The impact of a physician’s recommendation and gender on informed decision making: A randomized controlled study in a simulated decision situation

2020 ◽  
Author(s):  
Marie Eggeling ◽  
Anna Meinhardt ◽  
Ulrike Cress ◽  
Joachim Kimmerle ◽  
Martina Bientzle
Keyword(s):  
Decision Making ◽  
Cruciate Ligament ◽  
Treatment Options ◽  
General Information ◽  
Treatment Preference ◽  
Controlled Study ◽  
Treatment Preferences ◽  
Hypothetical Scenario ◽  
And Gender ◽  
The Impact

Objective: This study examined the influence of physicians’ recommendations and gender on the decision-making process in a preference-sensitive situation. Methods: N = 201 participants were put in a hypothetical scenario in which they suffered from a rupture of the anterior cruciate ligament (ACL). They received general information on two equally successful treatment options for this injury (surgery vs. physiotherapy) and answered questions regarding their treatment preference, certainty and satisfaction regarding their decision, and attitude toward the treatment options. Then participants watched a video that differed regarding physician’s recommendation (surgery vs. physiotherapy) and physician’s gender (female vs. male voice and picture). Afterward, they indicated again their treatment preference, certainty, satisfaction, and attitude, as well as the physician’s professional and social competence.Results: Participants changed their treatment preferences in the direction of the physician’s recommendation (P<.001). Decision certainty (P<.001) and satisfaction (P<.001) increased more strongly if the physician’s recommendation was congruent with the participant’s prior attitude than if the recommendation was contrary to the participant’s prior attitude. Finally, participants’ attitudes toward the recommended treatment became more positive (surgery recommendation: P<.001; physiotherapy recommendation: P<.001). We found no influence of the physician’s gender on participants’ decisions, attitudes, or competence assessments.Conclusion: This research indicates that physicians should be careful with recommendations when aiming for shared decisions, as they might influence patients even if the patients have been made aware that they should take their personal preferences into account. This could be particularly problematic if the recommendation is not in line with the patient’s preferences.

scholarly journals Head to head randomized trial of two decision aids for prostate cancer

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Angela Fagerlin ◽  
Margaret Holmes-Rovner ◽  
Timothy P. Hofer ◽  
David Rovner ◽  
Stewart C. Alexander ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Shared Decision Making ◽  
Decision Aid ◽  
Physician Visit ◽  
Treatment Preference ◽  
Baseline Survey ◽  
Treatment Preferences ◽  
Shared Decision ◽  
The Impact

Abstract Background While many studies have tested the impact of a decision aid (DA) compared to not receiving any DA, far fewer have tested how different types of DAs affect key outcomes such as treatment choice, patient–provider communication, or decision process/satisfaction. This study tested the impact of a complex medical oriented DA compared to a more simplistic decision aid designed to encourage shared decision making in men with clinically localized prostate cancer. Methods 1028 men at 4 VA hospitals were recruited after a scheduled prostate biopsy. Participants completed baseline measures and were randomized to receive either a simple or complex DA. Participants were men with clinically localized cancer (N = 285) by biopsy and who completed a baseline survey. Survey measures: baseline (biopsy); immediately prior to seeing the physician for biopsy results (pre- encounter); one week following the physician visit (post-encounter). Outcome measures included treatment preference and treatment received, knowledge, preference for shared decision making, decision making process, and patients’ use and satisfaction with the DA. Results Participants who received the simple DA had greater interest in shared decision making after reading the DA (p = 0.03), found the DA more helpful (p’s < 0.01) and were more likely to be considering watchful waiting (p = 0.03) compared to those receiving the complex DA at Time 2. While these differences were present before patients saw their urologists, there was no difference between groups in the treatment patients received. Conclusions The simple DA led to increased desire for shared decision making and for less aggressive treatment. However, these differences disappeared following the physician visit, which appeared to change patients’ treatment preferences. Trial registration This trial was pre-registered prior to recruitment of participants.

scholarly journals How Gender Identity and Treatment Progress Impact Decision-Making, Psychotherapy and Aftercare Desires of Trans Persons

2019 ◽  
Vol 8 (5) ◽  
pp. 749
Author(s):  
Toby K. Mayer ◽  
Andreas Koehler ◽  
Jana Eyssel ◽  
Timo O. Nieder
Keyword(s):  
Decision Making ◽  
Gender Identity ◽  
Online Community ◽  
Online Survey ◽  
Clinical Sample ◽  
Treatment Preferences ◽  
Individual Treatment ◽  
Treatment Progress ◽  
Treatment Experience ◽  
The Impact

The gender identity of trans individuals influences their treatment preferences, and this in turn seems to affect their individual treatment progress. However, there has been no research which—next to the impact of gender identity on treatment desires—has also investigated the influence of treatment progress using a measure which assumes various possible transition pathways of trans persons.Therefore, an online community survey of trans people was conducted in Germany in 2015. Data were collected via an online survey from a non-clinical sample of n = 415 trans individuals (over half assigned female at birth), aged 16–76 (Mean (M) = 38.12). Almost one fifth of participants embraced non-binary or genderqueer (NBGQ) identities. Participants progressed 60.77% (standard deviation (SD) = 35.21) through treatment at point of data collection, as measured by the individual treatment progress score (ITPS). All participants, especially participants assigned male at birth, differed significantly in desire to participate in decision-making processes based on transition progress; individuals without treatment experience had less desire to decide treatment plans. NBGQ participants assigned male at birth in early stages of transition had significantly more desire for psychotherapy during transition than participants of the same identity in later transition stages. All participants, especially binary participants, significantly differed in desire for aftercare based on transition progress; individuals without treatment experience indicated more desire for aftercare. Results indicate health professionals should expect changing treatment desires in trans individuals at various stages of transition, particularly at treatment start, and based on gender identity.

A Cross-Cultural Study of the Influence of Country of Origin, Justice, Power Distance, and Gender on Ethical Decision Making

2012 ◽  
Vol 11 (1) ◽  
pp. 5-34 ◽  
Author(s):  
Mary B. Curtis ◽  
Teresa L. Conover ◽  
Lawrence C. Chui
Keyword(s):  
Decision Making ◽  
Behavioral Intentions ◽  
Ethical Decision ◽  
Ethical Decision Making ◽  
Distance Perception ◽  
Power Distance ◽  
Country Of Origin ◽  
Justice Perceptions ◽  
And Gender ◽  
The Impact

ABSTRACT This study examines the impact of national culture on ethical decision making. We theorize and test a mediation model where country of origin influences perceptions of justice and power distance, which in turn influence behavioral intentions in regard to ethical dilemmas. Our sample includes accounting students from four countries: China, Japan, Mexico, and the U.S. We find that country of origin, justice perceptions, power distance perception, and gender are all related to ethical decision making. We investigate these relationships with two different ethical scenarios, and find that these relationships differ between the two contexts. Additionally, power distance and justice partially mediate the relationship between country of origin and ethical decision making. We find that gender is significantly related to ethical decision making in one of the two scenarios, and explore gender differences in all of the measured constructs across countries. Finally, we contrast the various measures of justice, power distance, and agreement with behavioral intentions in the two ethical scenarios between countries. We find that the two eastern countries (China and Japan) and the two western countries (U.S. and Mexico) demonstrate expected East-West patterns in power distance. However, this East-versus-West pattern is not supported when considering between-country differences in justice, agreement with the layoff decision, and agreement with whistleblowing.

A comparison of treatment preferences, decision making, and psychosocial outcomes in advanced cancer patients with and without minor children: A matched cohort study.

2019 ◽  
Vol 37 (31_suppl) ◽  
pp. 91-91
Author(s):  
Eliza Myung Park ◽  
Allison Mary Deal ◽  
Laura C. Hanson ◽  
Donald L. Rosenstein ◽  
Laura J. Quillen ◽  
...  
Keyword(s):  
Decision Making ◽  
Advanced Cancer ◽  
Psychosocial Functioning ◽  
Metastatic Cancer ◽  
Well Being ◽  
Influential Factor ◽  
Life Extension ◽  
Treatment Preferences ◽  
Minor Children ◽  
The Impact

91 Background: Patients with advanced cancer who have minor children face unique challenges when coping with their life-limiting illness and the impact of their illness on their families. The goal of this study was to examine whether psychosocial functioning, treatment preferences, and treatment decisions in advanced cancer differ by parental status. Methods: A cohort of 60 parents with metastatic solid tumors age-matched with 60 non-parents (N = 120) participated in three structured interviews assessing treatment preferences and decisions over six months with complementary medical record review. Participants also completed validated measures of psychosocial functioning. Results: Seventy percent (n = 85) of the sample completed all study assessments. Mean age (45 years, SD 8), mean performance status score (ECOG = 1.2, SD 0.9), median duration of metastatic illness (19 months, range 1-115), gender ratio (66% female), and dropout rates were similar between groups. Parents and non-parents reported similar overall health-related quality of life, but parents were more likely to report poorer emotional well-being (p = 0.006) and more symptoms of depression (p = 0.04) and anxiety (p = 0.04) than non-parents. Parents and non-parents were equally likely to describe life-extension as their primary goal of anti-neoplastic treatment. Parents reported greater willingness to live in pain (48% “very willing” vs 27%, p = 0.007) and accept intubation/ventilation (40% vs 20%, p = 0.01) for life-extension. Compared to non-parents, parents were more likely to report their family members as the most influential factor in their decision-making (44% vs 12%) and less likely to cite their oncologist’s recommendation (25% vs 41%). There were no significant differences between groups for completion of a health care power of attorney or living will. Conclusions: Compared to similarly aged adults with metastatic cancer, parents experience greater psychological distress, are more willing to live in pain for life extension, and place greater importance on family-related factors in their cancer treatment decision-making.

scholarly journals Clinician views of patient decisional conflict when deciding between dialysis and conservative management: Qualitative findings from the PAlliative Care in chronic Kidney diSease (PACKS) study

2017 ◽  
Vol 31 (10) ◽  
pp. 921-931 ◽  
Author(s):  
Helen Noble ◽  
Kevin Brazil ◽  
Aine Burns ◽  
Sarah Hallahan ◽  
Charles Normand ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Decision Making ◽  
Palliative Care ◽  
United Kingdom ◽  
Kidney Disease ◽  
Conservative Management ◽  
Treatment Options ◽  
Decisional Conflict ◽  
The United Kingdom ◽  
The Impact

Background: Only a paucity of studies have addressed clinician perspectives on patient decisional conflict, in making complex decisions between dialysis and conservative management (renal supportive and palliative care). Aim: To explore clinician views on decisional conflict in patients with end-stage kidney disease. Design: Interpretive, qualitative study. Setting and participants: As part of the wider National Institute for Health Research, PAlliative Care in chronic Kidney diSease study, semi-structured interviews were conducted with clinicians (nephrologists n = 12; 7 female and clinical nurse specialists n = 15; 15 female) across 10 renal centres in the United Kingdom. Interviews took place between April 2015 and October 2016 and a thematic analysis of the interview data was undertaken. Results: Three major themes with associated subthemes were identified. The first, ‘Frequent changing of mind regarding treatment options’, revealed how patients frequently altered their treatment decisions, some refusing to make a decision until deterioration occurred. The second theme, ‘Obligatory beneficence’, included clinicians helping patients to make informed decisions where outcomes were uncertain. In weighing up risks and benefits, and the impact on patients, clinicians sometimes withheld information they thought might cause concern. Finally, ‘Intricacy of the decision’ uncovered clinicians’ views on the momentous and brave decision to be made. They also acknowledged the risks associated with this complex decision in giving prognostic information which might be inaccurate. Limitations: Relies on interpretative description which uncovers constructed truths and does not include interviews with patients. Conclusion: Findings identify decisional conflict in patient decision-making and a tension between the prerequisite for shared decision-making and current clinical practice. Clinicians also face conflict when discussing treatment options due to uncertainty in equipoise between treatments and how much information should be shared. The findings are likely to resonate across countries outside the United Kingdom.

scholarly journals The Impact of Visualization Format and Navigational Options on Laypeople’s Perception and Preference of Surgery Information Videos: Randomized Controlled Trial and Online Survey (Preprint)

2018 ◽  
Author(s):  
Marie Eggeling ◽  
Martina Bientzle ◽  
Thomas Shiozawa ◽  
Ulrike Cress ◽  
Joachim Kimmerle
Keyword(s):  
Decision Making ◽  
Knowledge Acquisition ◽  
Online Survey ◽  
Medical Information ◽  
Cruciate Ligament ◽  
Survey Study ◽  
Factual Knowledge ◽  
Significant Group ◽  
Realistic Visualization ◽  
The Impact

BACKGROUND Patients need to be educated about possible treatment choices in order to make informed medical decisions. As most patients are medical laypeople, they find it difficult to understand complex medical information sufficiently to feel confident about a decision. Multimedia interventions such as videos are increasingly used to supplement personal consultations with medical professionals. Former research has shown that such interventions may have a positive effect on understanding, decision making, and emotional reactions. However, it is thus far unclear how different features of videos influence these outcomes. OBJECTIVE We aimed to examine the impact of visualization formats and basic navigational options in medical information videos about cruciate ligament surgery on recipients’ knowledge gain, emotions, attitude, and hypothetical decision-making ability. METHODS In a between-group randomized experiment (Study 1), 151 participants watched 1 of 4 videos (schematic vs realistic visualization; available vs unavailable navigational options). In a separate online survey (Study 2), 110 participants indicated their preference for a video design. All participants were medical laypeople without personal experience with a cruciate ligament rupture and were presented with a fictional decision situation. RESULTS In Study 1, participants who used navigational options (n=36) gained significantly more factual knowledge (P=.005) and procedural knowledge (P<.001) than participants who did not have or use navigational options (n=115). A realistic visualization induced more fear (P=.001) and disgust (P<.001) than a schematic video. Attitude toward the surgery (P=.02) and certainty regarding the decision for or against surgery (P<.001) were significantly more positive after watching the video than before watching the video. Participants who watched a schematic video rated the video significantly higher than that by participants who watched a realistic video (P<.001). There were no significant group differences with regard to hypothetical decision making and attitude toward the intervention. In addition, we did not identify any influence of the visualization format on knowledge acquisition. In Study 2, 58 of 110 participants (52.7%) indicated that they would prefer a schematic visualization, 26 (23.6%) preferred a realistic visualization, 17 (15.5%) wanted either visualization, and 9 (8.2%) did not want to watch a video at all. Of the participants who wanted to watch a video, 91 (90.1%) preferred to have navigational options, 3 (3.0%) preferred not to have navigational options, and 7 (6.9%) did not mind the options. CONCLUSION Our study indicates that the perception of medical information videos is influenced by their design. Schematic videos with navigational options are the most helpful among all videos to avoid negative emotions and support knowledge acquisition when informing patients about an intervention. The visualization format and navigational options are important features that should be considered when designing medical videos for patient education. CLINICALTRIAL Deutsches Register Klinischer Studien DRKS00016003; https://www.drks.de/drks_web/ navigate.do?navigationId= trial.HTML&TRIAL_ID=DRKS00016003 (Archived by WebCite at http://www.webcitation.org/746ASSAhN)

scholarly journals Value Orientations and Fertility Intentions of Finnish Men and Women

2003 ◽  
pp. 201-226
Author(s):  
Anneli Miettinen ◽  
Pirjo Paajanen
Keyword(s):  
Decision Making ◽  
Family Policy ◽  
Gender Role Attitudes ◽  
Fertility Intentions ◽  
Value Orientations ◽  
Men And Women ◽  
Childbearing Intentions ◽  
Policy Measures ◽  
And Gender ◽  
The Impact

In thispaper we examine howpersona! values and attitudes are related to childbearingintentions among 18-40-year-old Finnish men and women. Wefocus on religiousand individualistic values and on attitudes towardschildrenand thefamily, as well asattitudes towards work and gender roles. The impact of value and attitude orientationsand situationalfactors onfertility decision-making are investigated separatelyat parities 0, 1 and 2 using logistic regression. Our study uses a subsample of 1,237men andwomen drawnfrom thePPA2survey ofthe attitudes ofFinns towardsfamilyand children,family policy measures, values in life as well as theirfertility intentions.Wefind that information on persona! values and attitudes does increase our knowledgeon determinants of childbearing intentions and decision-making, although notali our initial hypotheses concerning the association, or direction of the association,between certain attitudes and fertility intentions were confirmed in the data. Religiousvalues, as well as work-relatedattitudes and individualistic values appeared tohave little bearing on childbearing intentions, while various attitudes towards childrenwere related to intentions to have (more) children. In addition, a conservativefamilistic attitude was related to intentions as well as gender role attitudes. The impactof values and attitudes varied by parity, providing support to the nation thatchildbearing decisions are made sequentially".

scholarly journals P621 Physician preferences for biologics (originator vs. biosimilar) for the treatment of ulcerative colitis in France, Germany and the UK

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S515-S516
Author(s):  
L Huynh ◽  
S Hass ◽  
B E Sands ◽  
M S Duh ◽  
H Sipsma ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Patient Preference ◽  
Treatment Options ◽  
Additional Treatment ◽  
Treatment Preference ◽  
Treatment Preferences ◽  
Clinical Settings ◽  
Good Tolerability ◽  
New Treatment ◽  
The Uk

Abstract Background Although originator biologics are effective therapies for patients with ulcerative colitis (UC), they can be costly and may not be widely available. Therefore, less expensive biosimilars have been developed and approved to treat and manage symptoms. In this new treatment landscape, UC-treatment preferences are unknown. Thus, this interim analysis aimed to characterise physician preferences for biologics for the treatment of UC in France, Germany and the UK. Methods As part of a broader chart review study, treatment preferences were also collected from participating gastroenterologists and general practitioners (GPs) in France, Germany and the UK who had treated patients (≥ 18 years) with moderate-to-severe UC who had received ≥ 1 UC-related biologic any time from 2014 to 25 October 2019. Descriptive statistics were used to describe the sample overall, and by physician speciality and treatment preference. Results Physicians (161 gastroenterologists; 57 GPs) were from different clinical settings in France (39.9%), Germany (28.4%) and the UK (31.7%). Overall, infliximab (33.0%) and adalimumab (32.1%) were selected more often as first treatment options than their biosimilars (17.0% and 9.6%, respectively). Gastroenterologists preferred biosimilars more frequently than GPs did (35.4% vs. 1.8%). More physicians who preferred biosimilars were from France (48.3%) than Germany (17.2%) or the UK (34.5%). In France and the UK, 93.8% of physicians who selected biosimilars worked in hospital settings; in Germany, 50.0% worked in clinics and 50.0% worked in practice settings with statutory and private patients. Physicians who preferred biosimilars treated more patients with UC in the preceding 12 months than those who preferred originators did (mean ± SD: 110.3 ± 113.9 vs. 94.0 ± 93.2). Although most physicians reported efficacy as a reason for biologic preference (93.6%), physicians who preferred originators were more likely to report good tolerability (73.8%) and patient preference (20.6%) and less likely to report affordability or availability (11.9%) than physicians who preferred biosimilars (63.8%, 10.3% and 44.8%, respectively). In patients who failed anti-TNF therapy, vedolizumab was the preferred treatment (78.9%), although this preference differed by speciality (gastroenterologists: 83.2%; GPs: 66.7%). Conclusion Originator biologics for treating patients with moderate-to-severe UC dominate the treatment landscape in Europe, driven primarily by efficacy, tolerability and patient preference. However, variations and differences in preferences by speciality and clinical setting may suggest a need to explore additional treatment options to manage disease symptoms among patients with UC.

Surgical decision-making among patients with uncontrolled epilepsy: “Making important decisions about my brain, which I happen to love”

2020 ◽  
pp. 174239532096862
Author(s):  
Huibrie C Pieters ◽  
Sandra R Dewar ◽  
Lizza Ranit ◽  
Tomoko J Iwaki ◽  
Jerome Engel
Keyword(s):  
Decision Making ◽  
Focal Epilepsy ◽  
Treatment Options ◽  
Visual Image ◽  
Constructivist Grounded Theory ◽  
Thought Processes ◽  
Risks And Benefits ◽  
Surgical Evaluation ◽  
Drug Resistant Epilepsy ◽  
The Impact

Objective To explore decision-making from patients’ perceptions of risks and benefits of epilepsy surgery for refractory focal seizures. Methods Using constructivist grounded theory, in-person interviews were conducted with 35 adults with refractory focal epilepsy who were undergoing a pre-surgical evaluation or who had consented for surgery. Results For this sample of participants decision-making about surgery was complex, centering on the meaning of illness for the self and the impact of epilepsy and its treatment for significant others. Two interrelated categories crystalized from our data: the unique context of brain surgery and how the decisional counterweights of risks and benefits were considered. Discussion Exploring components of decision-making from the patients’ perspective afforded an opportunity to describe thought processes intrinsic to how people with drug-resistant epilepsy weighed their treatment options. Tensions were evident in how decisions were made. We use the analogy of an imaginary tightrope-walker to create a visual image of what patients face as they consider the illness experience (past and present), their hopes for the future, and the simultaneous uncertainty centered around balancing the counterweights of treatment risks and benefits.

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