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Explaining the Process of Determining Futility Increases Lay Public Acceptance.

ABSTRACT: Rationale: National guidelines have laid out a process to conflict resolution in cases of potentially inappropriate medical interventions. Objectives: To determine the association between information about a process-based approach and lay public perceptions of the appropriateness of withholding medically inappropriate interventions. Methods: Respondents from a nationwide sample completed a survey with two adult intensive care unit-based vignettes: one about advanced cancer where doctors told the family that additional chemotherapy would not be offered, and a second case of multiorgan failure after brain hemorrhage where dialysis would not be offered. Participants were randomly assigned to see or not see information about a detailed process for the determination to withhold (second opinion, ethics consultation, exploring transfer to another institution). The primary outcome was the perceived appropriateness of not providing the treatment (four-point scale, dichotomized for analysis, modified Poisson regression), and the secondary outcome was the negative emotional reaction to the case (positive and negative affect schedule, range 1-5, higher is greater negative emotional response, linear regression). Results: A total of 1,191 respondents were included. Providing detailed process information increased the perceived appropriateness of withholding treatment by approximately 10 percentage points in each vignette: (chemotherapy, 75.7-85.4%; dialysis, 68.0-79.3%). Process information remained associated with perceived appropriateness of withholding treatment after adjustment for order effects and prespecified respondent characteristics (chemotherapy: prevalence ratio, 1.13; 95% confidence interval [CI], 1.07-1.19) (dialysis: prevalence ratio, 1.17; 95% CI, 1.10-1.25). Process information was not associated with emotional response to the cases (chemotherapy: β = -0.04; 95% CI, -0.16 to 0.09) (dialysis: β = -0.02; 95% CI, -0.14 to 0.10; both adjusted for order effects). Conclusions: Providing process-based conflict resolution information increased public acceptance of determinations of medical futility, supporting the practice outlined in national consensus statements.

SUBMITTER: Bailoor K

PROVIDER: S-EPMC6543468 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Research findings are best understood by considering contextual factors such as treatment plausibility: how likely it is that a studied treatment or manipulation is effective, based on theory and data. If a treatment is implausible, then more evidence should be required before believing it has an effect. The current study assessed the extent to which the interpretation of a research finding is affected by treatment plausibility. Participant age varied from 18 to 82 (M = 27.4, SD = 9.4), and about half of the participants (53%) were college students. A total of 600 participants read a brief news article about an experiment with a new type of psychotherapy for weight loss. The current study used a 2 (treatment plausibility) × 3 (results type) between-subjects factorial design. Treatment plausibility had two levels: (1) a plausible cognitive behavioral therapy and (2) an implausible "psychic reinforcement therapy" that was described as employing psychic messages to promote weight loss. The three levels of the results type factor varied how the study results were presented in the article: (1) standard results with no mention of treatment plausibility, (2) standard results followed by interpretive statements focused on treatment plausibility, and (3) no results-the study was described as still in progress. Participants rated their belief in the effectiveness of the therapy on a scale of 0 to 100% in 10% increments. When treatment plausibility was not discussed in the article, average ratings for the implausible therapy were relatively high (M = 63.1%, SD = 25.0, 95% CI% [58.2-68.1]) and similar to those for the plausible therapy (M = 69.2%, SD = 21.5, 95% CI% [65.0-73.5]). Ratings for the implausible treatment were moderately lower when the article explained why the results supporting it were questionable (M = 48.5%, SD = 26.6, 95% CI% [43.2-53.8]). The findings of the current study suggest that students and other members of the public may draw incorrect inferences from research partly because they do not appreciate the importance of treatment plausibility. This could be remedied, though not completely, by explicitly discussing the plausibility of the treatment based on theory and prior data.

Project description:Background: Brain health is one of the cornerstones of a long and full life. Active care for brain health and reduction of lifestyle-related risks for brain disorders may be a key strategy in tackling the growing prevalence of mental and neurological illnesses. Public knowledge, perception, and preventive behavior need to be considered in the planning of effective strategies for brain health promotion. Our research is the first effort aimed at assessing Slovenian lay public knowledge, search and use of scientific information about the brain, and care for brain health. Methods: An online survey was used to gather data for descriptive and associative statistical analyses of a sample of the Slovenian public (n = 2568) in August 2017. Participants with formal brain-related education were excluded, leaving the remaining sample of the lay public (n = 1012). Demographic characteristics and information regarding the perceived importance and knowledge of brain health and engagement in preventive behaviors of participants were collected, and key associative analyses were carried out. Results: The majority of respondents (89%) considered brain health to be important. Over one-third (39%) considered their knowledge of the brain as sufficient relative to their needs. Most of the respondents identified science-recommended practices to be important for brain health. No recommendation was followed daily by the majority of the respondents, primarily due to declared lack of time (59%), and lack of information (32%). Information was obtained primarily from television (38%), followed by newspapers and magazines (31%), the Internet (31%), and direct conversations (27%). However, the highest-rated, preferred source of information was lectured by experts. One-third of our sample struggled with the trustworthiness of information sources. Female gender and older age were associated with a higher frequency of healthy practices. Personal or familial diagnoses of brain disorders were not associated with a higher frequency of the behavior in favor of brain health, but did affect available time and perceived value of preventive practices. Conclusions: Our research provides an initial insight into the perceptions, knowledge, and brain health-promoting behavior of the Slovenian lay public. Our findings can inform future strategies for science communication, public education and engagement, and policy-making to improve lifelong active care for brain health.

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Explaining the Process of Determining Futility Increases Lay Public Acceptance.

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