Values Clarity Research Articles

A targeted decision aid for the elderly to decide whether to undergo colorectal cancer screening: development and results of an uncontrolled trial

BackgroundCompeting causes of mortality in the elderly decrease the potential net benefit from colorectal cancer screening and increase the likelihood of potential harms. Individualized decision making has been recommended, so that the elderly can decide whether or not to undergo colorectal cancer (CRC) screening. The objective is to develop and test a decision aid designed to promote individualized colorectal cancer screening decision making for adults age 75 and over.MethodsWe used formative research and cognitive testing to develop and refine the decision aid. We then tested the decision aid in an uncontrolled trial. The primary outcome was the proportion of patients who were prepared to make an individualized decision, defined a priori as having adequate knowledge (10/15 questions correct) and clear values (25 or less on values clarity subscale of decisional conflict scale). Secondary outcomes included overall score on the decisional conflict scale, and preferences for undergoing screening.ResultsWe enrolled 46 adults in the trial. The decision aid increased the proportion of participants with adequate knowledge from 4% to 52% (p < 0.01) and the proportion prepared to make an individualized decision from 4% to 41% (p < 0.01). The proportion that preferred to undergo CRC screening decreased from 67% to 61% (p = 0. 76); 7 participants (15%) changed screening preference (5 against screening, 2 in favor of screening)ConclusionIn an uncontrolled trial, the elderly participants appeared better prepared to make an individualized decision about whether or not to undergo CRC screening after using the decision aid.

Another Look at the Impact of Personal and Organizational Values Congruency

This study re-examined the impact of personal and organizational values congruency on positive work outcomes and investigated the extent to which this relationship is affected by demographic variables. Data collection paralleled an earlier study (Posner and Schmidt, Journal of Business Ethics 12, 1993, 341) and validated those findings, lending additional credibility to the continuing importance of this phenomenon. Both personal values congruence and organizational values clarity were significantly related to commitment, satisfaction, motivation, anxiety, work stress, and ethics using a cross-sectional sample of 711 managers from across the United States. Gender, educational level, and functional area did not impact these relationships, although years of experience (expressed by age, managerial experience, and hierarchical level) did make a difference.

Beyond behavior: eliciting broader change with motivational interviewing

Descriptions of Motivational interviewing (MI) usually focus on helping clients change a single problematic behavior. In contrast, the current case study shows that MI can serve as a more comprehensive psychotherapy, focused not only on multiple problem behaviors but also on broader change consistent with its roots in client-centered therapy. In this case, the therapist interwove a focus on several discrete behaviors with a focus on broader lifestyle change as well as increased clarity of client cognitions, values, and choices, resulting in several lasting changes.

Patients were more consistent in randomized trial at prioritizing childbirth preferences using graphic-numeric than verbal formats

Objective We developed an evidence-based decision aid to help women with a prior cesarean to prioritize their childbirth preferences related to a future birth. Because there was uncertainty about which scale format would assist the patients in being most consistent in prioritizing preferences in a multiattribute decision model, we compared a graphic-numeric scale with a text-anchored scale. Study Design and Setting Ninety-six postnatal women with a prior cesarean were randomized to use 1 of 2 preference scale formats in a computerized childbirth decision aid. We measured the level of inconsistency (intransitivity) when patients prioritized their childbirth preferences and clarity of values before and after using the decision aid. Results When the trade-offs involved risk, women were more consistent when using graphic-numeric than text-anchored formats ( P = 0.015). They prioritized safety to their baby as 4 times more important than any other decision factor including safety to self. Both groups reduced unclear childbirth values over time ( P < 0.001). Women who over-used the extreme ends of the scale when evaluating risk were more likely to be inconsistent ( P < 0.001). Conclusion Patients were more consistent in making trade-offs involving risk using graphic-numeric formats than text-anchored formats to measure patient preferences.

Amylose content and starch properties generated by five variant Wx alleles for granule-bound starch synthase in common wheat (Triticum aestivum L.)

In common and durum wheats (Triticum aestivum L. and T. durum Desf.), variant waxy (Wx) alleles have been reported for three Wx proteins (Wx-A1, -B1 and -D1), responsible for amylose synthesis in flour starch. Five variant alleles, Wx-A1c, -A1e, -B1c, -B1d and -D1c, were examined to elucidate their effects on amylose content in flour starch. Common wheat lines carrying a Wx protein produced by one variant (e.g., Wx-A1c) and one control (e.g., Wx-A1a) allele were bred and their starches were compared. Results showed that Wx-A1e did not produce amylose (waxy phenotype), whereas three alleles (Wx-A1c, -B1c and -B1d) reduced amylose, and -D1c might have increased it slightly. Most data on blue value, swelling power and starch paste clarity in water and dimethyl sulphoxide also suggested the variant Wx alleles either reduced or increased amylose content.

Randomized trial of a self-administered decision aid for colorectal cancer screening

Previous studies have not assessed whether evidence-based information about the outcomes of colorectal cancer screening increases informed choice among people from a range of socioeconomic backgrounds nor have they assessed whether this can be administered away from a health-care provider. Randomized controlled trial in six primary care locations. Three hundred and fourteen people aged 50-74 years received a self-administered decision aid (DA) booklet about outcomes of biennial faecal occult blood testing (FOBT) screening or government consumer guidelines (G). Significantly more DA recipients (20.9%) were 'informed' compared with G recipients (5.8%) (P = 0.0001, OR 4.32; 95% CI 2.49 to 7.52); the DA did not affect values clarity (61.9% clear after DA versus 59.1% after G) nor screening decisions overall (87.3% would screen after DA versus 90.5% after G). Test uptake at one month was uniformly low (5.2% DA versus 6.6% G); mostly due to being 'too busy'. DA recipients were more likely to make decisions 'integrating' knowledge with values (10.4% DA versus 1.5% G). Decisions not to screen were equally uncommon in both groups but more likely to be uninformed in G (P = 0.03). More DA recipients from all education levels were 'informed' (P = 0.02), particularly in lower education (50.0% DA versus 17.8% G) and university-educated groups (79.4% DA versus 32.1% G). Detailed absolute risk and benefit information about FOBT screening can be effectively used at home by people to increase informed choice. The DA was effective in people with lower education levels. Unique Protocol ID 211705 ClinicalTrials.gov ID NCT 00148226.

A Mixed-Method Exploration of Body Image and Sexual Health Among Adolescent Boys

This study uses a mixed-method approach to examine the relationship between body image and sexual health among adolescent boys. In Study 1, eight 12th-grade boys participated in semistructured interviews focusing on dating and sexuality. Qualitative analyses revealed several differences between boys who were satisfied with their bodies and boys who were not. Specifically, boys who were satisfied with their bodies indicated that they were clear about what they wanted sexually and were comfortable communicating those wants with partners. In contrast, boys with low body satisfaction were often unclear about their sexual choices and resisted talking about sexuality with partners. Study 2 examined these same themes using quantitative data from 149 boys from the 12th grade who completed surveys assessing body image, sexual experiences, and sexual attitudes. Body satisfaction was significantly associated with sexual agency and with clarity of personal sexual values. Implications for promoting adolescent sexual health are discussed.

Efficacy of a training intervention on the quality of practitioners' decision support for patients deciding about place of care at the end of life: A randomized control trial: Study protocol

BackgroundMost people prefer home palliation but die in an institution. Some experience decisional conflict when weighing options regarding place of care. Clinicians can identify patients' decisional needs and provide decision support, yet generally lack skills and confidence in doing so. This study aims to determine whether the quality of clinicians' decision support can be improved with a brief, theory-based, skills-building intervention.TheoryThe Ottawa Decision Support Framework (ODSF) guides an evidence based, practical approach to assist clinicians in providing high-quality decision support. The ODSF proposes that decisional needs [personal uncertainty, knowledge, values clarity, support, personal characteristics] strongly influence the quality of decisions patients make. Clinicians can improve decision quality by providing decision support to address decisional needs [clarify decisional needs, provide facts and probabilities, clarify values, support/guide deliberation, monitor/facilitate progress].Methods/DesignThe efficacy of a brief education intervention will be assessed in a two-phase study. In phase one a focused needs assessment will be conducted with key informants. Phase two is a randomized control trial where clinicians will be randomly allocated to an intervention or control group. The intervention, informed by the needs assessment, knowledge transfer best practices and the ODSF, comprises an online tutorial; an interactive skills building workshop; a decision support protocol; performance feedback, and educational outreach. Participants will be assessed: a) at baseline (quality of decision support); b) after the tutorial (knowledge); and c) four weeks after the other interventions (quality of decision support, intention to incorporate decision support into practice and perceived usefulness of intervention components). Between group differences in the primary outcome (quality of decision support scores) will be analyzed using ANOVA.DiscussionFew studies have investigated the efficacy of an evidence-based, theory guided intervention aimed at assisting clinicians to strengthen their patient decision support skills. Expanding our understanding of how clinicians can best support palliative patients' decision-making will help to inform best practices in patient-centered palliative care. There is potential transferability of lessons learned to other care situations such as chronic condition management, advance directives and anticipatory care planning. Should the efficacy evaluation reveal clear improvements in the quality of decision support provided by clinicians who received the intervention, a larger scale implementation and effectiveness trial will be considered.Trial registrationThis study is registered as NCT00614003

Politinės reklamos stilius : seimo rinkimų kompanija 2008-aisiais Kaune

Until quire recently, as little as almost two decades ago, there was no political advertising at all, either in Lithuania or in the Soviet Union. Now we live in altogether different times - there is a market with its supply and demand, so there needs to be advertising as well. In advance of parliamentary elections all parties carry on political campaigns during which each tries to stand out clearly from the others as it woos voters. How this is done and what stylistic means are used can be seen both from the Kaunas press which is literally flooded by political ads and from the leaflets distributed separately. All this reveals our general political culture. The election advertisements seen in Kaunas show that our politicians do not especially value brevity and clarity. Only one or two candidates are satisfied with five or six sentences describing themselves and/or indicating their party's goals for the next four years. Since the voters are generally passive and interest in the elections, the parties, and their candidates is slight, the political agitation comes across as too highfalutin, with specificity, clarity, effectiveness sacrificed in favor of empty rhetorical pomposity. The style of this parliamentary election reflects a tired (or, more accurately, an as-yet-unformed) political culture whose deficiencies are masked by boring articles, absurd slogans, and unrealistic promises. For the time being we are a weak, or as is often put, an immature society that responds only to strong stimuli with the result that the winners are those who scream loud and/or shine garishly.

Randomized controlled trial of the effectiveness of an intervention to implement evidence-based patient decision support in a nursing call centre

We evaluated the effect of an intervention on call centre nurses' knowledge of decision support and skills in coaching callers facing value-sensitive health decisions. Forty-one registered nurses at a health call centre were randomly assigned to an intervention or control group. The intervention was a coaching protocol, online tutorial, skills building workshop and performance feedback. The main outcome measures were: knowledge test; blinded quality assessment of coaching skills during simulated calls and call duration. Compared with controls, nurses in the intervention group had better knowledge (74 versus 60%, P = 0.007) and decision coaching skills (81 versus 44%, P < 0.001), particularly in assessing decisional needs (information, values clarity, support, stage and timing of decision) and addressing support issues. Call duration did not differ (18.5 versus 16.7 min, P = 0.73). The coaching protocol was rated as compatible with nurses' views on decision-making and more advantageous compared with their usual practices. The intervention improved the quality of nurses' decision coaching without affecting call duration.

Preliminary testing of a just-in-time, user-defined values clarification exercise to aid lower literate women in making informed breast cancer treatment decisions.

To report on the initial testing of a values clarification exercise utilizing a jewellery box within a computerized patient decision aid (CPtDA) designed to assist women in making a surgical breast cancer treatment decision. Pre-post design, with patients interviewed after diagnosis, and then after completing the CPtDA sometime later at their preoperative visit. Fifty-one female patients, who are low literate and naïve computer users, newly diagnosed with early stage breast cancer from two urban public hospitals. A computerized decision aid that combines entertainment-education (edutainment) with enhanced (factual) content. An interactive jewellery box is featured to assist women in: (1) recording and reflecting over issues of concern with possible treatments, (2) deliberating over surgery decision, and (3) communicating with physician and significant others. Patients' use of the jewellery box to store issues during completion of the CPtDA, and perceived clarity of values in making a treatment decision, as measured by a low literacy version of the Decisional Conflict Scale (DCS). Over half of the participants utilized the jewellery box to store issues they found concerning about the treatments. On average, users flagged over 13 issues of concern with the treatments. Scores on the DCS Uncertainty and Feeling Unclear about Values subscales were lower after the intervention compared to before the decision was made. A values clarification exercise using an interactive jewellery box may be a promising method for promoting informed treatment decision making by low literacy breast cancer patients.

Defining, Navigating, and Negotiating Success: The Experiences of Mid-Career Robert Wood Johnson Clinical Scholar Women

We studied female graduates of the Robert Wood Johnson Clinical Scholars Program (CSP, Class of 1984 to 1989) to explore and describe the complexity of creating balance in the life of mid-career academic woman physicians. We conducted and qualitatively analyzed (kappa 0.35 to 1.0 for theme identification among rater pairs) data from a semi-structured survey of 21 women and obtained their curricula vitae to quantify publications and grant support, measures of academic productivity. Sixteen of 21 (76%) women completed the survey. Mean age was 48 (range: 45 to 56). Three were full professors, 10 were associate professors, and 3 had left academic medicine. Eleven women had had children (mean 2.4; range: 1 to 3) and 3 worked part-time. From these data, the conceptual model expands on 3 key themes: (1) defining, navigating, and negotiating success, (2) making life work, and (3) making work work. The women who described themselves as satisfied with their careers (10/16) had clarity of values and goals and a sense of control over their time. Those less satisfied with their careers (6/16) emphasized the personal and professional costs of the struggle to balance their lives and described explicit institutional barriers to fulfillment of their potential. For this group of fellowship-prepared academic women physicians satisfaction is achieving professional and personal balance.

Incentive effects on cardiovascular reactivity in active coping with unclear task difficulty

Two experiments with a total of 96 participants assessed cardiovascular response in active coping. The studies were run in 2 × 2 designs and manipulated the clarity of task difficulty (clear vs. unclear) and incentive value (low vs. high) of a memory task, which was either easy (Experiment 1) or extremely difficult (Experiment 2). In accordance with the theoretical predictions of motivational intensity theory [Brehm, J.W., Self, E.A., 1989. The intensity of motivation. Annu. Rev. Psychol. 40, 109–131; Wright, R.A., 1996. Brehm's theory of motivation as a model of effort and cardiovascular response. In: Gollwitzer, P.M., Bargh, J.A. (Eds.), The Psychology of Action: Linking Cognition and Motivation to Behaviour, Guilford, New York, pp. 424–453], systolic reactivity varied directly with incentive value when task difficulty was unclear. In contrast, when task difficulty was clear, incentives had no influence and cardiovascular reactivity was low. These findings provide the first evidence for the predictions of motivational intensity theory with regard to unclear task difficulty and complete past research that has focused on the effects of fixed and unfixed task difficulty on cardiovascular reactivity.

Quality assessment of the visits of pharmaceutical company representatives to hospital pharmacists.

To evaluate whether the quality of pharmaceutical company representatives' (PCRs) visits to hospital pharmacists can be improved by written communication of the results of an evaluation of their visits. Pilot study with prospective evaluation of overall visit quality and strength of request for adding drugs to the hospital formulary, and of the scientific quality of products presentations using a standardized form. Two one-year study periods (59 vs. 61 visits) separated by the intervention (global results of the first period sent to each drug company). No difference was observed between both periods in overall visit quality (VAS 0 = null, 10 = excellent: mean 4.7 (2.1 SD) vs. 5.2 (2.1) or strength of request for adding drug to hospital formulary (VAS 0 = null, 10 = extreme: 7.0 [2.6] vs. 7.2 [2.7]). Clarity and scientific value of products' presentations and scientific value of responses were better during the second study period, as a sign of quality improvement. This study suggests that systematic quality evaluation of PCRs visits and communication of results to drug companies may improve the scientific quality of products' presentation.

Meeting the Maasai

This article reflects on implications of a brief ethnographic field trip to visit a remote Maasai clan in Northern Kenya. The author, approaching the inquiry from an interest in evolutionary psychology and the study of family business, conducted in-depth interviews with a range of elders, warriors, women, and children, asking questions relating to the intersection of kinship, culture, and organization. The reflections take the form of eight messages for management. These relate to such themes as the relationship between social harmony and the clarity and simplicity of social structure, collectivist values and stewardship models of leadership, the role of mythical beliefs in sustaining cultural integrity, the fragility of strong cultures to certain kinds of change, and the ethical challenges and dilemmas posed by some of the factors that help to sustain them. The article concludes by emphasizing the degree to which one can choose how to configure business cultures to generate outcomes that one regards as desirable and ethical.

Creating an Advanced Practice Nurse–friendly Culture

Advanced practice nurses (APNs) have extraordinary opportunities in acute and critical care settings. However, new obstacles accompany these opportunities and these obstacles can needlessly hamper APN practice and reduce the APN's contributions to patient care. Contributions by APNs can be maximized by deliberately and thoughtfully creating a practice culture that is APN-friendly. This article analyzes eight characteristics important to creating the APN-friendly culture: clarity of vision and values, commitment, communication, collaboration, credibility, contributions, confidence, and complexity. Creating an APN-friendly culture is a worthwhile organizational investment in order to enhance optimal APN practice and to benefit patients and families.

Ethical Guidlines in the Treatment of Compulsive Sexual Behavior

Counselors who treat clients for compulsive sexual behavior often encounter challenging ethical decisions that are not fully addressed by professional codes of conduct. This article describes six core concepts that can provide a meaningful and efficient framework for a counselor to independently evaluate ethically challenging situations. These core concepts provide informed consent, operate in a competent and theoretically sound manner, insure confidentiality, and maintain clarity of cultural and personal values. Special attention is devoted to confidentiality dilemmas including duty to warn/protect, HIV, minors, and family secrets, as well as counselor boundary issues such as self-disclosure, touch, sexual attraction, and a personal history of compulsive sexual behavior.

College of American Pathologists Conference XXXV: Solid tumor prognostic factors - Which, how and so what? Summary document and recommendations for implementation

The College of American Pathologists convened a prognostic factor conference in June 1999 to consider prognostic and predictive factors in breast, colon, and prostate cancer, and to stratify these factors into categories reflecting the strength of published evidence. Because so little progress in prognostic factor clinical utility has been made in the last 5 years, the conference participants focused their attention on decreasing variation in methods, interpretation, and reporting of these factors so that greater clarity of value could be achieved. The conference was organized to promote discussion, broad input, and future planning. An initial plenary session provided an overview of the status of tumor marker research, the impact of variation in medicine and pathology, and statistical issues related to prognostic factor research. In working group sessions for each cancer type, participants interactively evaluated and refined the documents created by the expert panels. A second plenary session dealt with issues common to all 3 groups, including the problem of micrometastases in lymph nodes in these sites; statistical issues that arose during the breakout discussions; and issues of variation in methods, interpretation, and reporting of immunohistochemical assays. A faculty session brainstormed strategies that could be used to implement the changes recommended. This session included invited representatives of the Food and Drug Administration, Health Care Financing Administration, Centers for Disease Control and Prevention, National Cancer Institute, American Joint Committee on Cancer, and International Union Against Cancer. Cancer site and general recommendations were presented and discussed during a final session to achieve consensus of the conference participants and to address feasibility of implementation of these recommendations. A final discussion focused on future initiatives that might lead to implementation of the changes proposed in the conference by the various organizations represented. This report summarizes the general conference recommendations, cancer working group recommendations, and plans for implementation of the recommendations.

The effects of an 'explicit' values clarification exercise in a woman's decision aid regarding postmenopausal hormone therapy.

OBJECTIVE: To evaluate the incremental effect of a graphic weigh-scale values clarification exercise to explicitly consider the personal importance of the benefits versus the risks in a woman's decision aid regarding postmenopausal hormone therapy. DESIGN: Randomized controlled trial. Intervention Decision aid including information on options, benefits and risks, and their probabilities either followed by: (1) a graphic weigh-scale values clarification exercise to explicitly consider the personal importance of each benefit and risk; or (2) a summary of the main benefits and risks to implicitly consider benefits versus the risks. SAMPLE: Two-hundred and one women aged 50-69 years from Ottawa, Canada, who had never used hormone therapy. OUTCOME: Perceived clarity of values, a sub-scale of the decisional conflict scale; congruence between personal values of benefits and risks (measured on 0-10 importance rating scale) and choices (accept, decline, unsure regarding preventive hormone therapy [HRT]) using discriminant function analysis. RESULTS: There were no statistically significant differences between interventions in perceived clarity of values and overall congruence between values and choices. Amongst those choosing HRT, there was a trend in those exposed to the graphic weigh-scale exercise to have better congruence between values and choices compared to implicit values clarification (P = 0.06). CONCLUSION: The use of the graphic weigh-scale exercise in a decision aid conveys no overall short-term benefit. Further study is needed to specifically determine effects in those changing the status quo and on the quality of patient-practitioner communication and persistence with decisions.

Confusing debriefing and defusing postnatally: The need for clarity of terms, purpose and value

Postnatal debriefing is being recommended in the literature. However, there is little clarity of terminology and there has been no systematic evaluation of this technique. The latter is urgently needed.