Browsing by Subject "Risk communication"

Now showing 1 - 4 of 4
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    An Analysis of Primary Care Clinician Communication About Risk, Benefits, and Goals Related to Chronic Opioid Therapy
    (SAGE Publications, 2019-12-10) Danielson, Elizabeth C.; Mazurenko, Olena; Andraka-Christou, Barbara T.; DiIulio, Julie; Downs, Sarah M.; Hurley, Robert W.; Harle, Christopher A.; Health Policy and Management, School of Public Health
    Background. Safe opioid prescribing and effective pain care are particularly important issues in the United States, where decades of widespread opioid prescribing have contributed to high rates of opioid use disorder. Because of the importance of clinician-patient communication in effective pain care and recent initiatives to curb rising opioid overdose deaths, this study sought to understand how clinicians and patients communicate about the risks, benefits, and goals of opioid therapy during primary care visits. Methods. We recruited clinicians and patients from six primary care clinics across three health systems in the Midwest United States. We audio-recorded 30 unique patients currently receiving opioids for chronic noncancer pain from 12 clinicians. We systematically analyzed transcribed, clinic visits to identify emergent themes. Results. Twenty of the 30 patient participants were females. Several patients had multiple pain diagnoses, with the most common diagnoses being osteoarthritis (n = 10), spondylosis (n = 6), and low back pain (n = 5). We identified five themes: 1) communication about individual-level and population-level risks, 2) communication about policies or clinical guidelines related to opioids, 3) communication about the limited effectiveness of opioids for chronic pain conditions, 4) communication about nonopioid therapies for chronic pain, and 5) communication about the goal of the opioid tapering. Conclusions. Clinicians discuss opioid-related risks in varying ways during patient visits, which may differentially affect patient experiences. Our findings may inform the development and use of more standardized approaches to discussing opioids during primary care visits.
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    Comparing neonatal morbidity and mortality estimates across specialty in periviable counseling
    (Taylor & Francis, 2015-12) Edmonds, Brownsyne Tucker; McKenzie, Fatima; Panoch, Janet; Frankel, Richard M.; Department of Obstetrics and Gynecology, IU School of Medicine
    Objective To describe and compare estimates of neonatal morbidity and mortality communicated by neonatologists and obstetricians in simulated periviable counseling encounters. Methods A simulation-based study of 16 obstetricians (OBs) and 15 neonatologists counseling standardized patients portraying pregnant women with ruptured membranes at 23 weeks gestation. Two investigators tabulated all instances of numerically-described risk estimates across individuals and by specialty. Results Overall, 12/15 (80%) neonatologists utilized numeric estimates of survival; 6/16 (38%) OBs did. OBs frequently deferred the discussion of “exact numbers” to neonatologists. The twelve neonatologists provided 13 unique numeric estimates, ranging from 3% to 50% survival. Half of those neonatologists provided 2-3 different estimates in a single encounter. By comparison, six OBs provided 4 unique survival estimates (“50%”, “30-40%”, “1/3-1/2”, “<10%”). Only 2/15 (13%) neonatologists provided numeric estimates of survival without impairment. None of the neonatologists used the term ‘intact’ survival, while 5 OBs did. Three neonatologists gave numeric estimates of long-term disability and one OB did. Conclusion We found substantial variation in estimates and noteworthy omissions of discussions related to long-term morbidity. Across specialties, we noted inconsistencies in the use and meaning of terms like ‘intact survival.’ More tools and training are needed to improve the quality and consistency of periviable risk-communication.
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    Cracked skulls and social liability : relating helmet safety messages to motorcycle riders
    (2014-04-02) Voight, Susan Amy; Goering, Elizabeth M.; Parrish-Sprowl, John; Rhodes, Nancy
    Grounded theory analysis, informed by a socio-cultural lens, was applied to the narratives of eighteen motorcycle riders in order to understand, from the rider’s perspective, receptivity to warning messages regarding motorcycle helmet use. This study relied upon narrative analysis to identify patterns in communication that surround motorcycle riders’ experiences. Socio-cultural cues identified importance in the process of interest development in motorcycle riding, search for information regarding motorcycle riding, response to danger within the motorcycle riding experience, and attitude toward protection messages. Narratives specific to danger, or experiences of motorcycle accidents were analyzed for comparison with fear appeal theory. Special focus was applied to Terror Management Theory (TMT) and applied to the communication surrounding the real experiences of motorcycle accident and the perceived threat of danger while motorcycle riding. Communication evidencing relational influence was examined for examples of socially constructed interpretation of social identity and an individual rider's perspective of their lifeworld. The analysis revealed evidence of the TMT concept of burying or denying thoughts of danger. The TMT concept of lifeworld influence on behavior was evidenced in riders who did not accept warning messages involving helmet use. Examples of attitude and behavior change where present in two study participants’ narratives that described experience of severe injury and also the death of a friend. The riders cited these occurrences as experiences that inhibited their previous behavior of placing thoughts of motorcycle injury and death in the back of mind. Although small in number, this participant group offered multiple categorizations of rider descriptions. The narratives offered distinction in time of life when riding interest developed. As well, motorcycle training facilities were often noted as a source of communication from which riders obtained influence on their future behaviors. From this information insight was gained to offer suggestions for future research on time of message delivery. Riders who develop interest in riding as adults represent a category on which to focus preliminary educational messages. Individuals who have not yet developed an interest in motorcycle riding may benefit from societal cues that demonstrate safe riding behavior. Future research in mass media appeals focused on motorcycle riders are suggested, as is development of educational programs for delivery to high school audiences.
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    Layperson Views about the Design and Evaluation of Decision Aids: A Public Deliberation
    (Sage, 2021-07) Schwartz, Peter H.; O’Doherty, Kieran C.; Bentley, Colene; Schmidt, Karen K.; Burgess, Michael M.; Medicine, School of Medicine
    Purpose: We carried out the first public deliberation to elicit lay input regarding guidelines for the design and evaluation of decision aids, focusing on the example of colorectal ("colon") cancer screening. Methods: A random, demographically stratified sample of 28 laypeople convened for 4 days, during which they were informed about key issues regarding colon cancer, screening tests, risk communication, and decision aids. Participants then deliberated in small and large group sessions about the following: 1) What information should be included in all decision aids for colon screening? 2) What risk information should be in a decision aid and how should risk information be presented? 3) What makes a screening decision a good one (reasonable or legitimate)? 4) What makes a decision aid and the advice it provides trustworthy? With the help of a trained facilitator, the deliberants formulated recommendations, and a vote was held on each to identify support and alternative views. Results: Twenty-one recommendations ("deliberative conclusions") were strongly supported. Some conclusions matched current recommendations, such as that decision aids should be available for use with and without providers present (conclusions 1-4) and should support informed choice (conclusion 9). Some conclusions differed from current recommendations, at least in emphasis-for example, that decision aids should disclose cost of screening (conclusion 11) and should be kept simple and understandable (conclusion 14). Deliberants recommended that decision aids should disclose the baseline risk of getting colon cancer (conclusions 15, 17). Limitations: Single location and medical decision. Conclusions: Guidelines for design of decision aids should consider putting a greater focus on disclosing cost and keeping decision aids simple, and they possibly should recommend disclosing less extensive amounts of quantitative information than currently recommended.