and governance challenges that affect their decision-making. This study was based on a Q-method approach, a procedure that allows researchers to evaluate the range of positions that exist about a topic in a structured manner based on the experiences of a wide group of people. We created statements on a wide range of urban forest management and governance challenges and asked urban forest managers to rate their level of agreement with these statements via an online survey. Managers generally agreed about the challenges posed by urban development and climate change for implementing local government policies on urban forest protection and expansion. However, there were divergent views about how effective solutions based on increasing operational capacities, such as increasing budgets and personnel, could address these challenges. For some managers, it was more effective to improve critical governance challenges, such as inter-departmental and inter-municipal coordination, community engagement, and addressing the culture of risk aversion in local governments. Urban forest regional strategies aimed at coordinating management and governance issues across cities should build on existing consensus on development and environmental threats and address critical management and governance issues not solely related to local government operational capacity.

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HEALTH TECHNOLOGY ASSESSMENT FOR THE NHS IN ENGLAND AND WALES

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462302000168 ◽

2002 ◽

Vol 18 (2) ◽

pp. 161-165 ◽

Cited By ~ 7

Author(s):

Kent Woods

Keyword(s):

Decision Making ◽

Health Technology Assessment ◽

Technology Assessment ◽

Clinical Excellence ◽

Health Technology ◽

Relevant Evidence ◽

Healthcare Decision Making ◽

Wide Range ◽

Scientific Task ◽

Context Specific

In healthcare decision making, there is an important functional separation between assessment and appraisal. In the U.K. National Health Service (NHS), this distinction is illustrated by the separation of roles between the Health Technology Assessment Programme and the National Institute for Clinical Excellence. However, it can be seen at every level within the healthcare system. Assessment of a technology is a scientific task that synthesizes all relevant evidence on effectiveness and cost-effectiveness; its results are therefore generalizable. Appraisal of the technology is informed by the assessment but adds context-specific judgments on the applicability of the evidence, the feasibility and impact of alternative options, relative priorities, and wider social and ethical aspects. An explicit distinction between assessment and appraisal is helpful in achieving clarity, consistency, and consensus. It also makes clear the need for a wide range of assessment reviews to support decision making by commissioners, providers, and users of health services. Increasingly, the secondary research supported by the NHS R&D Programme is being distributed electronically. It is also being used to identify areas in which further primary research should be commissioned.

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Sources of variability in the prospective relation of language to social, emotional, and behaviour problem symptoms: implications for Developmental Language Disorder

10.31234/osf.io/sv5hw ◽

2021 ◽

Author(s):

Shaun Goh ◽

Sarah Louise Griffiths ◽

Courtenay Norbury

Keyword(s):

Structural Equation ◽

Structural Equation Models ◽

Language Disorder ◽

Survey Design ◽

Behaviour Problem ◽

Developmental Language Disorder ◽

Emotional Symptoms ◽

Social Emotional ◽

Wide Range ◽

The Relationship

Children with developmental language disorder (DLD) are at risk for social, emotional and behavioural (SEB) maladjustment throughout development, though it is unclear if poor language proficiency per se can account for this risk, as associations between language and SEB appear more variable among typical language children. This study investigates whether the relationship between language and SEB problems is stronger at very low levels of language, and considers confounders including socio-economic status, sex and non-verbal intelligence. These are examined using a population-based survey design, including children with a wide range of language and cognitive profiles, and assessed using the Strengths and Difficulties Questionnaire and six standardised language measures (n = 363, weighted n = 6,451). Structural equation models adjusted for prior levels of SEB reveal that the relationship of language at age 5-6 years to SEB at 7-9 years was non-linear. Language more strongly predicted all clusters of SEB at disordered language levels relative to typical language levels; with standardised betas of -0.25 versus 0.03 for behavioural, -0.31 versus -0.04 for peer, and 0.27 versus 0.03 for prosocial, problems. Wald tests between these pairs of betas yielded p-values from .049 to .014. Sex moderated the nonlinear association between language and emotional symptoms. These findings indicate a clinical need to support language development in order to mitigate against problems of SEB, and to carefully monitor the mental health needs of children with DLD, particularly in the context of multiple, and potentially sex-specific, risks.

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Doctors’ engagement with a formal system of continuing professional development in Ireland: a qualitative study in perceived benefits, barriers and potential improvements

BMJ Open ◽

10.1136/bmjopen-2021-049204 ◽

2021 ◽

Vol 11 (11) ◽

pp. e049204

Author(s):

Holly Rose Hanlon ◽

Lucia Prihodova ◽

Thelma Russell ◽

Deirdre Donegan ◽

Ann O'Shaughnessy ◽

...

Keyword(s):

Professional Development ◽

Thematic Analysis ◽

Online Survey ◽

Professional Competence ◽

Formal System ◽

Continuing Professional Development ◽

Cross Sectional ◽

Wide Range ◽

Workplace Challenges ◽

Cross Sectional Design

ObjectivesTo examine experiences of participation in a mandatory system of continuing professional development (CPD) among doctors in Ireland, in order to identify areas for improvement.DesignA qualitative cross-sectional design was used.Participants1408 participants (701 male, 707 female) were recruited via email from a population of 4350 doctors enrolled on a Royal College of Physicians of Ireland Professional Competence Scheme (PCS) for the 2017/2018 year, and completed an online survey as part of a larger study examining experiences and attitudes towards participation in PCS. A subset of the sample (434 participants) responded to an optional open-ended question about PCS participation. Responses to the open-ended question were analysed using thematic analysis.ResultsThematic analysis resulted in five main themes relating to perceived barriers to PCS participation across a wide range of areas: ‘Evidence of participation’, ‘The structure of PCS’, ‘Questioning the benefits of formal CPD’, ‘Workplace challenges’ and ‘Access issues’.ConclusionsTaken together, the five themes outlined in this study give a wide-ranging, in-depth picture of the challenges faced by Irish doctors, which expand on well-documented factors such as time constraints, to illustrate a series of complex, interacting factors. Some barriers, such as difficulty obtaining evidence of participation, may be relatively easily addressed. Others, such as issues with the way the PCS is structured, are more intractable, and require further research to understand more fully and develop appropriate solutions.

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Trust and Transparency in times of Crisis: Results from an Online Survey During the First Wave (April 2020) of the COVID-19 Epidemic in the UK

10.1101/2020.09.01.20183822 ◽

2020 ◽

Author(s):

Luisa Enria ◽

Naomi Waterlow ◽

Nina Trivedy Rogers ◽

Hannah Brindle ◽

Sham Lal ◽

...

Keyword(s):

Decision Making ◽

Online Survey ◽

Control Strategies ◽

Scientific Evidence ◽

Positive Opinion ◽

Online Questionnaire ◽

Demographic Groups ◽

Government Transparency ◽

The Government ◽

The Uk

Background: The success of government COVID-19 control strategies relies on public trust and broad acceptance of response measures. We investigated public perceptions of the UK government COVID-19 response, focusing on the relationship between trust and transparency, during the first wave (April 2020) of the COVID-19 pandemic in the United Kingdom. Methods: Anonymous survey data were collected (2020-04-06 to 2020-04-22) from 9,322 respondents, aged 20+ using an online questionnaire. We took a mixed methods approach to data analysis, combining statistical analyses, structural topic modelling (STM) and qualitative thematic coding of a sub-set of responses. Missing data were imputed via multiple imputation. Results: Most respondents (95.1%) supported government enforcement of behaviour change. While 52.1% of respondents thought the government was making good decisions, differences were apparent across demographic groups, for example respondents from Scotland had lower odds of responding positively than respondents in London. Higher educational levels saw decreasing odds of having a positive opinion of the government response and decreasing household income associated with decreasing positive opinion. Of respondents who thought the government was not making good decisions 60% believed the economy was being prioritised over people and their health. Positive views on government decision-making were associated with positive views on government transparency about the COVID-19 response. Qualitative analysis about government transparency highlighted five key themes: (1) the justification of opacity due to the condition of crisis, (2) generalised mistrust of politics, (3) concerns about the role of scientific evidence, (4) quality of government communication and (5) questions about political decision-making processes. Conclusion: We recommend targeted community engagement tailored to different groups experiences and a focus on accountability and openness around how decisions are made in the response to the UK COVID-19 pandemic.

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Risk communication in tables versus text: a registered report randomized trial on ‘fact boxes'

Royal Society Open Science ◽

10.1098/rsos.190876 ◽

2020 ◽

Vol 7 (3) ◽

pp. 190876 ◽

Cited By ~ 6

Author(s):

Cameron Brick ◽

Michelle McDowell ◽

Alexandra L. J. Freeman

Keyword(s):

Decision Making ◽

Science Communication ◽

Online Survey ◽

Primary Outcome ◽

Primary Outcome Measure ◽

Medical Decision ◽

Preventative Intervention ◽

Wide Range ◽

Message Format ◽

Communication Supports

Objectives: identifying effective summary formats is fundamental to multiple fields including science communication, systematic reviews, evidence-based policy and medical decision-making. This study tested whether table or text-only formats lead to better comprehension of the potential harms and benefits of different options, here in a medical context. Design: pre-registered, longitudinal experiment: between-subjects factorial 2 (message format) × 2 topic (therapeutic or preventative intervention) on comprehension and later recall (CONSORT-SPI 2018). Setting: longitudinal online survey experiment. Participants: 2305 census-matched UK residents recruited through the survey panel firm YouGov. Primary outcome measure: comprehension of harms and benefits and knowledge recall after six weeks. Results: fact boxes—simple tabular messages—led to more comprehension ( d = 0.39) and slightly more knowledge recall after six weeks ( d = 0.12) compared to the same information in text. These patterns of results were consistent between the two medical topics and across all levels of objective numeracy and education. Fact boxes were rated as more engaging than text, and there were no differences between formats in treatment decisions, feeling informed or trust. Conclusions: the brief table format of the fact box improved the comprehension of harms and benefits relative to the text-only control. Effective communication supports informed consent and decision-making and brings ethical and practical advantages. Fact boxes and other summary formats may be effective in a wide range of communication contexts.

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Risk communication in tables vs. text: a Registered Report randomised trial on 'fact boxes'

10.31234/osf.io/jx97q ◽

2019 ◽

Author(s):

Cameron Brick ◽

Michelle McDowell ◽

Alexandra Lee Jessica Freeman

Keyword(s):

Decision Making ◽

Science Communication ◽

Online Survey ◽

Primary Outcome ◽

Randomised Trial ◽

Medical Decision ◽

Preventative Intervention ◽

Wide Range ◽

Message Format ◽

Communication Supports

ObjectivesAbstractIdentifying effective summary formats is fundamental to multiple fields including science communication, systematic reviews, evidence-based policy, and medical decision making. This study will test whether table or text-only formats lead to better comprehension of the potential harms and benefits of different options, here in a medical context.DesignPre-registered, longitudinal experiment: between-subjects factorial 2 (message format) x 2 topic (topic: therapeutic or preventative intervention) on comprehension and later recall (CONSORT- SPI 2018).SettingLongitudinal online survey experiment.Participants[[ N ]] census-matched UK residents recruited through the survey panel firm YouGov. Primary outcome measureComprehension of harms and benefits and knowledge recall after one month.ResultsFact boxes—simple tabular messages—led to [[ less, equal, more ]] comprehension than text- only formats and [[ greater, equal, lower ]] knowledge recall after one month. Fact boxes led to [[more, equivalent, fewer]] treatment decisions compared to the text-only control. These patterns of results were [[ the same, different ]] between the two topics [[ explain any differences ]].ConclusionsThe brief table format of the fact box [[ improved, did not improve ]] comprehension of harms and benefits relative to the text-only control. Effective communication supports informed consent and decision making and brings ethical and practical advantages. Fact boxes and other summary formats may be effective in a wide range of communication contexts.

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