Michelle McDowell

Predictors of change in unmet supportive care needs in cancer

Objective: Patient Reported Outcome (PRO) assessments can assist health professionals to tailor their health practices to the individual needs of patients and improve patient care over time. The present study assessed prospective predictors of unmet supportive care needs in cancer patients over a six‐month period.

A review of prostate‐specific antigen screening prevalence and risk perceptions for first‐degree relatives of men with prostate cancer

First-degree relatives of men with prostate cancer have a higher risk of being diagnosed with prostate cancer than men without a family history. The present review examines the prevalence and predictors of testing in first-degree relatives, perceptions of risk, prostate cancer knowledge and psychological consequences of screening. Medline, PsycInfo and Cinahl databases were searched for articles examining risk perceptions or screening practices of first-degree relatives of men with prostate cancer for the period of 1990 to August 2007. Eighteen studies were eligible for inclusion. First-degree relatives participated in prostate-specific antigen (PSA) testing more and perceived their risk of prostate cancer to be higher than men without a family history. Family history factors (e.g. being an unaffected son rather than an unaffected brother) were consistent predictors of PSA testing. Studies were characterized by sampling biases and a lack of longitudinal assessments. Prospective, longitudinal assessments with well-validated and comprehensive measures are needed to identify factors that cue the uptake of screening and from this develop an evidence base for decision support. Men with a family history may benefit from targeted communication about the risks and benefits of prostate cancer testing that responds to the implications of their heightened risk.

Prospective predictors of psychosocial support service use after cancer

Objective: To identify prospective predictors of psychosocial support service utilisation by people with cancer. Consistent with the theory of planned behaviour (TPB), attitudes towards help seeking and behavioural intentions were predicted to lead to greater support service utilisation.

A Randomized Trial Comparing Two Low-Intensity Psychological Interventions for Distressed Patients With Cancer and Their Caregivers

PURPOSE/OBJECTIVES To compare the effectiveness of two low-intensity approaches for distressed patients with cancer and caregivers who had called cancer helplines seeking support. Baseline distress was hypothesized as a moderator of intervention effect. DESIGN Randomized trial. SETTING Community-based cancer helplines in Queensland and New South Wales, Australia. SAMPLE 354 patients with cancer and 336 caregivers. METHODS Participants were randomized to either a single session of nurse-led self-management intervention or a five-session psychologist cognitive behavioral intervention delivered by telephone. Assessments were undertaken at baseline (preintervention) and at 3, 6, and 12 months. MAIN RESEARCH VARIABLES Psychological and cancer-specific distress and post-traumatic growth. FINDINGS No significant moderation by baseline cancer-specific distress was noted. For low-education patients, only the psychologist intervention was associated with a significant drop in distress. For all other participants, distress decreased over time in both arms with small to large effect sizes (Cohens ds = 0.05-0.82). Post-traumatic growth increased over time for all participants (Cohens ds = 0.6-0.64). CONCLUSIONS Many distressed patients with cancer and their caregivers may benefit significantly from a single session of a nurse psychoeducation intervention that can be delivered remotely by telephone and supported by self-management materials. Research is needed to develop an algorithm that moves beyond the use of distress as the only indicator for referral to specialist psychological services. Survivors and caregivers with low education and low literacy may require more in-depth and targeted support. IMPLICATIONS FOR NURSING Brief nurse psychoeducation and stress management for cancer survivors and caregivers should be considered as part of a tiered approach to psychosocial care.

A Simple Tool for Communicating the Benefits and Harms of Health Interventions A Guide for Creating a Fact Box

One of the major hurdles to promoting informed decision making in health is the continued use of poor risk presentation formats. This article offers a guide to develop a Fact Box, a simple decision tool to present data about the benefits and harms of treatments that has been demonstrated to improve understanding of health risks, an important part of risk literacy. The article offers guidance about how to determine the evidence basis for a health topic, select outcomes to report, extract and present numbers or outcomes, and design the layout. The guide also addresses potential challenges for summarizing evidence and provides alternatives for addressing issues related to missing, insufficient, imprecise, or conflicting evidence and for dealing with issues related to statistical and clinical significance. The guide concludes with details on how to document the development of the Fact Box for the purpose of transparency and reproducibility. Fact Boxes are an efficient tool to promote risk literacy and should be available in every physician’s office.

Meta-Analysis of the Effect of Natural Frequencies on Bayesian Reasoning.

The natural frequency facilitation effect describes the finding that people are better able to solve descriptive Bayesian inference tasks when represented as joint frequencies obtained through natural sampling, known as natural frequencies, than as conditional probabilities. The present meta-analysis reviews 20 years of research seeking to address when, why, and for whom natural frequency formats are most effective. We review contributions from research associated with the 2 dominant theoretical perspectives, the ecological rationality framework and nested-sets theory, and test potential moderators of the effect. A systematic review of relevant literature yielded 35 articles representing 226 performance estimates. These estimates were statistically integrated using a bivariate mixed-effects model that yields summary estimates of average performances across the 2 formats and estimates of the effects of different study characteristics on performance. These study characteristics range from moderators representing individual characteristics (e.g., numeracy, expertise), to methodological differences (e.g., use of incentives, scoring criteria) and features of problem representation (e.g., short menu format, visual aid). Short menu formats (less computationally complex representations showing joint-events) and visual aids demonstrated some of the strongest moderation effects, improving performance for both conditional probability and natural frequency formats. A number of methodological factors (e.g., exposure to both problem formats) were also found to affect performance rates, emphasizing the importance of a systematic approach. We suggest how research on Bayesian reasoning can be strengthened by broadening the definition of successful Bayesian reasoning to incorporate choice and process and by applying different research methodologies.

Patterns of prostate-specific antigen (PSA) testing in Australian men: the influence of family history

•  To describe how a family history of prostate cancer influences mens prostate cancer testing behaviours, information support preferences, and motives for testing.

Prevalence and predictors of cancer specific distress in men with a family history of prostate cancer

To examine prevalence and predictors of cancer‐specific distress in undiagnosed men with and without a family history of prostate cancer, and to examine the contribution of perceptions of an affected relatives cancer experience on the distress of unaffected male relatives.

Natural Frequencies Do Foster Public Understanding of Medical Tests: Comment on Pighin, Gonzalez, Savadori and Girotto (2016)

Patients and doctors often need to make decisions based on the results of medical tests. When these results are presented in the form of conditional probabilities, even doctors find it difficult to interpret them correctly. There is over 20 y of research supporting the finding that people are better able to calculate the correct positive predictive value of a test when given information in natural frequencies, as opposed to conditional probabilities. Natural frequencies are one of a few psychological tools that have made it into evidence-based medicine. Recently, Pighin and others (Med Decis Making 2016;36:686–91) argued that natural frequencies could hinder informed decision making, a critique based on a single task and a crude scoring criterion we refer to as the 50%-Split. Our commentary addresses these criticisms based on three analyses. First, we show how the 50%-Split scoring used by Pighin and others misclassifies known errors, such as solely attending to the hit rate (true-positive rate) of the test, as strategies that support understanding. Second, we reanalyze data from 21 additional problems completed by various participant groups to show that their scoring criterion does not support their results in 19 out of 21 cases. Third, we apply the mean deviation scoring method and show that, when given information in natural frequency formats, participants provide estimates that are closer to the correct Bayesian solution than for conditional probability formats. In each analysis, natural frequencies lead to more correct judgements and therefore promote informed decision making relative to conditional probabilities. We welcome further discussions of performance metrics that can provide insight into how the public and therefore patients understand the implications of medical test results.

Fact Box decision support tools reduce decisional conflict about antibiotics for pneumonia and artificial hydration in advanced dementia: a randomized controlled trail

Background fact Boxes are decision support tools that can inform about treatment effects. Objectives to test whether Fact Box decision support tools impacted decisional conflict, knowledge and preferences about the use of antibiotics and artificial hydration in advanced dementia. Design randomized controlled trial. Setting Swiss-German region of Switzerland. Subjects two hundred thirty-two participants (64 physicians, 100 relatives of dementia patients, 68 professional guardians) randomly allocated to intervention (N = 114) or control (N = 118). Intervention two-page Fact Box decision support tools on antibiotics for pneumonia and artificial hydration in advanced dementia (at 1-month). Methods participants were mailed questionnaires at baseline and one month later that asked questions about treatments based on hypothetical scenarios. The primary outcome was change in decisional conflict (DCS-D; range 0 < 100) about treatment decisions. Secondary outcomes included knowledge about treatments (range 0 < 7) and preferences to forego treatments. Results participants were: mean age, 55.6 years; female, 62.8%. Relative to control participants, intervention participants experienced less decisional conflict about using antibiotics (unstandardized beta (b) = -8.35, 95% Confidence Interval (CI), -12.43, -4.28) and artificial hydration (b = -6.02, 95% CI, -9.84, -2.20) at 1-month compared to baseline. Intervention participants displayed greater knowledge about the use of antibiotics (b = 2.24, 95% CI, 1.79, 2.68) and artificial hydration (b = 3.01, 95% CI, 2.53, 3.49), and were significantly more likely to prefer to forego antibiotics (odds ratio, 2.29, 95% CI, 1.08, 4.84) but not artificial hydration. Conclusions fact Box decision support tools reduced decisional conflict, increased knowledge and promoted preferences to forego antibiotics in advanced dementia among various decision-makers. Trial registration FORSbase (12091).