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ABSTRACT: OBJECTIVE: To examine when and why women disbelieve tailored information about their risk of developing breast cancer. METHODS: 690 women participated in an online program to learn about medications that can reduce the risk of breast cancer. The program presented tailored information about each woman's personal breast cancer risk. Half of women were told how their risk numbers were calculated, whereas the rest were not. Later, they were asked whether they believed that the program was personalized, and whether they believed their risk numbers. If a woman did not believe her risk numbers, she was asked to explain why. RESULTS: Beliefs that the program was personalized were enhanced by explaining the risk calculation methods in more detail. Nonetheless, nearly 20% of women did not believe their personalized risk numbers. The most common reason for rejecting the risk estimate was a belief that it did not fully account for personal and family history. CONCLUSIONS: The benefits of tailored risk statistics may be attenuated by a tendency for people to be skeptical that these risk estimates apply to them personally. PRACTICE IMPLICATIONS: Decision aids may provide risk information that is not accepted by patients, but addressing the patients' personal circumstances may lead to greater acceptance.
Patient Education and Counseling 04/2013; · 2.31 Impact Factor
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ABSTRACT: PURPOSE: Career development award programs often require formal establishment of mentoring relationships. The authors sought to gain a nuanced understanding of mentoring from the perspective of a diverse national sample of faculty clinician-researchers who were all members of formal mentoring relationships. METHOD: Between February 2010 and August 2011, the authors conducted semistructured, in-depth telephone interviews with 100 former recipients of National Institutes of Health mentored career development awards and 28 of their mentors. Purposive sampling ensured a diverse range of viewpoints. Multiple analysts thematically coded verbatim transcripts using qualitative data analysis software. RESULTS: Three relevant themes emerged: (1) the numerous roles and behaviors associated with mentoring in academic medicine, (2) the improbability of finding a single person who can fulfill the diverse mentoring needs of another individual, and (3) the importance and composition of mentor networks. Many respondents described the need to cultivate more than one mentor. Several participants discussed the use of peer mentors, citing benefits such as pooled resources and mutual learning. Female participants generally acknowledged the importance of having at least one female mentor. Some observed that their portfolio of mentors needed to evolve to remain effective. CONCLUSIONS: Those who seek to promote the careers of faculty in academic medicine should focus on developing mentoring networks rather than on hierarchical mentoring dyads. The members of each faculty member's mentoring team or network should reflect the protégé's individual needs and preferences, with special attention toward ensuring diversity in terms of area of expertise, academic rank, and gender.
Academic medicine: journal of the Association of American Medical Colleges 02/2013; · 2.34 Impact Factor
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ABSTRACT: PURPOSE: Professional rejection is a frequent experience in an academic medical career. The authors sought to understand how rejection affects those pursuing such careers and why some individuals may be more resilient than others in a population of individuals with demonstrated ability and interest in research careers. METHOD: Between February 2010 and August 2011, the authors conducted semistructured, in-depth telephone interviews with 100 former recipients of National Institutes of Health mentored career development awards and 28 of their mentors. Purposive sampling ensured a diverse range of viewpoints. Multiple analysts thematically coded verbatim transcripts using qualitative data analysis software. RESULTS: Participants described a variety of experiences with criticism and rejection in their careers, as well as an acute need for persistence and resilience in the face of such challenges. Through their narratives, participants also vividly described a range of emotional and behavioral responses to their experiences of professional rejection. Their responses illuminated the important roles that various factors, including mentoring and gender, have played in shaping the ultimate influence of rejection on their own careers and on the careers of those they have mentored. CONCLUSIONS: Responses to rejection vary considerably, and negative responses can lead promising individuals to abandon careers in academic medicine. Resilience does not, however, seem to be immutable-It can be learned. Given the frequency of experiences with rejection in academic medicine, strategies such as training mentors to foster resilience may be particularly helpful in improving faculty retention in academic medicine.
Academic medicine: journal of the Association of American Medical Colleges 02/2013; · 2.34 Impact Factor
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ABSTRACT: PURPOSE: Few researchers have explored the negotiation experiences of academic medical faculty even though negotiation is crucial to their career success. The authors sought to understand medical faculty researchers' experiences with and perceptions of negotiation. METHOD: Between February 2010 and August 2011, the authors conducted semistructured, in-depth telephone interviews with 100 former recipients of National Institutes of Health mentored career development awards and 28 of their mentors. Purposive sampling ensured a diverse range of viewpoints. Multiple analysts thematically coded verbatim transcripts using qualitative data analysis software. RESULTS: Participants described the importance of negotiation in academic medical careers but also expressed feeling naïve and unprepared for these negotiations, particularly as junior faculty. Award recipients focused on power, leverage, and strategy, and they expressed a need for training and mentorship to learn successful negotiation skills. Mentors, by contrast, emphasized the importance of flexibility and shared interests in creating win-win situations for both the individual faculty member and the institution. When faculty construed negotiation as adversarial and/or zero-sum, participants believed it required traditionally masculine traits and perceived women to be at a disadvantage. CONCLUSIONS: Academic medical faculty often lack the skills and knowledge necessary for successful negotiation, especially early in their careers. Many view negotiation as an adversarial process of the sort that experts call "hard positional bargaining." Increasing awareness of alternative negotiation techniques (e.g., "principled negotiation," in which shared interests, mutually satisfying options, and fair standards are emphasized) may encourage the success of medical faculty, particularly women.
Academic medicine: journal of the Association of American Medical Colleges 02/2013; · 2.34 Impact Factor
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ABSTRACT: OBJECTIVE: To assess the impact of Guide to Decide (GtD), a web-based, personally-tailored decision aid designed to inform women's decisions about prophylactic tamoxifen and raloxifene use. METHODS: Postmenopausal women, age 46-74, with BCRAT 5-year risk ≥1.66% and no prior history of breast cancer were randomized to one of three study arms:intervention (n=690), Time 1 control (n=160), or 3-month control (n=162). Intervention participants viewed GtD prior to completing a post-test and 3 month follow-up assessment. Controls did not. We assessed the impact of GtD on women's decisional conflict levels and treatment decision behavior at post-test and at 3 months, respectively. RESULTS: Intervention participants had significantly lower decisional conflict levels at post-test (p<0.001) and significantly higher odds of making a decision about whether or not to take prophylactic tamoxifen or raloxifene at 3-month follow-up (p<0.001) compared to control participants. CONCLUSION: GtD lowered decisional conflict and helped women at high risk of breast cancer decide whether to take prophylactic tamoxifen or raloxifene to reduce their cancer risk. PRACTICE IMPLICATIONS: Web-based, tailored decision aids should be used more routinely to facilitate informed medical decisions, reduce patients' decisional conflict, and empower patients to choose the treatment strategy that best reflects their own values.
Patient Education and Counseling 02/2013; · 2.31 Impact Factor
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ABSTRACT: OBJECTIVE: To test a video intervention as a way to improve predictions of mood and quality-of-life with an emotionally evocative medical condition. Such predictions are typically inaccurate, which can be consequential for decision making. METHOD: In Part 1, people presently or formerly living with ostomies predicted how watching a video depicting a person changing his ostomy pouch would affect mood and quality-of-life forecasts for life with an ostomy. In Part 2, participants from the general public read a description about life with an ostomy; half also watched a video depicting a person changing his ostomy pouch. Participants' quality-of-life and mood forecasts for life with an ostomy were assessed. RESULTS: Contrary to our expectations, and the expectations of people presently or formerly living with ostomies, the video did not reduce mood or quality-of-life estimates, even among participants high in trait disgust sensitivity. Among low-disgust participants, watching the video increased quality-of-life predictions for ostomy. CONCLUSION: Video interventions may improve mood and quality-of-life forecasts for medical conditions, including those that may elicit disgust, such as ostomy. PRACTICE IMPLICATIONS: Video interventions focusing on patients' experience of illness continue to show promise as components of decision aids, even for emotionally charged health states such as ostomy.
Patient Education and Counseling 11/2012; · 2.31 Impact Factor
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ABSTRACT: Few studies have examined how specific emotions may affect decision-making processes. Anxiety may be especially relevant in health decisions such as those related to cancer in which thoughts of illness or death may be abundant. We examined associations between women's anxiety about developing breast cancer and variables related to their decision to take a medication that could reduce their chances of the disease. Six-hundred and thirty-two American women, who had an increased risk of breast cancer, reviewed a web-based decision aid about tamoxifen. We examined associations between their baseline, self-reported anxiety about developing the disease and post decision aid measures including knowledge about tamoxifen, attitude toward the medication, and behavioral intentions to look for more information and take the medication. Results showed that anxiety was not associated with knowledge about tamoxifen, but it was associated with attitude toward the medication such that women who were more anxious about developing breast cancer were more likely to think the benefits were worth the risks. Greater anxiety was also associated with greater behavioral intentions to look for additional information and take the medication in the next few months. Secondary analyses showed that behavioral intentions were related to knowledge of tamoxifen and attitude toward the medication only for women who were reporting low levels of anxiety. Overall, the findings suggest that anxiety about breast cancer may motivate interest in tamoxifen and not necessarily through affecting knowledge or attitudes.
Social Science [?] Medicine 11/2012; · 2.70 Impact Factor
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ABSTRACT: It is unclear whether male and female physician researchers who perform similar work are currently paid equally.
To determine whether salaries differ by gender in a relatively homogeneous cohort of physician researchers and, if so, to determine if these differences are explained by differences in specialization, productivity, or other factors.
A US nationwide postal survey was sent in 2009-2010 to assess the salary and other characteristics of a relatively homogeneous population of physicians. From all 1853 recipients of National Institutes of Health (NIH) K08 and K23 awards in 2000-2003, we contacted the 1729 who were alive and for whom we could identify a mailing address.
The survey achieved a 71% response rate. Eligibility for the present analysis was limited to the 800 physicians who continued to practice at US academic institutions and reported their current annual salary.
A linear regression model of self-reported current annual salary was constructed considering the following characteristics: gender, age, race, marital status, parental status, additional graduate degree, academic rank, leadership position, specialty, institution type, region, institution NIH funding rank, change of institution since K award, K award type, K award funding institute, years since K award, grant funding, publications, work hours, and time spent in research.
The mean salary within our cohort was $167,669 (95% CI, $158,417-$176,922) for women and $200,433 (95% CI, $194,249-$206,617) for men. Male gender was associated with higher salary (+$13,399; P = .001) even after adjustment in the final model for specialty, academic rank, leadership positions, publications, and research time. Peters-Belson analysis (use of coefficients derived from regression model for men applied to women) indicated that the expected mean salary for women, if they retained their other measured characteristics but their gender was male, would be $12,194 higher than observed.
Gender differences in salary exist in this select, homogeneous cohort of mid-career academic physicians, even after adjustment for differences in specialty, institutional characteristics, academic productivity, academic rank, work hours, and other factors.
JAMA The Journal of the American Medical Association 06/2012; 307(22):2410-7. · 30.03 Impact Factor
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ABSTRACT: Allocation of resources for the treatment of mental illness is low relative to the burden imposed by these illnesses. The reason for this discrepancy has not been established. Few studies have directly and systematically compared public evaluations of the importance of treating mental illnesses and general medical illnesses. This study assessed public willingness to pay for treatments of mental health conditions and of general medical conditions to determine whether willingness to pay less for mental health treatments is due to the perception that mental health conditions are less burdensome.
U.S. adults (N=710) in a nationally representative sample were provided with descriptions of two mental and three general medical illnesses. Respondents rated their willingness to pay to avoid each illness and then their perception of the burdensomeness of each illness.
Participants rated the two mental illnesses as relatively more burdensome than the general medical illnesses, but the amount they were willing to pay to avoid the mental illnesses was lower. Specifically, participants were willing to pay 40% less to avoid the mental illnesses compared with the general medical conditions, for a comparable benefit in terms of quality of life.
Even though respondents recognized that severe mental illnesses can dramatically lower quality of life, they were less willing to pay to avoid such illnesses than they were to pay to cure less burdensome general medical illnesses.
Psychiatric services (Washington, D.C.) 03/2012; 63(4):319-24. · 2.81 Impact Factor
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ABSTRACT: Background Many decisions can be understood in terms of actors' valuations of benefits and costs. The article investigates whether this is also true of patient medical decision making. It aims to investigate (i) the importance patients attach to various reasons for and against nine medical decisions; (ii) how well the importance attached to benefits and costs predicts action or inaction; and (iii) how such valuations are related to decision confidence. Methods In a national random digit dial telephone survey of U.S. adults, patients rated the importance of various reasons for and against medical decisions they had made or talked to a health-care provider about during the past 2 years. Participants were 2575 English-speaking adults age 40 and older. Data were analysed by means of logistic regressions predicting action/inaction and linear regressions predicting confidence. Results Aggregating individual reasons into those that may be regarded as benefits and those that may be regarded as costs, and weighting them by their importance to the patient, shows the expected relationship to action. Perceived benefits and costs are also significantly related to the confidence patients report about their decision. Conclusion The factors patients say are important in their medical decisions reflect a subjective weighing of benefits and costs and predict action/inaction although they do not necessarily indicate that patients are well informed. The greater the difference between the importance attached to benefits and costs, the greater patients' confidence in their decision.
Health expectations: an international journal of public participation in health care and health policy 11/2011; · 1.80 Impact Factor
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ABSTRACT: To examine the careers of career development award recipients.
In 2009, a postal survey was conducted of 818 recipients of K08 and K23 awards in 2000-2001 to examine career paths and personal characteristics.
Of 589 respondents (72% response rate), 211 (35.9%) were female. Women were less likely to have children (P<.001) than men. The vast majority of respondents (89.6%) remained in academic medicine. Among those, over three-quarters continued to spend significant time on research. On univariate analysis, women were not significantly less likely to report promotion, leadership positions, or application for R01 grants. They were less likely to have received an R01 (P=.006) and to perceive themselves as successful (P=.002), and they published fewer papers (P=.001). Overall, 118 women (55.9%) and 274 men (72.5%) met at least one of the following criteria for success: serving as principal investigator on an R01 or grants>$1,000,000 since K award receipt, publishing at least 35 publications since K award year, or serving as dean, department chair, or division chief. In a multivariate model, gender (odds ratio 1.72, P=.003) was associated with the likelihood of success by this definition, and analysis revealed no significant interactions (including with parental status).
Most of these promising investigators of both genders remained in academia and received promotions. However, gender differences in success existed, unrelated to parental status, suggesting a need for ongoing investigation of the causes of gender differences in academic medical careers.
Academic medicine: journal of the Association of American Medical Colleges 09/2011; 86(11):1415-21. · 2.34 Impact Factor
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ABSTRACT: With increasing frequency, patients are being asked to make complex decisions about cancer screening, prevention, and treatment. These decisions are fraught with emotion and cognitive difficulty simultaneously. Many Americans have low numeracy skills making the cognitive demands even greater whenever, as is often the case, patients are presented with risk statistics and asked to make comparisons between the risks and benefits of multiple options and to make informed medical decisions. In this commentary, we highlight 10 methods that have been empirically shown to improve patients' understanding of risk and benefit information and/or their decision making. The methods range from presenting absolute risks using frequencies (rather than presenting relative risks) to using a risk format that clarifies how treatment changes risks from preexisting baseline levels to using plain language. We then provide recommendations for how health-care providers and health educators can best to communicate this complex medical information to patients, including using plain language, pictographs, and absolute risks instead of relative risks.
CancerSpectrum Knowledge Environment 09/2011; 103(19):1436-43. · 14.07 Impact Factor
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ABSTRACT: Risk perception is important for motivating health behavior (e.g., Janz & Becker, 1984), but different measures of the construct may change how important that relationship appears. In two studies, we examined associations between four measures of risk perception, health behavior intentions and possible behavioral determinants.
Participants in these studies, who were due for colorectal cancer screening, read an online message about the importance of screening to reduce the chance of cancer. We examined bivariate and multivariate associations between risk perception measures, including absolute, comparative, and feelings-of-risk, and behavioral intentions to screen, general worry, and knowledge and attitudes related to screening.
Results across the two studies were consistent, with all risk perception measures being correlated with intentions and attitudes. Multivariate analyses revealed that feelings-of-risk was most predictive of all variables, with the exception of general worry, for which comparative measures were the most predictive.
Researchers interested in risk perception should assess feelings-of-risk along with more traditional measures. Those interested in influencing health behavior specifically should attempt to increase feelings of vulnerability rather than numerical risk.
Health Psychology 08/2011; 31(1):106-13. · 3.87 Impact Factor
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Amanda J Dillard, Peter A Ubel,
Dylan M Smith,
Brian J Zikmund-Fisher,
Vijay Nair,
Holly A Derry,
Aijun Zhang,
Rosemarie K Pitsch,
Sharon Hensley Alford,
Jennifer B McClure,
Angela Fagerlin
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ABSTRACT: Comparative risk perceptions may rival other types of information in terms of effects on health behavior decisions.
We examined associations between comparative risk perceptions, affect, and behavior while controlling for absolute risk perceptions and actual risk.
Women at an increased risk of breast cancer participated in a program to learn about tamoxifen which can reduce the risk of breast cancer. They reported comparative risk perceptions of breast cancer and completed measures of anxiety, knowledge, and tamoxifen-related behavior intentions. Three months later, the women reported their behavior.
Comparative risk perceptions were positively correlated with anxiety, knowledge, intentions, and behavior 3 months later. After controlling for participants' actual risk of breast cancer and absolute risk perceptions, comparative risk perceptions predicted anxiety and knowledge, but not intentions or behavior.
Comparative risk perceptions can affect patient outcomes like anxiety and knowledge independently of absolute risk perceptions and actual risk information.
Annals of Behavioral Medicine 06/2011; 42(2):262-8. · 4.20 Impact Factor
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ABSTRACT: To examine intensive care unit (ICU) clinicians' willingness to trade off societal benefits in favor of a small chance of rescuing an identifiable critically ill patient.
We sent mixed-methods questionnaires to national samples of US ICU clinicians, soliciting their preferences for allocating their last bed to a gravely ill patient with little chance to survive, versus a deceased or dying patient for whom aggressive management could help others through organ donation.
Complete responses were obtained from 684 of 2,206 physicians (31.0%) and 438 of 988 nurses (44.3%); there was no evidence of non-response bias. Physicians were more likely than nurses to adhere to the "rule of rescue" by allocating the last bed to the gravely ill patient (45.9 vs. 32.6%, difference = 13.2%; 95% CI 9.1-17.3%). The magnitude of the social benefit to be obtained through organ donor management (5 or 30 life-years added for transplant recipients) had small and inconsistent effects on clinicians' willingness to prioritize the donor. In qualitative analyses, the most common reason for allocating the last bed to an identifiable patient (identified by 65% of physicians and 75% of nurses) was that clinicians perceived strong obligations to identifiable living patients.
More than one-third of ICU clinicians forewent substantial social benefits so as to devote resources to an individual patient unlikely to benefit from them. Such allegiance to the rule of rescue suggests challenges for efforts to reform ICU triage practices.
European Journal of Intensive Care Medicine 06/2011; 37(7):1210-7. · 5.17 Impact Factor
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The Lancet 04/2011; 379(9810):7-9. · 38.28 Impact Factor
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ABSTRACT: Patients facing difficult decisions often ask physicians for recommendations. However, little is known regarding the ways that physicians' decisions are influenced by the act of making a recommendation.
We surveyed 2 representative samples of US primary care physicians-general internists and family medicine specialists listed in the American Medical Association Physician Masterfile-and presented each with 1 of 2 clinical scenarios. Both involved 2 treatment alternatives, 1 of which yielded a better chance of surviving a fatal illness but at the cost of potentially experiencing unpleasant adverse effects. We randomized physicians to indicate which treatment they would choose if they were the patient or they were recommending a treatment to a patient.
Among those asked to consider our colon cancer scenario (n = 242), 37.8% chose the treatment with a higher death rate for themselves but only 24.5% recommended this treatment to a hypothetical patient (χ(2)(1) = 4.67, P = .03). Among those receiving our avian influenza scenario (n = 698), 62.9% chose the outcome with the higher death rate for themselves but only 48.5% recommended this for patients (χ(2)(1) = 14.56, P < .001).
The act of making a recommendation changes the ways that physicians think regarding medical choices. Better understanding of this thought process will help determine when or whether recommendations improve decision making.
Archives of internal medicine 04/2011; 171(7):630-4. · 11.46 Impact Factor
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Angela Fagerlin,
Amanda J Dillard,
Dylan M Smith,
Brian J Zikmund-Fisher,
Rosemarie Pitsch,
Jennifer B McClure,
Sarah Greene,
Sharon Hensley Alford,
Vijayan Nair,
Daniel F Hayes,
Cheryl Wiese, Peter A Ubel
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ABSTRACT: Although tamoxifen can prevent primary breast cancer, few women use it as a preventive measure. A second option, raloxifene, has recently been approved. The objective of the study was to determine women's interest in tamoxifen and raloxifene after reading a decision aid (DA) describing the risks and benefits of each medication. Women with 5-year risk of breast cancer ≥ 1.66 from two large health maintenance organizations were randomized to receive a DA versus usual care. After reading an on-line DA that discussed the risks and benefits of tamoxifen and raloxifene, women completed measures of risk perception, decisional conflict, behavioral intentions, and actual behavior related to tamoxifen and raloxifene. 3 months following the intervention, 8.1% of participants had looked for additional information about breast cancer prevention drugs, and 1.8% had talked to their doctor about tamoxifen and/or raloxifene. The majority, 54.7%, had decided to not take either drug, 0.5% had started raloxifene, and none had started tamoxifen. Participants were not particularly worried about taking tamoxifen or raloxifene and did not perceive significant benefits from taking these drugs. Over 50% did not perceive a change in their risk of getting breast cancer if they took tamoxifen or raloxifene. After reading a DA about tamoxifen and raloxifene, few women were interested in taking either breast cancer prevention drug.
Breast Cancer Research and Treatment 03/2011; 127(3):681-8. · 4.43 Impact Factor
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Archives of internal medicine 03/2011; 171(6):487-8. · 11.46 Impact Factor
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ABSTRACT: This study tests whether a joint evaluation method for assessing quality of life can stabilize ratings by providing contextual information, thereby helping participants calibrate responses on a rating scale. We also use the method to test for scale recalibration between patients and non-patients.
In an Internet survey, participants (N = 1,865) rated a target health condition, either diabetes or obesity, on a 100-point rating scale. Participants either rated several other items on the same rating scale first (joint evaluation), or rated the target condition first (single evaluation). We compared target condition ratings for joint versus single evaluation, as well as the rank position of that item among the other items. We also compared ratings and rankings for patients versus non-patients.
The method effectively picked up distinct patterns of scale usage, with evidence of scale recalibration for obesity ratings, but not for diabetes ratings. The stabilizing effects of the method were mixed. For both diabetes and obesity, the joint evaluation task helped stabilize the rank position of the target condition, but not the rating.
Results do not conclusively support joint evaluation as a method for reducing noise in rating scale usage, but do support its use for detecting scale recalibration between patients and non-patients.
Quality of Life Research 02/2011; 20(8):1169-77. · 2.30 Impact Factor
