Decision Confidence Research Articles

Orthognathic patient perception of 3D facial soft tissue prediction planning

The primary aim of this study was to explore patients’ perceptions regarding the impact of 3D prediction planning (3D PP) of facial soft tissue changes following orthognathic surgery.The study was carried out on 30 patients who were shown photorealistic 3D soft tissue prediction planning before undergoing orthognathic surgery to demonstrate the expected facial changes. Distraction osteogenesis and cleft deformities were excluded from the study before consenting to surgery. Following surgery, the included patients were asked to complete a standard questionnaire to explore their perceptions regarding the impact, accuracy, and value of 3D prediction planning.The majority of the 30 participants perceived 3D PP to be beneficial in reducing their presurgical anxiety, increasing their motivation to undergo surgery, improving the accuracy of their surgical expectations, and enhancing doctor–patient communication. Most of the patients perceived their surgical soft tissue changes to be better than the predictions. Significant positive correlations were detected between satisfaction with the delivered service and the facility of seeing 3D PP (rs = 0.4; p = 0.034). Similarly, 3D PP improved patients’ confidence in the surgical decision (rs = 0.4; p = 0.031), as well as increasing their motivation to undergo surgery (rs = 0.5; p = 0.010).3D PP was found to be effective in improving the quality of orthognathic surgical care.

ANALISIS FAKTOR-FAKTOR YANG MEMPENGARUHI KEPERCAYAAN PELANGGAN TERHADAP KEPUTUSAN PELANGGAN DALAM PENITIPAN JASA INAP HEWAN PELIHARAAN DI JUNIOR PETSHOP KOTA LUBUKLINGGAU

The purpose of this study is to determine what factors influence customer confidence in customer decisions in pet inpatient care services at Junior Petshop, Lubuklinggau City. Data collection was carried out by observation and interviews. Data analysis using descriptive. The results of the study are what factors influence customer confidence in customer decisions in pet inpatient care services at Junior Petshop, Lubuklinggau City. Judging from trust, it is influenced by factors such as reputation and perceived quality. Reputation can be important to build a consumer's trust in the seller because the consumer does not have personal experience with the seller. Reputation by word of mouth can also be the key to consumer interest. The appearance and design of the company can also influence the first impression that is formed. Meanwhile, the factors that influence customer decisions are caused by cultural factors, social factors and personal factors. Cultural factors include nationality, religion, racial group and geographic area. Social factors are influenced by the reference group, family, and the role and social status of the community, while personal factors include age and life cycle stage, occupation, economic conditions, lifestyle, and the buyer's personality and self-concept.

Public perceptions of scientific advice: toward a science savvy public culture?

ObjectivesBoth the political appetite for a science-based coronavirus disease 2019 (COVID-19) policy and its acceptability to the public are little understood, at a time of sharp distrust not only of governments but also of scientists and their journals' review practices. We studied the case of France, where the independent Scientific Council on COVID-19 was appointed by President Macron on March 12, 2020. Study designWe conducted a survey on a representative sample of the French adult population. MethodsOur data were collected by the French Institute of Public Opinion using a self-administered online questionnaire. This was completed by a sample of 1016 people stratified to match French official census statistics for gender, age, occupation, and so on. We conducted statistical analysis using Python (Pandas—SciPy—Statsmodels) with Chi-squared and Wilcoxon rank-sum tests to control for statistical significance. ResultsIntense media coverage has given the council a very high public profile, with three respondents out of four (73%) having heard about it. Perceptions are positive but complex. French citizens expect science to be important in political decision-making. Four of five (81.5%) want political decisions, in general, to be based on scientific knowledge. But one in two (55%) says that the government has not relied enough on science and only 36% are satisfied with the government's crisis management to date. Although most feel that the council has a legitimate advisory role even in situations of uncertainty (only 15% disagree), it is not perceived as fully independent. Only 44% think that it directly represents the scientific community, and only one of three people considers it completely independent from the government (39%) and the pharmaceutical industry (36%). ConclusionsOur study confirms that while the transparency of scientific advice is important, it alone cannot ensure public confidence in political decision-making. We suggest that efforts made today to instill a ‘science-savvy’ public culture—one that allows the complex articulation between scientific knowledge, uncertainty, and political decision-making to be understood and accounted for would greatly benefit evidence-based policy in future crises.

Impact of the Vega Healthcare Provider Report on Provider Satisfaction and Decision-Making Confidence in Simulated Patient Portal Visits for Migraine (2090)

Impact of the Vega Healthcare Provider Report on Provider Satisfaction and Decision-Making Confidence in Simulated Patient Portal Visits for Migraine (2090)

Strategies of attack–defense game for wireless sensor networks considering the effect of confidence level in fuzzy environment

It is a common case that Wireless Sensor Networks are attacked by malware in the real world. According to the game theory, the action of attack–defense between Wireless Sensor Network(WSN) and malware can be regarded as a game. While substantial efforts have been made to address this issue, most of these efforts have predominantly focused on the analysis of attack–defense game in the known environment. Given that the process of gaming in real world often contains a lot of fuzzy information, we extend the focus in this line by considering the fuzzy exterior environment. Specifically, we assume the WSN attack–defense Stackelberg game is in the fuzzy environment by using fuzzy variable. Then Stackelberg game theory is utilized to calculate the equilibrium solutions of the introduced maximax chance-constrained model and minimax chance-constrained model. Based on the simulation data, this study demonstrates the confidence levels and decision perspectives affect the optimal strategy of WSN and the reliability of WSN. Finally, the novel analytical method is compared with the non-fuzzy WSN attack–defense game method. The analysis shows that the novel approach is optimal in terms of predicting the behavior of malware in resisting the attack of malware.

Experience of using video support by prehospital emergency care physician in ambulance care - an interview study with prehospital emergency nurses in Sweden

IntroductionWhen in need of emergency care and ambulance services, the ambulance nurse is often the first point of contact for the patient with healthcare. This role requires comprehensive knowledge of the ambulance nurse to be able to assign the right level of care and, if necessary, to provide self-care advice for patients with no further conveyance to hospital. Recently, an application was developed for transmitting real-time video to facilitate consultation between ambulance nurses and prehospital physicians in the role of regional medical support (RMS) for ambulance care. The use of video communication as a complement of medical support when referring to self-care is still an unexplored method in a prehospital setting.Our study aimed to elucidate ambulance nurses’ experience of video consultation with RMS physician during the assessment of patients considered to be triaged to self-care.MethodWe conducted a qualitative design study using semi-structured interviews with open questions. Twelve ambulance nurses were included in the study. To explore the ambulance nurses’ experience of performing video consultation with RMS physician, in cases when a patient was assessed and triaged to self-care, a content analysis was performed.ResultsA main category emerged from the results: “ Video consultation as decision support in the ambulance care promotes increased patient participation and for the ambulance nurses, it creates a feeling of increased patient safety “. The main category was based and formed on the following categories: “ Simultaneous presence of ambulance nurse and a physician increases patient participation during the assessment resulting in a confident care decision “. “Interprofessional collaboration strengthens the medical assessment”. “Video technology promotes accessibility for patients needs in the ambulance care regardless of emergency level”.ConclusionsAmbulance nurses experienced that the use of video consultation increases patient involvement and confidence in healthcare when both the ambulance nurse and the physician were present when deciding on self-care advice. The live imaging allowed the ambulance nurse and prehospital physician to reach a consensus on the patient’s current medical care needs, which in turn led to a feeling of increased patient safety for the ambulance nurses.

Pupil Dilation and the Slow Wave ERP Reflect Surprise about Choice Outcome Resulting from Intrinsic Variability in Decision Confidence.

Central to human and animal cognition is the ability to learn from feedback in order to optimize future rewards. Such a learning signal might be encoded and broadcasted by the brain’s arousal systems, including the noradrenergic locus coeruleus. Pupil responses and the positive slow wave component of event-related potentials reflect rapid changes in the arousal level of the brain. Here, we ask whether and how these variables may reflect surprise: the mismatch between one’s expectation about being correct and the outcome of a decision, when expectations fluctuate due to internal factors (e.g., engagement). We show that during an elementary decision task in the face of uncertainty both physiological markers of phasic arousal reflect surprise. We further show that pupil responses and slow wave event-related potential are unrelated to each other and that prediction error computations depend on feedback awareness. These results further advance our understanding of the role of central arousal systems in decision-making under uncertainty.

The roles of sensory perceptions and mental imagery in consumer decision-making

The current study examines the relationship between sensory perceptions and mental imagery and the mechanism through which sensory perceptions and mental imagery influence behavioral intent in store-based retailing. An online survey was conducted with in-store purchasers (N = 455). The results showed a significant correlation between sensory perceptions and mental imagery. Supporting the sensory marketing framework, both sensory perceptions and mental imagery indirectly influenced behavioral intent via anticipatory emotion and decision confidence. No direct relationships between sensory perceptions and behavioral intent, and between mental imagery and behavioral intent were found. Supporting Construal Level Theory, sensory perceptions had consistently stronger influences on consumer responses than mental imagery, while the underlying process was identical between sensory perceptions and imagery. The findings from this study shed new light onto sensory research and offer relevant managerial implications to enhance in-store shopping experiences.

Are children\u2019s judgments of another\u2019s accuracy linked to their metacognitive confidence judgments?

The world can be a confusing place, which leads to a significant challenge: how do we figure out what is true? To accomplish this, children possess two relevant skills: reasoning about the likelihood of their own accuracy (metacognitive confidence) and reasoning about the likelihood of others’ accuracy (mindreading). Guided by Signal Detection Theory and Simulation Theory, we examine whether these two self- and other-oriented skills are one in the same, relying on a single cognitive process. Specifically, Signal Detection Theory proposes that confidence in a decision is purely derived from the imprecision of that decision, predicting a tight correlation between decision accuracy and confidence. Simulation Theory further proposes that children attribute their own cognitive experience to others when reasoning socially. Together, these theories predict that children’s self and other reasoning should be highly correlated and dependent on decision accuracy. In four studies (N = 374), children aged 4–7 completed a confidence reasoning task and selective social learning task each designed to eliminate confounding language and response biases, enabling us to isolate the unique correlation between self and other reasoning. However, in three of the four studies, we did not find that individual differences on the two tasks correlated, nor that decision accuracy explained performance. These findings suggest self and other reasoning are either independent in childhood, or the result of a single process that operates differently for self and others.

Contrasting profiles of product returners and keepers

Purpose This paper aims to investigate whether the consumers who return a product and those who end up keeping a product after experiencing post-purchase dissonance (PPD) possess distinct underlying characteristics. Design/methodology/approach Field survey study consisting of two separate surveys conducted with consumers of New York City and neighboring areas of New York and New Jersey. Findings Product returners and keepers exhibited disparate demographic profiles regarding gender and household income, along with ethnicity to some extent. The two groups also exhibited different predispositions with regard to confidence in the purchase decision and expectations about their purchase. Finally, returners and keepers were engaged in divergent thoughts, feelings and activities to cope with PPD. Practical implications The findings of this study offer marketing practitioners new knowledge and insight into understanding product returners and keepers and will assist them in developing strategies to reduce and manage increasing product returns by consumers more effectively. Originality/value This study is the first to present empirical evidence that product returners and keepers have distinct profiles of demographic characteristics and predispositions toward purchase. The study also has found divergent PPD coping strategies used by the two types of consumers, which exposes an obsolete understanding of PPD in the marketing literature.

The Level of Consumer Confidence in the Purchase Decision of Hotel and Restaurant Tourism Products

The existence of the COVID-19 pandemic has affected the tourism industry, including the purchase of hotel and restaurant services. This study aims to determine the level of consumer confidence in purchasing decisions for hotel and restaurant tourism products. The research method used is descriptive quantitative with a questionnaire instrument and data collection techniques using questionnaires, interviews. The population used in this study is respondents who use hotel and restaurant services in Jabodetabek with various demographics of the work of trainers, consultants and practitioners, but preferably 90 people who are accustomed to using these services. The sample used is saturated sample, so that the entire population becomes a sample of 90 respondents. The results showed that the coefficient of determination or R Square was 0.766. that is, the variable under study explains 76.6% and the remaining 23.4% is explained by other variables not examined in this study. The results of the research on the level of consumer confidence in the decision to purchase hotel and restaurant products during the Covid 19 pandemic, obtained a determination coefficient value of 76.6%. It can be concluded that the level of consumer confidence in purchasing decisions during the Covid 19 period. Consumers who decide to purchase hotel and restaurant tourism products for the purpose of work, travel, and refreshing or traveling. The purpose of purchasing hotel tourism products is dominant with the aim of West Java as much as 27%. Meanwhile, the destination for purchasing restaurant tourism products is dominant in the Jakarta area as much as 33%. Hotel and restaurant service providers continue to use the application of health protocols.

Info-Gap Models for Optimal Multi-Year Management of Regional Water Resources Systems under Uncertainty

The common practices for the planning and management of Water Resources Systems (WSSs) have been challenged in the last few decades by global climate change processes, which are observed around the world in increasing frequencies. Climate change is manifested by climate variability, temperature increase, and extreme events such as droughts and floods, which have a decisive effect on natural resource availability and in turn on water quality. Historical records may not be sufficient to reliably account for uncertain future predictions under climate change conditions. While such highly uncertain situations become the “normal” case worldwide, the traditional practices of probabilistic risk measures cannot be used to appropriately quantify the uncertain phenomena under non-stationarity conditions. To better account for uncertain future conditions, the objective of this study is to develop a water management model based on Info-Gap Decision Theory (IGDT) using optimization under deep uncertainty conditions. The Info-Gap theory is a framework that measures the confidence in the operational decisions by quantifying the robustness to uncertainty without accounting for any probabilistic data. To demonstrate the method as a tool to better guide the long-term sustainable operation of the water supply system under uncertain future conditions, we applied the Info-Gap model to the Sea of Galilee (SoG) regional WSS, which is a significant part of the Israeli National Water System (INWS). For Israel, which is, like other Middle East semi-arid regions, prone to dry conditions and limited water availability, there are well-founded concerns that prolonged periods of drought lie ahead, as a consequence of the global climate change processes. This study contributes a management tool for decision making under deep uncertainty to improve the decision-making process and better adapt to unpredictable uncertain future conditions. We demonstrate how the IGDT could be formulated and used to analyze WSSs under different settings and demonstrate how decisions could be derived from the IGDT formulation. We also show a sensitivity analysis for the obtained solutions.

Conducting Real-world Evidence Studies on the Clinical Outcomes of Diabetes Treatments.

Real-world evidence (RWE), the understanding of treatment effectiveness in clinical practice generated from longitudinal patient-level data from the routine operation of the healthcare system, is thought to complement evidence on the efficacy of medications from randomized controlled trials (RCTs). RWE studies follow a structured approach. (1) A design layer decides on the study design, which is driven by the study question and refined by a medically informed target population, patient-informed outcomes, and biologically informed effect windows. Imagining the randomized trial we would ideally perform before designing an RWE study in its likeness reduces bias; the new-user active comparator cohort design has proven useful in many RWE studies of diabetes treatments. (2) A measurement layer transforms the longitudinal patient-level data stream into variables that identify the study population, the pre-exposure patient characteristics, the treatment, and the treatment-emergent outcomes. Working with secondary data increases the measurement complexity compared to primary data collection that we find in most RCTs. (3) An analysis layer focuses on the causal treatment effect estimation. Propensity score analyses have gained in popularity to minimize confounding in healthcare database analyses. Well-understood investigator errors, like immortal time bias, adjustment for causal intermediates, or reverse causation, should be avoided. To increase reproducibility of RWE findings, studies require full implementation transparency. This article integrates state-of-the-art knowledge on how to conduct and review RWE studies on diabetes treatments to maximize study validity and ultimately increased confidence in RWE-based decision making.

Do performance-monitoring related cortical potentials mediate fluency and difficulty effects on decision confidence?

It remains unclear to what extent the performance-monitoring (PM) processes involved in perceptual decisions are also involved in more complex reasoning decisions. To address this problem, we examined whether PM-related cortical potentials known to correlate with confidence ratings in the context of simple perceptual decisions also correlate with confidence ratings in a more complex reasoning task. In an EEG experiment, 49 participants had to quickly decide whether an equation (e.g. 9 * 7 = 65) was correct or incorrect and then report their confidence in that decision. Task difficulty and response fluency were varied to manipulate confidence. Pooling responses across correct as well as incorrect trials, we analyzed amplitudes of Error-Related Negativity (pooled ERN) and Error Positivity (pooled Pe). We found that pooled ERN but not pooled Pe had a positive significant correlation with decision confidence and that unpooled ERN correlated with confidence for correct, but not for error trials. Further analysis indicated that although pooled ERN correlated with task difficulty, neither pooled or unpooled potentials mediated the effects of difficulty or fluency on confidence. These results suggest that pooled ERN might reflect implicit performance monitoring and that confidence for simple perceptual and complex reasoning decisions may rely on different neural mechanisms.

The confident conservative: Ideological differences in judgment and decision-making confidence.

In this research, we document the existence of broad ideological differences in judgment and decision-making confidence and examine their source. Across a series of 14 studies (total N = 4,575), we find that political conservatives exhibit greater judgment and decision-making confidence than do political liberals. These differences manifest across a wide range of judgment tasks, including both memory recall and "in the moment" judgments. Further, these effects are robust across different measures of confidence and both easy and hard tasks. We also find evidence suggesting that ideological differences in closure-directed cognition might in part explain these confidence differences. Specifically, conservatives exhibit a greater motivation to make rapid and efficient judgments and are more likely to "seize" on an initial response option when faced with a decision. Liberals, conversely, tend to consider a broader range of alternative response options before making a decision, which in turn undercuts their confidence relative to their more conservative counterparts. We discuss theoretical implications of these findings for the role of ideology in social judgment and decision-making. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The role of decision confidence in advice-taking and trust formation.

In a world where ideas flow freely across multiple platforms, people must often rely on others' advice and opinions without an objective standard to judge whether this information is accurate. The present study explores the hypothesis that an individual's internal decision confidence can be used as a signal to learn the accuracy of others' advice, even in the absence of feedback. According to this "agreement-in-confidence" hypothesis, people can learn about an advisor's accuracy across multiple interactions according to whether the advice offered agrees with their own initial opinions, weighted by the confidence with which these initial opinions are held. We test this hypothesis using a judge-advisor system paradigm to precisely manipulate the profiles of virtual advisors in a perceptual decision-making task. We find that when advisors' and participants' judgments are independent, people can correctly learn advisors' features, like their accuracy and calibration, whether or not objective feedback is available. However, when their judgments (and thus errors) are correlated-as is the case in many real social contexts-predictable distortions in trust can be observed between feedback and feedback-free scenarios. Using agent-based simulations, we explore implications of these individual-level heuristics for network-level patterns of trust and belief formation. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

What Radiologist Should Know about MRI Translational Forces and Hazard: An Ex-Vivo Simulation of Retained Metallic Shrapnel.

Background In a country immersed in endless rounds of wars, retained metallic foreign bodies remain a significant dilemma in the daily practice of every Lebanese radiologist. When a shrapnel's hazard is of concern, the decision between performing or refusing a justified MRI exam is not always straightforward. In this small trial, we aimed to better understand the shrapnel's MRI safety by mimicking our daily practice. Methods Five shrapnel with an incremental increase in their long axis were put in an animal flesh and then introduced into a 3 T magnetic field. The behavior of each shrapnel was concretely assessed by performing before and after magnetic field exposure CT acquisitions. Results Translation along the z-axis ranged from 0.9 mm to 2.8 mm. Torque angle ranged between 2.8 and 54 degrees with an average of 15.62 degrees. Conclusions Shrapnel's movements in the magnetic field are not negligible during the acute phase of injury where there is no reinforcing fibroblastic reaction and invite us to reconsider the MRI safety of these metallic foreign bodies. Standard radiographs may be sufficient, but a targeted CT scan may be of better value for a confident decision for assessment of shrapnel position near viscera and major vessels.

Ventromedial Prefrontal Cortex Activity and Sympathetic Allostasis During Value-Based Ambivalence.

Anxiety is characterized by low confidence in daily decisions, coupled with high levels of phenomenological stress. Ventromedial prefrontal cortex (vmPFC) plays an integral role in maladaptive anxious behaviors via decreased sensitivity to threatening vs. non-threatening stimuli (fear generalization). vmPFC is also a key node in approach-avoidance decision making requiring two-dimensional integration of rewards and costs. More recently, vmPFC has been implicated as a key cortical input to the sympathetic branch of the autonomic nervous system. However, little is known about the role of this brain region in mediating rapid stress responses elicited by changes in confidence during decision making. We used an approach-avoidance task to examine the relationship between sympathetically mediated cardiac stress responses, vmPFC activity and choice behavior over long and short time-scales. To do this, we collected concurrent fMRI, EKG and impedance cardiography recordings of sympathetic drive while participants made approach-avoidance decisions about monetary rewards paired with painful electric shock stimuli. We observe first that increased sympathetic drive (shorter pre-ejection period) in states lasting minutes are associated with choices involving reduced decision ambivalence. Thus, on this slow time scale, sympathetic drive serves as a proxy for “mobilization” whereby participants are more likely to show consistent value-action mapping. In parallel, imaging analyses reveal that on shorter time scales (estimated with a trial-to-trial GLM), increased vmPFC activity, particularly during low-ambivalence decisions, is associated with decreased sympathetic state. Our findings support a role of sympathetic drive in resolving decision ambivalence across long time horizons and suggest a potential role of vmPFC in modulating this response on a moment-to-moment basis.

The Effect of a Complementary Therapy Education Seminar on Support Persons of Individuals with Cancer.

Objectives: Complementary therapy (CT) use is prevalent among individuals living with cancer, who often consult family and friends (i.e., support persons) in making decisions about CT. This study examines the effect of an education seminar for adult cancer patients and support persons on the support persons' use, knowledge, and decision-making processes related to CT. Design: A patient education seminar that included support persons was developed and evaluated as part of a CT decision support research program. Survey data were collected before and after the education seminar to examine its impact on support persons' knowledge and use of CT, as well as their engagement in the CT decision-making process. Setting: The study was conducted in Western Canada. Subjects: 62 adult support persons. Interventions: Participants attended a 4-h CT education seminar at one in four provincial cancer centers. The seminar provided recommendations regarding how to make informed decisions about CT, where to find credible information, and key issues to consider to avoid potential risks of CT use. The evidence related to popular CT was also reviewed. Outcome Measures: The primary outcome was support persons' CT knowledge. Secondary outcomes included CT use, information-seeking behavior, decision self-efficacy, decision conflict, and distress. Results: A significant increase in support persons' CT knowledge was observed, as well as improved confidence in CT decision making. There was no significant difference in participants' CT use following the education seminar. Most indicated they would continue to locate information about CT using the Internet. A significant decrease in support persons' decisional conflict was reported; however, there were no significant change in distress related to CT decision making. Conclusions: This study demonstrates the importance of including support persons in patient education related to CT and the positive impact on their knowledge and treatment decision-making processes. No significant change in CT use, information seeking behavior and distress related to CT decisions, however, was observed in the study.

Abstract PS4-27: A prospective multicenter study evaluating the impact of the 21-Gene Breast Recurrence Score® upon physician treatment decision and cost in lymph node-positive breast cancer patients in Quebec

Abstract Background: Locoregional lymph node involvement has historically been used as the most important deciding factor for the administration of chemotherapy in the adjuvant setting of breast cancer patients. The 21-gene Breast Recurrence Score® assay (the assay) is emerging as an important tool to assist with chemotherapy decisions amongst hormone receptor (HR)-positive, node-positive breast cancer (BC) patients. Previous studies have suggested that node-positive patients with low Recurrence Score (RS) results do not benefit from chemotherapy. We wanted to better understand the impact of the assay upon physician treatment decisions and treatment cost in this patient cohort. Methods: We conducted a multicenter prospective observational trial for ER/PR-positive HER2-negative BC patients that have undergone surgical treatment for T1-T3 disease and 1-3 positive lymph nodes. Physicians were required to complete a questionnaire indicating treatment choice prior to and post availability of Recurrence Score results. Patients were enrolled in the study from the time of consent to 6 months after the start of adjuvant therapy. The primary endpoint was change in the physician’s recommendation for chemotherapy prior to and post assay results. Secondary endpoints include the change in recommendation for additional growth factor (GF) supportive therapy, change in physician’s expressed level of confidence, and changes in estimated cost of recommended treatments prior to and post assay results. Results: 70 patients were enrolled between March 2018 and September 2019 at five hospital centers, as part of the McPeak Sirois Group of Quebec. The median age of the cohort was 61 years (range, 38 to 82 years). 18.5% (n=13) of the cohort consisted of patients < 50 years, and 81.4% (n=57) were > or = to 50 years. 64.3% (n=45) of the patients had one positive lymph node and 35.7% (n=25) of the patients had 2 or 3 positive lymph nodes. 25.7% (n=18) of the patients had a RS < 11 and 68.6% (n=48) had a RS result between 11-25. For the entire cohort, we found that the proportion of patients for whom chemo-hormonal therapy was recommended was reduced by an absolute 67.1% by knowledge of the RS result (OR (odds of having chemo-hormonal therapy post-RS recommendation versus pre-RS recommendation) = 0.03 [95% CI: 0.01-0.08]; P<0.0001). The RS results led to an absolute reduction in physician recommendation in chemo-hormonal therapy by 38.5% for patients < 50 years, and by 73.7% of patients (OR=0.02 [95% CI: 0.01-0.06]; P <0.0001) for patients > or = to 50 years. Changes in treatment recommendation were identified for patients with one positive node, 73.3% (OR=0.02 [95% CI: 0.01-0.07]; P<0.0001); and for patients with two or three positive nodes, 56.0% (OR=0.06 [95% CI: 0.02-0.23]; P<0.0001). Recommendations for GF supportive therapy due to RS results decreased by 42.6% (OR=0.16 [95% CI: 0.07-0.34]; P <0.0001). Moreover, RS results led to an increase in confidence in physician treatment decisions for 68.6% of patients (OR=18.3 [95% CI: 7.90-42.28]; P <0.0001). We found that the cost of chemotherapy, in addition to anti-emetics and GF supportive therapy, decreased by 69.9% per patient (pre-RS mean, $3,968 CAN; versus post-RS mean, $1,196 CAN) (P <0.0001). Conclusions: Overall, we found that the 21-gene Breast Recurrence Score® assay changed physician treatment decisions in about two-thirds of all patients with hormone receptor-positive, node-positive BC, regardless of the number of positive nodes (up to 3). The assay increased physician confidence and was associated with an important decrease in treatment cost. Taken together, the assay is a cost-effective approach that can decrease the use of chemotherapy amongst HR-positive, node-positive BC patients in Quebec. Citation Format: Saima Hassan, Rami Younan, Erica Patocskai, Louise Provencher, Brigitte Poirier, Lucas Sideris, Pierre Dubé, Jean-Francois Boileau, Catalin Mihalcioiu, André Robidoux. A prospective multicenter study evaluating the impact of the 21-Gene Breast Recurrence Score® upon physician treatment decision and cost in lymph node-positive breast cancer patients in Quebec [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS4-27.