Peter Ubel

Questions about when to limit unhelpful treatments are often raised in general medicine but are less commonly considered in psychiatry. Here we describe a survey of U.S. psychiatrists intended to characterize their attitudes about the management of suicidal ideation in patients with severely treatment-refractory illness. Respondents (n = 212) received one of two cases describing a patient with suicidal ideation due to either borderline personality disorder or major depressive disorder. Both patients were described as receiving all guideline-based and plausible emerging treatments. Respondents rated the expected helpfulness and likelihood of recommending each of four types of intervention: hospitalization, additional medication changes, additional neurostimulation, and additional psychotherapy. Across both cases, most respondents said they were likely to provide each intervention, except for additional …

ImportanceDespite increasing evidence and recognition of persistent gender disparities in academic medicine, qualitative data detailing the association of gender-based experiences with career progression remain sparse, particularly at the mid- to senior-career stage.ObjectiveTo investigate the role gender has played in everyday professional experiences of mid- to senior-career women clinician-scientists and their perceptions of gender-related barriers experienced across their careers.Design, Setting, and ParticipantsIn this qualitative study, a total of 60 of 159 invited clinician-scientists who received National Institutes of Health K08 or K23 awards between 2006 and 2009 and responded to a survey in 2021 agreed to participate. Invitees were selected using random, purposive sampling to support sample heterogeneity. Semistructured in-depth interviews were conducted January to May 2022. For this study …

Methods:We conducted a qualitative descriptive study of physicians who treat patients with advanced prostate cancer from September 2021 to June 2022. Participants were purposively sampled from across the United States.Results:Twenty-seven physicians participated. We identified 17 domains and three overarching themes affecting physician decision-making for advanced prostate cancer care. The themes were as follows:(1) physician and practice factors affect prescribing decisions,(2) health practice resource availability affects the likelihood that patients will receive the recommended treatment and that the treatment will be in-line with patients' values, and (3) patient nonclinical factors influence physician decision-making, but patient values could be better incorporated into prescribing decisions. Based on the analyses, we constructed a preliminary framework of clinician decision-making for advanced prostate …

BackgroundEvidence-based medical therapy for heart failure with reduced ejection fraction (HFrEF) often entails substantial out-of-pocket costs that can vary appreciably between patients. This has raised concerns regarding financial toxicity, equity, and adherence to medical therapy. In spite of these concerns, cost discussions in the HFrEF population appear to be rare, partly because out-of-pocket costs are generally unavailable during clinical encounters. In this trial, out-of-pocket cost information is given to patients and clinicians during outpatient encounters with the aim to assess the impact of providing this information on medication discussions and decisions.HypothesisCost-informed decision-making will be facilitated by providing access to patient-specific out-of-pocket cost estimates at the time of clinical encounter.DesignIntegrating Cost into Shared Decision-Making for Heart Failure with Reduced Ejection …

ImportanceThe culture of academic medicine may foster mistreatment that disproportionately affects individuals who have been marginalized within a given society (minoritized groups) and compromises workforce vitality. Existing research has been limited by a lack of comprehensive, validated measures, low response rates, and narrow samples as well as comparisons limited to the binary gender categories of male or female assigned at birth (cisgender).ObjectiveTo evaluate academic medical culture, faculty mental health, and their relationship.Design, Setting, and ParticipantsA total of 830 faculty members in the US received National Institutes of Health career development awards from 2006-2009, remained in academia, and responded to a 2021 survey that had a response rate of 64%. Experiences were compared by gender, race and ethnicity (using the categories of Asian, underrepresented in medicine …

INTRODUCTION AND OBJECTIVEMultiple medications have been approved for metastatic castrate-resistance prostate cancer (mCRPC). Clinicians are tasked with navigating the side effects, uncertain comparative efficacy, and patient preferences and values to create a treatment plan; this plan, however, must be approved by the insurance company. Herein, we qualitatively examine the relationship between the shared decision-making (SDM) process and insurance approval/authorization.METHODSSemi-structured interviews with medical oncologists and urologist who treat patients with mCRPC within the United States were performed. Interviews were transcribed and iteratively content coded. Central themes related to the interaction between insurance companies and implemented mCRPC treatments were summarized.RESULTSTwenty-seven physicians (19 oncology, 8 urology) were interviewed. Common …

The sudden onset of severe traumatic brain injury (sTBI) is an event suffered by millions of individuals each year. Regardless of this frequency in occurrence, accurate prognostication remains difficult to achieve among physicians. There are many variables that affect this prognosis. Physicians are expected to assess the clinical indications of the brain injury while considering other factors such as patient quality of life, patient preferences, and environmental context. However, this lack of certainty in prognosis can ultimately affect treatment recommendations and prompt clinical ethical issues at the bedside, as it leaves room for physician bias and interpretation. In this article, we introduce data on neurosurgeon values that may shed light on the process physicians and patients involved in sTBI undergo. In doing so, we highlight the many nuances in decision-making for patients suffering from sTBI and discuss potential …

Background:Compared with the general cancer population, people living with HIV (PLWH) and cancer are less likely to receive treatment and have significantly elevated cancer-specific mortality for many common cancer types. Physician recommendations drive the cancer therapy that patients receive, yet there is limited information assessing how cancer treatment decisions are made for people living with HIV and cancer. We sought to understand oncologist decision-making in PLWH and cancer by eliciting barriers, facilitators, and recommendations for enhancing care delivery.Setting:Participants were recruited between May 2019 and May 2021 from one academic medical center in the western United States (n= 13), another in the southeastern United States (n= 7), and community practices nationwide (n= 5).Methods:Using an inductive qualitative approach, we conducted in-depth interviews with 25 oncologists …

PURPOSE The implications of high prices for cancer drugs on health care costs and patients' financial burdens are a growing concern. Patients with metastatic castrate-resistant prostate cancer (mCRPC) are often candidates for multiple first-line systemic therapies with similar impacts on life expectancy. However, little is known about the gross and out-of-pocket (OOP) payments associated with each of these drugs for patients with employer-sponsored health insurance. We therefore aimed to determine the gross and OOP payments of first-line drugs for mCRPC and how the payments vary across drugs. METHODS This retrospective cohort study included 4,298 patients with prostate cancer who initiated therapy with one of six drugs approved for first-line treatment of mCRPC between July 1, 2013, and June 30, 2019. We compared gross and OOP payments during the 6 months after initiation of treatment for mCRPC …

Objective For youth with anorexia nervosa (AN), remission requires high caloric goals to achieve weight restoration, consumption of a wide variety of calorically dense foods, and reintroduction of eliminated foods. Family‐based treatment (FBT), the gold‐standard treatment for youth with AN, empowers parents to renourish their child and restore them to health; yet, parents often report struggling with shifting meal planning and grocery shopping behaviors to focus on nutritional rehabilitation and weight restoration. Methods This proof‐of‐concept study aimed to modify a simulated grocery store (Open Science Online Grocery [OSOG]) for parents of youth with AN and explore the acceptability and feasibility of its use as part of standard care. Study staff collaborated with six parent research partners to modify the OSOG prior to piloting it with participants. Participants were 10 parents of youth undergoing a first‐time …

BackgroundLittle is known about how the quality of decisions influences patient-reported outcomes (PROs). We hypothesized that higher decision quality for breast reconstruction would be independently associated with better PROs.MethodsWe conducted a prospective cohort study of patients undergoing mastectomy with or without reconstruction. Patients were enrolled before surgery and followed for 18 months. We used BREAST-Q scales to measure PROs and linear regression models to explore the relationship between decision quality (based on knowledge and preference concordance) and PROs. Final models were adjusted for baseline BREAST-Q score, radiation, chemotherapy, and major complications.ResultsThe cohort included 101 patients who completed baseline and 18-month surveys. Breast reconstruction was independently associated with higher satisfaction with breasts (β = 20.2, p = 0.0002 …

ObjectiveTo determine the frequency, degree, and nature of prognostic discordance between parents and physicians caring for infants with neurologic conditions.Study designIn this observational cohort study, we enrolled parents and physicians caring for infants with neurologic conditions in advance of a family conference. Parent-physician dyads completed a postconference survey targeting expected neurologic outcomes across 3 domains (motor, speech, and cognition) using a 6-point scale. Prognostic discordance was defined as a difference of ≥2 response options and was considered moderate (difference of 2-3 response options) or high (difference of 4-5 response options). Responses were categorized as differences in belief and/or differences in understanding using an existing paradigm.ResultsForty parent-physician dyads of 28 infants completed surveys. Parent-physician discordance about prognosis …

Background and ObjectivesClinicians often communicate complex, uncertain, and distressing information about neurologic prognosis to parents of critically ill infants. Although communication tools have been developed in other disciplines and settings, none address the unique needs of the neonatal and pediatric neurology context. We aimed to develop a parent-informed framework to guide clinicians in communicating information about neurologic prognosis.MethodsParents of infants with neurologic conditions in the intensive care unit were enrolled in a longitudinal study of shared decision-making from 2018 to 2020. Parents completed semistructured interviews following recorded family meetings with the health care team, at hospital discharge, and 6 months after discharge. All interviews targeted information about parent preferences for prognostic disclosure. We analyzed the data using a conventional content …

Purpose: Cancer is now the leading cause of non-AIDS death in the U.S. HIV population. People living with HIV (PLWH) are known to have lower cancer treatment rates and worse cancer outcomes. Disparate cancer treatment is driven by health system, patient, and clinician factors. Little attention has been given to the factors oncologists consider when making cancer treatment recommendations to PLWH. This study sought to examine oncologists' knowledge, attitudes, and practices that influence cancer treatment decision-making.Methods and MaterialsThis study used qualitative methods to explore oncologists' treatment decision-making process for PLWH and cancer. The sample included 25 radiation, medical, and surgical oncologists from two academic centers and five community practices. The interview domains were developed from the Andersen Healthcare Utilization Model, the Health Belief Model, and the …

PurposeTo understand time allocation of a national medical faculty cohort 1.5–2 years after the COVID-19 pandemic began, compared to before.MethodFrom August 2021–April 2022, the authors conducted a retrospective survey of 1,430 clinician-researchers who received National Institutes of Health career-development awards between 2006–2009 asking about domestic and professional time allocation pre-pandemic and at the time of surveys (TOS). Of 915 respondents (64%), the 830 who remained in academic positions constituted the analytic sample. Multivariable regression models identified demographic factors associated with each time outcome and change in time between pre-pandemic and TOS, and having experienced≥ 8-hour increase of total self-reported weekly professional work hours and domestic labor hours.ResultsMedian self-reported weekly professional work hours were 55 hours/week pre …

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Background Out‐of‐pocket costs have significant implications for patients with heart failure and should ideally be incorporated into shared decision‐making for clinical care. High out‐of‐pocket cost is one potential reason for the slow uptake of newer guideline‐directed medical therapies for heart failure with reduced ejection fraction. This study aims to characterize patient–cardiologist discussions involving out‐of‐pocket costs associated with sacubitril/valsartan during the early postapproval period. Methods and Results We conducted content analysis on 222 deidentified transcripts of audio‐recorded outpatient encounters taking place between 2015 and 2018 in which cardiologists (n=16) and their patients discussed whether to initiate, continue, or discontinue sacubitril/valsartan. In the 222 included encounters, 100 (45%) contained discussions about cost. Cost was discussed in a variety of contexts: when …

Background: More than 40% of patients with diabetes in the United States have trouble paying their medical bills. Among patients with health-related financial hardship, 56% have delayed or foregone care (1). By one estimate, an insulin-dependent patient with insurance spends about $4800 annually on medications, physicians’ visits, supplies, hospitalizations, and lost wages, equivalent to 15% of the median US per capita income (2).

Purpose/Objective(s)Cancer patients living with HIV are less likely to receive cancer treatment and have worse cancer survival than HIV-uninfected patients. There is minimal published data exploring drivers of the disparity and even less on mitigation strategies. We aimed to explore clinician cancer treatment decision-making for patients living with HIV, focusing on oncologist knowledge, attitudes, and practices.Materials/MethodsWe conducted semi-structured in-depth interviews with 25 medical, radiation, and surgical oncologists from two academic medical centers and several community practices. Participants were eligible if they recently had a consultation with a patient with both HIV and cancer as assessed through medical record review at the academic centers and by self-report for community practices. The interview guide explored oncologist attitudes, stigma, knowledge, and practices during the cancer …

Patients who experience difficulty making medical decisions are often referred to as “ambivalent.” However, the current lack of attention to the nuances between a cluster of phenomena that resemble ambivalence means that we are not always recognizing what is really going on with a patient. Importantly, different kinds of “ambivalence” may call for different approaches. In this paper, we present a taxonomy of ambivalence-related phenomena, provide normative analysis of some of the effects of—and common responses to—such mental states, and sketch some practical strategies for addressing ambivalence. In applying lessons from the philosophical literature and decision theory, our aim is to provide ethicists and clinicians with the tools to better understand and effectively intervene in cases of ambivalence.

BackgroundRates of shared decision making (SDM) are relatively low in early stage prostate cancer decisions, as patients’ values are not well integrated into a preference-sensitive treatment decision. The study objectives were to develop a SDM training video, measure usability and satisfaction, and determine the effect of the intervention on preparing patients to participate in clinical appointments.MethodsA randomized controlled trial was conducted to compare a plain-language decision aid (DA) to the DA plus a patient SDM training video. Patients with early stage prostate cancer completed survey measures at baseline and after reviewing the intervention materials. Survey items assessed patients’ knowledge, beliefs related to SDM, and perceived readiness/intention to participate in their upcoming clinical appointment.ResultsOf those randomized to the DA + SDM video group, most participants (91%) watched …

ObjectivesClinicians increasingly believe they should discuss costs with their patients. We aimed to learn what strategies clinicians, clinic leaders, and health systems can use to facilitate vital cost-of-care conversations.MethodsWe conducted focus groups and semi-structured interviews with outpatient clinicians at two US academic medical centers. Clinicians recalled previous cost conversations and described strategies that they, their clinic, or their health system could use to facilitate cost conversations. Independent coders recorded, transcribed, and coded focus groups and interviews.ResultsTwenty-six clinicians participated between December 2019 and July 2020: general internists (23%), neurologists (27%), oncologists (15%), and rheumatologists (35%). Clinicians proposed the following strategies: teach clinicians to initiate cost conversations; systematically collect financial distress information; partner with …

ObjectiveTo examine the treatment recommendation patterns among urologists and radiation oncologists, the level of concordance or discordance between physician recommendations, and the association between physician recommendations and the treatment that patients received.MethodThe study was a secondary analysis of data from a randomized clinical trial conducted November 2010 to April 2014 (NCT02053389). Eligible participants were patients from the trial who saw both specialists. The primary outcome was physician recommendations that were scored using an adapted version of the validated PhyReCS coding system. Secondary outcomes included concordance between physician recommendations and the treatment patients received.ResultsParticipants were 108 patients (Mean age 61.9 years; range 43-82; 87% non-Hispanic White). Urologists were more likely to recommend surgery (79% of …

Previous research has found gender differences in faculty rank among researchers in cardiology in the United States (US). 1 Explanations include differences in research productivity stemming from differences in institutional support and in distribution of household responsibilities, lack of mentorship and role models for women, and gender bias in the grant review process. 1, 2 Although such barriers may limit the number of papers female researchers publish, less is known about gender differences among researchers in cardiology in number of citations per paper for the papers they do publish, another metric that institutions may consider when evaluating researchers. This study estimated gender differences in the number of citations per paper among well-cited researchers in cardiology in the US. We used a publicly available database of 100,000 most-cited researchers across all scientific fields. 3 The database includes, by author, number of papers published since 1960 and number of citations since 1996. We used validated software(Genderize. io [https://genderize. io]) to predict gender, keeping names with a probability of the predicted gender of at least 60% as done in previous papers; 4 we assigned a gender to 96.1% of the sample. In sensitivity analyses, we kept names with a probability of predicted gender of at least 90%, although the former threshold was used in the main analyses to increase statistical power. We limited our sample to US researchers whose scientific field was “cardiovascular system and hematology;” a review of the first 150 researchers by number of citations showed that only 3 were researchers in hematology. We …

ObjectiveTo characterize decisional satisfaction, regret, and conflict among parents of critically ill infants with neurologic conditions.Study designIn this prospective cohort study, we enrolled parents of infants with neurologic conditions in the intensive care unit (ICU). Hospital discharge surveys included the validated Family Satisfaction with the ICU (FS-ICU) decision making subscale, Decision Regret Scale (DRS), and Decisional Conflict Scale (DCS). We defined high satisfaction with decision making as an FS-ICU score ≥75, high decisional regret/conflict as DRS/DCS score >25, and within-couple disagreement as a difference of at least 25 points between scores.ResultsWe enrolled 61 parents of 40 infants (n = 40 mothers, n = 21 fathers); 35 mothers and 15 fathers completed surveys. Most mothers reported high satisfaction with decision making (27 of 35; 77%) and low decision regret (28 of 35; 80%); 40% (14 of …

Parents and clinicians caring for infants with neurologic disease often make high-stakes decisions about infant care. To characterize how these decisions occur, we enrolled infants with neurologic conditions, their parents, and their clinicians in a longitudinal mixed methods study of decision making. We audio recorded family conferences as they occurred and analyzed conferences using a directed content analysis approach. We enrolled 40 infants and 61 parents who participated in 68 family conferences. Thirty-seven conferences contained a treatment decision. We identified 4 key domains of the decision-making process: medical information exchange, values-based exchange, therapeutic partnership, and integration of values into decision making. Discussion of values was typically parent initiated (n = 20, 83%); approximately one-third of conferences did not contain any discussion of parent values. Integration …

Context: On March 19, 2020, President Donald Trump endorsed using hydroxychloroquine for COVID-19 treatment despite inconclusive evidence of the drug's effectiveness. This study sought to understand the influence of political preferences on prescription uptake by quantifying the relationship between a geographic area's partisan leaning and hydroxychloroquine prescription rates following Trump's endorsement. Methods: We analyzed hydroxychloroquine prescriptions filled in 205 continental US designated market areas (DMAs) between March 1, 2018, and July 31, 2020, and the percentage of votes for Donald Trump in the 2016 presidential election in each DMA. We estimated associations by using an empirical strategy resembling a difference-in-differences estimation. Findings: Before President Trump's endorsement, mean weekly hydroxychloroquine prescription rates were …

ImportanceCommunication during conversations about death is critical; however, little is known about the language clinicians and families use to discuss death.ObjectiveTo characterize (1) the way death is discussed in family meetings between parents of critically ill infants and the clinical team and (2) how discussion of death differs between clinicians and family members.Design, Setting, and ParticipantsThis longitudinal qualitative study took place at a single academic hospital in the southeast US. Patients were enrolled from September 2018 to September 2020, and infants were followed up longitudinally throughout their hospitalization. Participants included families of infants with neurologic conditions who were hospitalized in the intensive care unit and had a planned family meeting to discuss neurologic prognosis or starting, not starting, or discontinuing life-sustaining treatment. Family meetings were recorded …

Introduction: Prior database studies have demonstrated that cancer patients with comorbid human immunodeficiency virus (HIV) have higher cancer-specific mortality and are less likely to receive cancer treatment. People living with HIV (PLWH) who achieve viral suppression have near normal life expectancy, highlighting the critical importance of reducing cancer treatment disparities. The purpose of this study is to understand how oncologists make treatment decisions for cancer patients living with HIV and to elicit recommendations for improving care in this population. Methods: We conducted in-depth interviews with 25 attending medical, radiation, and surgical oncologists from Duke University, University of Utah, and community practices in Florida, Georgia, Louisiana, Pennsylvania, and Virginia who had recently engaged in a consultation with PLWH and cancer. In semi-structured interviews, we explored three …

Background Palliative care has the potential to improve goal-concordant care in severe traumatic brain injury (sTBI). Our primary objective was to illuminate the demographic profiles of patients with sTBI who receive palliative care encounters (PCEs), with an emphasis on the role of race. Secondary objectives were to analyze PCE usage over time and compare health care resource utilization between patients with or without PCEs. Methods The National Inpatient Sample database was queried for patients age≥ 18 who had a diagnosis of sTBI, defined by using International Classification of Diseases, 9th Revision codes. PCEs were defined by using International Classification of Diseases, 9th Revision code V66. 7 and trended from 2001 to 2015. To assess factors associated with PCE in patients with sTBI, we performed unweighted generalized estimating equations regression. PCE association with decision …

Objective When the volume or complexity of health information exceeds the capacity to process it, patients may misinterpret or ignore critical information. Numerical information is especially challenging to process for many patients, yet no empirical data shows whether numerical information influences how well they could process and recall it. Method Using natural language processing tools, we estimated the amount of numerical and probability-related (quantitative) information that was provided in 112 paired urology–radiology clinical consultations with patients who had been recently diagnosed with prostate cancer. The primary outcome measured was patient knowledge about their prostate cancer outcomes assessed before and after the consultations. Results Patients with prostate cancer, Gleason score 6 or 7, and stage Time 1 or Time 2 participated in the study. Paired consultations included on average 11 …

ObjectivesThis study aimed to characterize the use and impact of assessments of understanding in parent-clinician communication for critically ill infants.MethodsWe enrolled parents and clinicians participating in family conferences for infants with neurologic conditions. Family conferences were audio recorded as they occurred. We used a directed content analysis approach to identify clinician assessments of understanding and parent responses to those assessments. Assessments were classified based on an adapted framework; responses were characterized as “absent,” “yes/no,” or “elaborated.”ResultsFifty conferences involving the care of 25 infants were analyzed; these contained 374 distinct assessments of understanding. Most (n = 209/374, 56%) assessments were partial (i.e. okay?); a minority (n = 60/374, 16%) were open-ended. When clinicians asked open-ended questions, parents elaborated in their …

Objective We characterize the content and role of prognostic discussion for infants with neurologic conditions. Methods In this descriptive qualitative study, we prospectively enrolled infants (age < 1 year) in the intensive care unit with a neurologic condition anticipated to have ≥1 family conference about prognosis or goals of care. We audiorecorded family conferences as they occurred. We used a rapid‐cycle qualitative approach to identify and refine themes. Results Forty infants and 61 parents were enrolled; 68 family conferences occurred for 24 infants. The majority of infant cases (n = 23/24, 96%) and conferences (n = 64/68, 94%) included discussion of neurologic prognosis. Common infant diagnoses included prematurity (n = 12, 52%), genetic conditions (n = 9, 35%), and brain malformations (n = 7, 30%). We identified 2 themes relating to the characterization of the infant's prognosis: (1) predictions of …

METHODSWe conducted a postal survey in 2014 of recipients of new NIH K08 and K23 awards between 2006 and 2009. 5 We evaluated work interference with family and family interference with work using previously validated measures. 6 Interference scale values are between 1 (least) and 5 (most). We further analyzed perceptions about the influence of family issues on career progress and, among those with spouses/domestic partners (“partnered”), the partner’s employment status, relative importance of the respondent’s career versus the partner’s, and accommodations made by partners to support respondents’ careers and vice versa. SAS (version 9.4, Cary, NC, USA) was used to describe and compare responses by gender using multivariable logistic regression models that adjusted for grant type, year of award, funding institute, institution at the time of initial K-award, degree, and specialty. The University of …

Background. The quality and availability of medical care to the population directly depends on the organization of the treatment and diagnostic process, which is directly related to the material and technical resources of medical organizations.Aims. Assess how the level of performance indicators of medical organizations of the dermatovenereological profile has changed after the restructuring of their material and technical resources for the period 2010–2020 in the Russian Federation as a whole.Materials and methods. The study is based on a retrospective analysis of the main intensive and extensive indicators that evaluate the work of medical organizations of the dermatovenereological profile.Results. Structural transformations of material and technical resources, which are under the jurisdiction of the dermatovenereological service, gave the following results in the whole of the Russian Federation. The activities of medical organizations intensified, which naturally led to a positive economic effect. The reduction of the excess number of resource-intensive beds in round-the-clock hospitals and the expansion of day hospitals due to the redistribution of part of the round-the-clock beds into beds and beds in day hospitals, increasing their capacity, did not negatively affect the volume of specialized dermatovenereological medical care for the population, they not only did not decrease, but even slightly increased.Conclusion. Thus, the study showed that the restructuring of the material and technical resources of the dermatovenereological service in the Russian Federation as a whole led to a positive effect of the use of material and technical resources …

Background Sacubitril/valsartan improves health outcomes for heart failure with reduced ejection fraction relative to angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers, but it carries higher out‐of‐pocket costs. Neither the impact of cost nor how to integrate cost into medical decisions is well studied. Methods and Results To evaluate the impact of out‐of‐pocket costs and a novel cost‐priming intervention on willingness to take sacubitril/valsartan for heart failure with reduced ejection fraction, participants with self‐reported heart disease were surveyed using the online Ipsos Knowledge Panel. Participants were presented with a modified decision aid for sacubitril/valsartan and then, in a 3× 2 factorial design, randomly assigned to 1 of 3 cost conditions (10, 50, or 100/month)andtoacontrolgrouporcost‐primingintervention …

The purpose of this article is to introduce a new tool—the Open Science Online Grocery—for studying the effects of the choice context on purchasing decisions. We first review the features of the tool: a mock online grocery store containing over 11,000 products wherein researchers can modify the choice context (e.g., positioning, labeling, suggestions) and observe resulting choice. Then, we present three studies illustrating how the tool can help assess how changes to labeling, ordering, and positioning affect choice. We find that both ordering and positioning have significant effects on choice while labeling does not. These findings largely align with existing research in field and laboratory settings. We hope this tool proves useful to researchers wanting to test choice context modifications in a relatively affordable and efficient manner.

Given the stalling improvement in vaccine hesitancy rates in the United States (US), it is important to understand why a chronically ill group, patients with left-ventricular assist devices (LVADs), might not get vaccinated and to delineate the barriers they may face in seeking care. We conducted an online survey to characterize the attitudes of patients with LVADs toward COVID-19 vaccination, identify their willingness to seek care during the pandemic, and characterize barriers to doing so. Our survey showed that the rate of vaccine hesitancy among LVAD patients is similar to that of the general population in the US. This rate is higher than expected for a chronically ill group at risk of severe COVID-19 infection. We also found that LVAD patients perceive barriers to seeking care during the pandemic. We recommend that LVAD care teams emphasize that patients should seek care for emergency medical conditions despite their fears of contracting COVID-19. Based on our results, we also recommend vaccine uptake education for this population focused on patients’ concerns about serious side effects and not enough research done on the vaccine.

Policy makers have increasingly advocated for healthcare price transparency, whereby prices are made salient before services are rendered. While such policies may empower consumers, they also bring price to the forefront of healthcare choices as never before, with yet underexplored consequences on consumers’ decisions. This article explores one: using price as a signal of quality. Five experiments demonstrate how healthcare consumers may come to form price-based inferences of quality and explore how these inferences may vary as a function of individuals’ health insurance coverage. Specifically, relative to high-coverage consumers (for whom insurance covers a relatively greater portion of healthcare expenses), low-coverage consumers (for whom insurance covers relatively less) tend to both choose lower-priced providers and perceive a weaker price-quality relationship, suggestive of motivated …

Background Web-based crowdfunding has become a popular method to raise money for medical expenses, and there is growing research interest in this topic. However, crowdfunding data are largely composed of unstructured text, thereby posing many challenges for researchers hoping to answer questions about specific medical conditions. Previous studies have used methods that either failed to address major challenges or were poorly scalable to large sample sizes. To enable further research on this emerging funding mechanism in health care, better methods are needed. Objective We sought to validate an algorithm for identifying 11 disease categories in web-based medical crowdfunding campaigns. We hypothesized that a disease identification algorithm combining a named entity recognition (NER) model and word search approach could identify disease categories with high precision and accuracy. Such an algorithm would facilitate further research using these data. Methods Web scraping was used to collect data on medical crowdfunding campaigns from GoFundMe (GoFundMe Inc). Using pretrained NER and entity resolution models from Spark NLP for Healthcare in combination with targeted keyword searches, we constructed an algorithm to identify conditions in the campaign descriptions, translate conditions to International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes, and predict the presence or absence of 11 disease categories in the campaigns. The classification performance of the algorithm was evaluated against 400 manually labeled …

Currently, US adults spend more than $10 billion per year on vitamins and dietary supplements, 1 believing against most evidence that fortified gummy bears and water infused with vitamins will improve their health and well-being. Vitamins are necessary for life, the difference between healthy gums and scurvy, between strong bones and rickets. But, as the recent US Preventive Services Task Force (USPSTF) recommendation statement2 and updated evidence report and systematic review3 show, there is little evidence that supplemental vitamins and minerals prevent cancer, cardiovascular disease, or mortality. No vitamins were found to reduce death from cancer or cardiovascular disease, with multivitamins earning an I statement from the USPSTF (meaning that evidence remains insufficient to recommend for or against taking such supplements). Additionally, beta carotene was found to increase the chance of …

RESULTS: Multiple oxysterols were identified in human maternal breast milk that induced oligodendrocyte production from NSCs in vitro. We found that Gli2 is functionally required for oxysterol-induced oligodendrogenesis. Following neonatal WMI in vivo, 20HC treatment increased numbers of mature OLs, improved myelination and rescued motor deficits in mice. Lineage tracing experiments showed that 20HC-mediated recovery of OL deficit is mediated in part through 20HC-induced SVZ-derived oligodendrogenesis in vivo. Additional recovery may be due to the impact of 20HC on oligodendrocyte progenitor cell maturation.

Vaccinating Health Care Employees In vaccinating low-risk employees early, leaders of some U.S. health care organizations violated their duty to promote public health and contributed to the narrative that powerful people in health care are willing to serve their own interests ahead of society’s.

BackgroundSacubitril Valsartan (SV), a guideline-recommended therapy for heart failure with reduced ejection fraction (HFrEF), improves outcomes but is associated with low uptake and high out-of-pocket costs for many patients (Medicare Part D average cost $57/month). Small studies have examined the potential impact of cost on willingness to take SV, but the impact of different prices among a broader sample is unknown.MethodsWe conducted an online survey using the Ipsos KnowledgePanel among panelists with a known diagnosis of a heart condition. After showing a decision aid explaining the benefits of SV in HFrEF, we asked if they would take SV if they had HFrEF and their doctor recommended it. Panelists were randomized to one of three price conditions for SV ($10, $50, or $100/month) and to being asked about their personal financial situation either before (cost primed) or after (nonprimed) being …

One way to test vaccines is through human challenge trials in which participants are intentionally infected with a contagious organism to expedite the process of assessing the vaccine’s effectiveness. Some experts believe challenge trials may play an important role in fighting COVID-19, especially if the vaccines under current study do not demonstrate sufficient efficacy, if spread of COVID-19 is controlled to a point that radically slows down traditional trials, or if new vaccines need to be rapidly developed for specific subpopulations. 1 Challenge trials involve significant time, burden and risk, requiring participants to spend 3–6 weeks in legal quarantine for 24 hours a day in a highsecurity facility. During this time, no inperson visitors will be allowed, except for very limited inperson contact from researchers collecting necessary data and checks. Following the quarantine period, participants will be asked to attend …

Objectives People living with HIV (PLWH) have increased risk for cancer and worse cancer-specific survival. We explored the emotional burden of cancer and HIV as a potential driver of cancer mortality.Research Approach Semi-structured qualitative interviews with PLWH and cancer.Participants 27 PLWH who had either completed cancer treatment, were currently undergoing treatment, or experienced challenges in completing treatment.Methodological Approach An inductive qualitative approach using the constant comparative method.Findings Participants drew strong parallels between being diagnosed with HIV and cancer. Many described HIV-related stigma that hindered social support. Cancer treatment side effects were a major challenge, impacting treatment adherence for both cancer and HIV.Implications for Psychosocial Providers There is a need for convenient, affordable, and visible services to support …

Sometimes doing what’s right depends on anticipating how people will react when you do the right thing. Consider two aspects of challenge trial payments discussed by Lynch and colleagues (Citation 2021). The first is the importance of promoting public trust in challenge trial payments. Lynch and colleagues point out that even if there is not any actual ethical impropriety in challenge trial payments, the public might worry that payments are taking advantage of vulnerable research participants, either by paying them too much or too little. Such public concerns could negatively affect the ability to carry out such trials. Lynch and colleagues suggest that their framework for ethical payment in research can help justify payment amounts to the public. We agree with their framework, but believe that the framework on its own will not necessarily be enough to counter public perceptions around over or under payment.Doing …

BackgroundOut-of-pocket (OOP) costs have significant implications for patients and should be incorporated into shared decision-making for clinical care. High OOP cost is a potential reason for slow uptake of sacubitril-valsartan (SV) despite its demonstrated benefits in heart failure with reduced ejection fraction. This study aims to characterize patient-physician discussions involving SV out-of-pocket cost and the impact of these discussions on clinical decisions.MethodsWe conducted content analysis on 395 de-identified transcripts of audio-recorded encounters involving SV between cardiologists and their patients in the outpatient setting. Transcripts were excluded if they did not contain substantive discussion of SV. Included transcripts were coded thematically through deductive content analysis and inter-coder discrepancies were resolved through team consensus.Results222 transcripts were included in the …

Each day, adolescents and young adults (AYAs) choose to engage in behaviors that impact their current and future health. Behavioral economics represents an innovative lens through which to explore decision-making among AYAs. Behavioral economics outlines a diverse set of phenomena that influence decision-making and can be leveraged to develop interventions that may support behavior change. Up to this point, behavioral economic interventions have predominantly been studied in adults. This article provides an integrative review of how behavioral economic phenomena can be leveraged to motivate health-related behavior change among AYAs. We contextualize these phenomena in the physical and social environments unique to AYAs and the neurodevelopmental changes they undergo, highlighting opportunities to intervene in AYA-specific contexts. Our review of the literature suggests behavioral …

ImportanceOne-third of US residents have trouble paying their medical bills. They often turn to their physicians for help navigating health costs and insurance coverage.ObjectiveTo determine whether physicians can accurately estimate out-of-pocket expenses when they are given all of the necessary information about a drug’s price and a patient’s insurance plan.Design, Setting, and ParticipantsThis national mail-in survey used a random sample of US physicians. The survey was sent to 900 outpatient physicians (300 each of primary care, gastroenterology, and rheumatology). Physicians were excluded if they were in training, worked primarily for the Veterans Administration or Indian Health Service, were retired, or reported 0% outpatient clinical effort. Analyses were performed from July to December 2020.Main Outcomes and MeasuresIn a hypothetical vignette, a patient was prescribed a new drug costing $1000 …

Wasteful health care spending results from low-value care, undertreatment, pricing failures, fraud, and administrative complexity. 1 Such spending costs US residents between $760 billion and $935 billion each year 1 and harms populations through burdensome health insurance prices and taxes. Therefore, we need a metaphor more powerful than waste; waste conjures images of byproducts that are benign if properly discarded—routed to treatment plants, cleaned, and recycled. We should refer to wasteful health care spending and its toxic effects as financial pollution.Pollution is waste that is harmful. 2 Financial pollution arises when exorbitant or unnecessary health care spending depletes resources needed for the well-being of the population. Akin to environmental pollution, financial pollution is human made, contaminates connected systems, remains largely invisible to many, and disproportionately harms …

BackgroundAdolescents with anorexia nervosa have set-shifting inefficiencies that can be exacerbated by starvation and that may interfere with outcomes of treatment interventions. Cognitive Remediation Therapy (CRT), an adjunctive treatment focused on improving set-shifting, can target inefficiencies and may augment treatment effectiveness. The best way to add CRT to the standard of care (Family Based Treatment, FBT) for adolescents with anorexia remains understudied.Methods/designThis is a randomized controlled trial designed to determine if CRT is effective in increasing flexibility in adolescents with anorexia and/or their parents. Participants are adolescents 12–18 years old with anorexia and their parents. 54 family groups will be randomized into one of three groups: FBT only, FBT plus Parent-focused CRT, or FBT plus Adolescent-focused CRT. Psychosocial, neurocognitive, and behavioral measures …

Purpose Acute myeloid leukemia (AML) is a hematologic malignancy characterized by a poor prognosis but also a paradoxical possibility of cure. This renders decision-making complex and imminent. Unfortunately, many patients with AML misestimate their prognosis and treatment risk. While decision aids can improve illness understanding and reduce decisional conflict, there are no validated decision aids for AML. We developed and tested a novel AML decision aid (NCT03442452). Methods Patients (n = 20) were recruited at Duke University from May 2018 to February 2019. Participants completed assessments of AML knowledge and decisional conflict, before and after using the electronic decision aid. The primary endpoint was feasibility (endpoint met if > 80% of study participants completed all study components). Secondary analyses of efficacy …

Background Presenting numeric data alone may result in patients underappreciating clinically significant benefits. Contextualizing statements to counter this may raise concern about absence of neutrality. These issues arose during construction of a decision aid for sacubitril-valsartan, a heart failure medication associated with a∼ 3% absolute reduction in 2-year mortality that carries high out-of-pocket cost. A contextualizing statement framing this as a “pretty big benefit” was incorporated. The impact of statements like this within decision aids is unknown. Objective This online Qualtrics survey sought to deepen understanding of benefit framing by testing the impact of varying contextualizing statements within a decision aid for sacubitril-valsartan. Design Participants were randomly assigned to receive one of six abbreviated versions of a decision aid for sacubitril-valsartan that varied only by contextualizing statement …

When discussing risks and benefits with cancer patients, physicians could focus on losses such as mortality rates and cancer recurrence or, alternatively, gains such as survival rates and curing cancer. Previous research has shown that the way health information is framed influences individuals’ preferences and choices. We operationalized gain–loss framing as physicians’ choice of words related to gains (cancer survival), or losses (cancer mortality). In an exploratory analysis, we investigated (a) whether physicians used gain or loss words as a function of their recommendation, (b) whether physicians’ choice of words was associated with patients’ treatment choices. We analyzed transcribed consultations with male patients who had intermediate-risk prostate cancer. Using an iterative process of gathering and evaluating words, we created gain- and loss-dictionaries. The loss-dictionary included words …

Pandemics rarely affect all age groups equally. Historically, pandemic influenzas have disproportionately impacted children. Coronavirus disease 2019 (COVID-19) primarily threatens adult populations. Yet in many hospitals, critical care resources are shared between adult and pediatric patients. Most ventilators can be used to treat both adults and children. Other resources—including medications, physical space, and staff—can be shared too.Most protocols for resource allocation in the setting of scarce critical care resources urge hospitals to enact policies that apply to all patients in need of critical care resources—for example, a patient with a congestive heart failure exacerbation should compete for the same resources as a patient with respiratory failure related to COVID-19. According to this framework, critically ill neonates and children, regardless of COVID-19 status, must be accounted for in hospital resource …

Minority Tax Reform Black faculty members are often expected to engage in diversity initiatives, a drain on their time and resources known as the “minority tax.” But taxes can be reformed, and several strategies could help reduce the negative sequelae of the minority tax.

Prostate cancer is the second leading cause of cancer death among men in the USA and affects Black men disproportionately [1],[2]. The US Preventive Services Task Force encourages prostate-specific antigen (PSA) testing decisions based on shared decision-making (SDM), in which patients are supported to make the best clinical decisions given their personal preferences [3]. However, studies suggest that SDM is rarely achieved in clinical practice, particularly during PSA screening consultations, owing to a lack of balanced discussion of the pros and cons of screening and a lack of clarification of patient preference [4],[5],[6],[7].Decision coaching is the process by which a non-healthcare professional coach “provides a patient with individualized, nondirective guidance to meet decision making needs in preparation for consultation” with a healthcare provider [8]. Prior research has shown that community health …

Background Black men are disproportionately affected by prostate cancer, the most common non-cutaneous malignancy among men in the USA. The United States Preventive Services Task Force (USPSTF) encourages prostate-specific antigen (PSA) testing decisions to be based on shared decision-making (SDM) clinician professional judgment, and patient preferences. However, evidence suggests that SDM is underutilized in clinical practice, especially among the most vulnerable patients. The purpose of this study is to evaluate the efficacy of a community health worker (CHW)-led decision-coaching program to facilitate SDM for prostate cancer screening among Black men in the primary care setting, with the ultimate aim of improving/optimizing decision quality. Methods We proposed a CHW-led decision-coaching program to facilitate SDM for prostate …

Journal of Health Politics, Policy and Law, Vol. 46, No. 2, April 2021© 2021 by Duke University Press deftly closes by illustrating how insights from other disciplines, ranging from animal behavior to philosophy, contribute to behavioral public policy. A more accessible read than Kahneman’s Thinking Fast and Slow (2011), Oliver’s book succeeds in accommodating newcomers of behavioral economics. Intentionally brief and didactic, Oliver’s book best functions as a teaching resource for undergraduate students or a handy reference for lay readers.A strength of the book is its organization, with its four main parts neatly mapping onto readers’ different levels of knowledge and interest. Those new to behavioral economics should start at the beginning, as chapters 1 through 3 chronicle the origins of behavioral economics. In these chapters, we read first about the field of economics, with its dogmatic theories of rational …

BackgroundDespite demonstrated benefits in heart failure with reduced ejection fraction (HFrEF), uptake of sacubitril-valsartan (SV) is modest. High cost is a potential driver. It is unknown what other factors impact willingness to take SV and how the context of the COVID-19 pandemic affects willingness to take (and pay for) medications for conditions such as HFrEF.MethodsWe conducted an online Qualtrics survey using quota-based sampling to reflect the HFrEF population. Participants were presented a decision aid (DA) for SV that described benefits, side effects, and costs. Participants were also presented a hypothetical prophylactic COVID-19 medication offering the same absolute 2-year mortality reduction as SV (3%). Primary outcomes were likelihood of taking SV and the COVID-19 medication at an out of pocket cost of $50/month. Multivariable logistic regression was used to analyze predictors of likelihood …

BackgroundResearch participant engagement, which we define as recruitment and retention in clinical trials, is a costly and challenging issue in clinical research. Research teams have leveraged a variety of strategies to increase research participant engagement in clinical trials, although a framework and evidence for effective participant engagement strategies are lacking. We (1) developed a novel conceptual framework for strategies used to recruit and retain participants in clinical trials based on their underlying behavioral principles and (2) categorized empirically tested recruitment and retention strategies in this novel framework.MethodsWe conducted a synthetic analysis of interventions tested in studies from two Cochrane reviews on clinical trial recruitment and retention, which included studies from 1986 to 2015. We developed a conceptual framework of behavioral strategies for increasing research …

In their article,“Supported Decision Making with People at the Margins of Autonomy,” Peterson, Karlawish, and Largent point to the fact that the concept of ‘supported decision-making’has recently been codified into several laws as well as discussed in the philosophical and disability-rights literature as an alternative to guardianship for adults with static intellectual and developmental impairments. They argue that supported decision-making has important relevance for people at “the margins of autonomy”—including for those with “dynamic impairments,” such as mild, but progressive, cognitive impairments. We applaud the authors for providing a conceptual framework to support these new legal arrangements. But we worry that these arrangements are unnecessarily formal for the vast majority of people with such progressive illnesses, and that codifying supported decisionmaking might cause as many problems as it …

Clinical guidelines recommend that physicians counsel patients about a host of obesity-related health behaviors, including providing guidance about physical activity and nutrition to prevent and treat obesity. Despite considerable time and effort spent encouraging healthy eating and more exercise, substantial improvements in these behaviors or obesity outcomes have not been realized. Why? Because we are not translating evidence-based obesity-related guidelines into behaviorally sound recommendations for patients. Various behavioral models can explain how children and families make daily obesity-related decisions. Traditionalstandardeconomictheoriesassumerational, utilitymaximizing decisions. Clinically, we frequently make recommendations that rely on patients acting rationally to improve their short-term and long-term health. However, we know that patients do not make rational decisions despite their …

Dr. Timothy Quill provoked a great deal of debate when The New England Journal of Medicine published his description of a woman named Diane, a patient whom Quill helped to commit suicide. Before Quill wrote about Diane's case, the medical ethics community and the public at large debated the morality of assisted suicide and euthanasia largely on the merits of several well-known cases: the "It's Over, Debbie" case from The Journal of the American Medical Association and the series of suicide-machine deaths organized by Dr. Kevorkian. Quill's clinical experience and his long-standing relationship with Diane contrast sharply with that of Dr. Kevorkian, a physician widely known for his efforts to help patients kill themselves with his suicide machines. Although Quill assisted Diane in committing suicide, he could have taken an even more active role in helping or encouraging her to end her life.

Background Surgical decision-making in severe traumatic brain injury (TBI) is complex. Neurosurgeons weigh risks and benefits of interventions that have the potential to both maximize the chance of recovery and prolong suffering. Inaccurate prognostication can lead to over- or under-estimation of outcomes and influence treatment recommendations. Objective To evaluate the impact of evidence-based risk estimates on neurosurgeon treatment recommendations and prognostic beliefs in severe TBI. Methods In a survey-based randomized experiment, a total of 139 neurosurgeons were presented with two hypothetical patient with severe TBI and subdural hematoma; the intervention group received additional evidence-based risk estimates for each patient. The main outcome was neurosurgeon treatment recommendation of non-surgical management. Secondary outcomes included prediction of functional recovery at six months. Results In the first patient scenario, 22% of neurosurgeons recommended non-surgical management and provision of evidence-based risk estimates increased the propensity to recommend non-surgical treatment (odds ratio [OR]: 2.81, 95% CI: 1.21–6.98; p = 0.02). Neurosurgeon prognostic beliefs of 6-month functional recovery were variable in both control (median 20%, IQR: 10%-40%) and intervention (30% IQR: 10%-50%) groups and neurosurgeons were less likely to recommend non-surgical management when they believed prognosis was favorable (odds ratio [OR] per percentage point increase in 6-month functional recovery: 0.97, 95% confidence interval [CI]: 0.95–0.99). The results for the second patient …

With the onset of the COVID-19 pandemic, scientists, medical providers, and policymakers across the globe scrambled to find both prophylactic and therapeutic treatments for the novel coronavirus. In early March 2020, a treatment that had shown early promise in studies from France and China was hydroxychloroquine, administered both alone and in combination with azithromycin. President Trump touted the promise of hydroxychloroquine in his televised White House briefings and on social media, and the Food and Drug Administration issued an emergency use authorization to allow for use of the drug in patients hospitalized for COVID-19. In the weeks following President Trump’s initial excitement about the antimalarial drugs, data shows that first-time hydroxychloroquine and chloroquine prescriptions increased significantly throughout the country. The objective of this research is to examine whether clinical judgment was influenced by geopolitical ethos. Did providers in politically right-leaning regions of the country more readily prescribe hydroxychloroquine/chloroquine than those in left-leaning regions? Can presidential election voting explain geographic hydroxychloroquine/chloroquine prescription trends during COVID-19?

Purpose When discussing risks and benefits with cancer patients, physicians could focus on losses such as mortality rates and recurrence or, alternatively, gains such as survival rates and curing cancer. Previous research has shown that the way health information is framed influences individuals’ preferences and choices 1. We developed dictionaries for automated text analysis and ran exploratory analysis investigating whether and when framing manifests in actual physician-patient conversations and how often only one (gain) or another (loss) frame dominates the conversation. Methods We analyzed transcribed consultations with patients who had low- or intermediate-risk prostate cancer. Using Linguistic Inquiry and Word Count (LIWC) software, we calculated the number of words describing gains or losses. We ran a regression analysis exploring framing in the communications. Results Our analysis revealed …

This article discusses parallels between interrogation techniques and hospitalization and how recognizing these parallels can improve the patient experience.

Objective This study aimed to assess the frequency and severity of sexual harassment toward ophthalmology trainees. Design Present study is an anonymous retrospective online survey. Participants U.S. ophthalmology residents and fellows participated in this study. Methods Sexual harassment comments directed toward University of Iowa ophthalmology trainees and faculty members were compiled. Statements were ranked by severity to develop the Iowa Verbal Sexual Harassment Scale. A brief, anonymous online survey incorporating the scale was sent to all United States ophthalmology residency program directors to distribute among trainees. Participants rated the prevalence, severity, and frequency of verbal and physical sexual harassment during training. Main Outcome Measures Response to the survey questions on the prevalence, severity, and frequency of reporting of verbal and physical …

ImportanceThere are limited data on which factors affect the critical and complex decision to withdraw life-supporting treatment (LST) in patients with severe traumatic brain injury (sTBI).ObjectiveTo determine demographic and clinical factors associated with the decision to withdraw LST in patients with sTBI.Design, Setting, and ParticipantsThis retrospective analysis of inpatient data from more than 825 trauma centers across the US in theAmerican College of Surgeons Trauma Quality Improvement Program database from January 2013 to December 2015 includedadult patients with sTBI and documentation of a decision regarding withdrawal of LST (WLST). Data analysis was conducted in September 2019.Main Outcomes and MeasuresFactors associated with WLST in sTBI.ResultsA total of 37931 patients (9817 women [25.9%]) were included in the multivariable analysis; 7864 (20.7%) had WLST. Black patients …

Methods| As detailed elsewhere, 3 the University of Michigan institutional review board provided approval and a waiver of documentation of consent. Between August 2010 and February 2011, we surveyed 1708 individuals who received new K08 and K23 awards from the National Institutes of Health during 2006 to 2009. In 2014, we conducted a follow-up survey that was administered exclusively to respondents to the initial questionnaire; 1066 (62.0% of the originally targeted population) responded to both surveys. 3We report analyses from the 816 physician-respondents who remained in academic positions at the time of follow-up. Multivariable logistic regression modeling evaluated individual, job, and environmental independent variables measured at baseline that were associated with the dependent variable of work-related burnout measured at follow-up using the validated Copenhagen Burnout Inventory …

Many people living with HIV (PLWHIV) state that they would be willing to take significant risks to be “cured” of the virus. However, how they interpret the word “cure” in this context is not clear. We used a randomized survey to examine whether PLWHIV had a different willingness to take a hypothetical HIV medication if it causes flu-like symptoms, but provides: (a) cure, (b) remission that was labeled “cure”, or (c) remission. PLWHIV (n = 454) were more willing to take a medication that provided a “cure” versus a “remission” if the side effects lasted less than 1 year. PLWHIV were more willing to take a medication that provided a remission that was labeled “cure” versus a “remission” (p = 0.01) if the side effects lasted 2 weeks. Clinicians and researchers should be aware of the impact of the word “cure” and ensure that PLWHIV fully understand the possible outcomes of their treatment options.

ObjectiveTo determine whether racial differences exist in patient preferences for prostate cancer treatment after being informed about options using a patient-centered vs. a standard decision aid (DA).MethodsThis article reports secondary analyses of a large study of men diagnosed with early stage prostate cancer. Men were recruited from 4 VA Health Systems and randomized to receive a patient-centered or standard DA about prostate cancer treatment options. Data were collected at 1) baseline, 2) after reading the DA but prior to diagnosis, and 3) after receiving a cancer diagnosis and meeting with a urologist.ResultsWhite patients who received the patient-centered DA written at a 7th grade reading level were more likely to prefer active surveillance and less likely to prefer radiation compared to those who received the standard DA written at >9th grade reading level. African American patients’ treatment …