Randomized Vignette Study Research Articles

Understanding Physician's Perspectives on AI in Health Care: Protocol for a Sequential Multiple Assignment Randomized Vignette Study.

As the availability and performance of artificial intelligence (AI)-based clinical decision support (CDS) systems improve, physicians and other care providers poised to be on the front lines will be increasingly tasked with using these tools in patient care and incorporating their outputs into clinical decision-making processes. Vignette studies provide a means to explore emerging hypotheses regarding how context-specific factors, such as clinical risk, the amount of information provided about the AI, and the AI result, may impact physician acceptance and use of AI-based CDS tools. To best anticipate how such factors influence the decision-making of frontline physicians in clinical scenarios involving AI decision-support tools, hypothesis-driven research is needed that enables scenario testing before the implementation and deployment of these tools. This study's objectives are to (1) design an original, web-based vignette-based survey that features hypothetical scenarios based on emerging or real-world applications of AI-based CDS systems that will vary systematically by features related to clinical risk, the amount of information provided about the AI, and the AI result; and (2) test and determine causal effects of specific factors on the judgments and perceptions salient to physicians' clinical decision-making. US-based physicians with specialties in family or internal medicine will be recruited through email and mail (target n=420). Through a web-based survey, participants will be randomized to a 3-part "sequential multiple assignment randomization trial (SMART) vignette" detailing a hypothetical clinical scenario involving an AI decision support tool. The SMART vignette design is similar to the SMART design but adapted to a survey design. Each respondent will be randomly assigned to 1 of the possible vignette variations of the factors we are testing at each stage, which include the level of clinical risk, the amount of information provided about the AI, and the certainty of the AI output. Respondents will be given questions regarding their hypothetical decision-making in response to the hypothetical scenarios. The study is currently in progress and data collection is anticipated to be completed in 2024. The web-based vignette study will provide information on how contextual factors such as clinical risk, the amount of information provided about an AI tool, and the AI result influence physicians' reactions to hypothetical scenarios that are based on emerging applications of AI in frontline health care settings. Our newly proposed "SMART vignette" design offers several benefits not afforded by the extensively used traditional vignette design, due to the 2 aforementioned features. These advantages are (1) increased validity of analyses targeted at understanding the impact of a factor on the decision outcome, given previous outcomes and other contextual factors; and (2) balanced sample sizes across groups. This study will generate a better understanding of physician decision-making within this context. DERR1-10.2196/54787.

The effects of peer inclusion in the design and implementation of university prison programming: A participatory action research, randomized vignette study.

Objective: Including people most impacted by a challenge in designing and implementing solutions to that challenge has reemerged in social science research. In prison settings, academics' outside knowledge of "what works" combined with incarcerated people's inside knowledge of lived experience could lead to more comprehensive rehabilitative programs. This combined approach may make less sense as an intervention in prison, however, due to sensitive and complicated interpersonal dynamics. We determine if incarcerated women perceive prison programs as more efficacious when other incarcerated women are collaboratively involved in the design and implementation of those programs, as compared to other program delivery methods. Methods: We employ a participatory action research framework in administering a randomized vignette to 200 incarcerated women. We randomize who designs and teaches a prison program in a hypothetical scenario, with incarcerated women alongside university researchers the key combined condition of interest. We then ask a series of questions regarding incarcerated women's perception of the program's efficacy. Results: Women who received the combined condition were four times more likely to view the program as legitimate when compared to programs taught by correctional staff. The combined condition was not significantly different on legitimacy when compared to either researchers alone or incarcerated women alone. We did not observe other expected relationships between the combined condition and perceived program efficacy. Conclusions and Implications for Practice: Researcher and incarcerated person-led programming should be implemented carefully in institutional settings to leverage the value of lived experience while avoiding creating further harm for confined people. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Community Perspectives on Patient Credibility and Provider Burden in the Treatment of Chronic Pain.

This study examined factors influencing lay perceptions of a provider's clinical burden in providing care to a person with chronic pain. In a between-subjects design that varied three levels of pain severity (4, 6, or 8 out of 10) with two levels of medical evidence (low/high), participants rated the credibility of pain reported by a hypothetical patient and the psychosocial factors expected to mediate the effects of evidence and severity on a provider's burden of care. A randomized vignette study in which community participants were recruited via Amazon Mechanical Turk. 337 community participants. Using a Qualtrics platform, participants read one of six vignettes describing a hypothetical patient with varying levels of medical evidence and pain severity and then rated perceived pain severity, pain credibility, psychosocial variables, and burden. Serial mediation models accounted for all effects of medical evidence and pain severity on burden. Low medical evidence was associated with increased burden, as mediated through lower pain credibility and greater concerns about patient depression, opioid abuse, and learning pain management. Higher levels of reported pain severity were associated with increased burden, as mediated through greater pain discounting and concerns about opioid abuse. The lay public is skeptical of chronic pain that is not supported by medical evidence or is reported at high levels of severity, raising concerns about psychosocial complications and drug seeking and expectations of higher burden of care. Such negative stereotypes can pose obstacles to people seeking necessary care if they or others develop a chronic pain condition.

Words matter: Labelling, bias and stigma in nursing

Words matter: Labelling, bias and stigma in nursing

Physicians’ Recognition and Management of Kidney Disease: A Randomized Vignette Study Evaluating the Impact of the KDIGO 2012 CKD Classification System

Rationale & ObjectiveThe Kidney Disease Outcome Quality Initiative (KDOQI) and Kidney Disease: Improving Global Outcomes (KDIGO) chronic kidney disease (CKD) classification systems published in 2002 and 2012, respectively, are recommended worldwide and based on strong epidemiologic data. However, their impact on CKD recognition and management is not well evaluated in clinical practice, and we therefore investigated whether they help physicians recognize and appropriately care for patients with CKD.Study DesignRandomized vignette experiment with fractional factorial design based on 6 kidney-related scenarios and 3 laboratory presentation methods reflecting the CKD guidelines. Participants evaluated 1 of 3 subsets of the 18 vignettes (ie, 6 vignettes each with 4 answer alternatives).Setting & Participants249 interns, general practitioners, and residents/fellows attending postgraduate meetings and courses in Norway and the United States.InterventionKidney-related results (serum creatinine level and urinary albumin excretion) were presented as the “minimal data” (high/low levels), KDOQI-2002 (estimated glomerular filtration rate [eGFR] reported automatically), or KDIGO-2012 (eGFR + albuminuria categorization + risk for complications) laboratory report.OutcomeCKD management choice by physicians.ResultsWhen kidney laboratory data were presented as the KDOQI-2002 report (automatic eGFR calculation), there was a significantly higher odds for correct patient management decisions compared with the minimal data report (OR, 1.57; P < 0.001). Additional significant improvement was obtained with the KDIGO-2012 report (OR, 2.28 for correct answer vs minimal data report [P < 0.001]; OR, 1.45 compared to KDOQI-2002 report [P = 0.005]). The KDIGO classification system improved physician management in 4 of the 6 clinical scenarios covering a wide range of kidney-related topics. Interaction analysis showed that general practitioners and those with 1 to 3 years of internal medicine experience had the greatest improvements with the new presentation techniques.LimitationsPhysicians’ management was evaluated by theoretical scenarios rather than direct patient care.ConclusionsAutomatic GFR estimation, albuminuria categorization, and notification of the associated risk for complications improve most physicians` recognition and management of a wide range of CKD clinical scenarios.

Perceptions of Same-Gender and Different-Gender Intimate Partner Cyber-Monitoring.

There is a paucity of research comparing perceptions of technology-facilitated partner monitoring or stalking between same-gender and different-gender relationships. As such, a randomized vignette study was conducted with 738 undergraduate students at a large Midwestern university, who read one of four stories of intimate partner cyber-monitoring (IPCM): same-gender IPCM with physical violence, same-gender IPCM without physical violence, different-gender IPCM with physical violence, and different-gender IPCM without physical violence. Results show that participants were significantly less likely to recommend the survivor break up with the abuser if the story described a same-gender relationship. If the story involved IPCM alone rather than also physical violence, participants were significantly less likely to label the abuse as "domestic violence," more likely to recommend doing nothing, and less likely to recommend most of the assessed protective actions-including being less likely to recommend asking the survivor to break up with the abuser, seeking help from friends and family, calling a domestic violence hotline, or calling the police. Results also indicate that IPCM is largely perceived to be less serious and less deserving of survivor support than physical intimate partner violence (IPV), for both same-gender and different-gender relationships. Implications for prevention education programming as well as research are discussed.

Do Words Matter? Stigmatizing Language and the Transmission of Bias in the Medical Record.

Clinician bias contributes to healthcare disparities, and the language used to describe a patient may reflect that bias. Although medical records are an integral method of communicating about patients, no studies have evaluated patient records as a means of transmitting bias from one clinician to another. To assess whether stigmatizing language written in a patient medical record is associated with a subsequent physician-in-training's attitudes towards the patient and clinical decision-making. Randomized vignette study of two chart notes employing stigmatizing versus neutral language to describe the same hypothetical patient, a 28-year-old man with sickle cell disease. A total of 413 physicians-in-training: medical students and residents in internal and emergency medicine programs at an urban academic medical center (54% response rate). Attitudes towards the hypothetical patient using the previously validated Positive Attitudes towards Sickle Cell Patients Scale (range 7-35) and pain management decisions (residents only) using two multiple-choice questions (composite range 2-7 representing intensity of pain treatment). Exposure to the stigmatizing language note was associated with more negative attitudes towards the patient (20.6 stigmatizing vs. 25.6 neutral, p < 0.001). Furthermore, reading the stigmatizing language note was associated with less aggressive management of the patient's pain (5.56 stigmatizing vs. 6.22 neutral, p = 0.003). Stigmatizing language used in medical records to describe patients can influence subsequent physicians-in-training in terms of their attitudes towards the patient and their medication prescribing behavior. This is an important and overlooked pathway by which bias can be propagated from one clinician to another. Attention to the language used in medical records may help to promote patient-centered care and to reduce healthcare disparities for stigmatized populations.

Do teachers equate male and masculine with lower academic engagement? How students’ gender enactment triggers gender stereotypes at school

Girls presently outperform boys in overall academic success. Corresponding gender stereotypes portray male students as lazy and troublesome and female students as diligent and compliant. The present study investigated whether these stereotypes impact teachers’ perceptions of students and whether students’ visible enactment of their gender at school (behaving in a very masculine or feminine way) increases the impact of these stereotypes on teachers’ perceptions of students. We hypothesized that teachers would ascribe more behavior that impedes learning and less behavior that fosters learning to male students who enact masculinity as compared with male students who show gender-neutral behavior and female students. Three pilot studies (N = 104; N = 82; N = 86) yielded pretested material for a randomized vignette study of N = 104 teachers. The teachers read one randomly assigned vignette describing a male (or female) student enacting his (or her) gender (or not) and rated how likely this student would be to display behaviors that impede or foster learning in a 2 (between: target students’ gender) × 2 (between: gender enactment [yes/no]) × 2 (between: teachers’ gender) × 2 (within: ascribed behavior) factorial design. As expected, male students enacting masculinity were rated as showing the lowest amount of academic engagement. Results are discussed with regard to the current debate on the causes of boys’ lower academic success.

Family Factors Affect Clinician Attitudes in Pediatric End-of-Life Decision Making: A Randomized Vignette Study

ContextConflicts between families and clinicians in pediatric end-of-life (EOL) care cause distress for providers, dissatisfaction for patients' families, and potential suffering for terminally ill children. ObjectivesWe hypothesized that family factors might influence clinician decision making in these circumstances. MethodsWe presented vignettes concerning difficult EOL decision making, randomized for religious objection to therapy withdrawal and perceived level of family involvement, to clinicians working in three Children's Hospital intensive care units. Additionally, attitudes about EOL care were assessed. ResultsThree hundred sixty-four respondents completed the questionnaire, for an overall response rate of 54%. Respondents receiving the “involved family” vignette were more likely to agree to continue medical care indefinitely (P<0.0005). Respondents were marginally more likely to pursue a court-appointed guardian for those patients whose families had nonreligious objections to withdrawal (P=0.05). Respondents who thought that a fear of being sued affected decisions were less likely to pursue unilateral withdrawal (odds ratio 0.8, 95% CI=0.6–0.9). Those who felt personal distress as a result of difficult EOL decision making, thought they often provided “futile” care, or those who felt EOL care was effectively addressed at the institution were less likely to want to defer to the parents' wishes (range of odds ratios 0.7–1). ConclusionIn this randomized vignette study, we have shown that family factors, particularly how involved a family seems to be in a child's life, affect what clinicians think is ethically appropriate in challenging EOL cases. Knowledge of how a family's degree of involvement may affect clinicians should be helpful to the clinical ethics consultants and offer some degree of insight to the clinicians themselves.

Knowledge of undisclosed corporate authorship (“ghostwriting”) reduces the perceived credibility of antidepressant research: a randomized vignette study with experienced nurses

BackgroundThere is much concern regarding undisclosed corporate authorship (“ghostwriting”) in the peer-reviewed medical literature. However, there are no studies of how disclosure of ghostwriting alone impacts the perceived credibility of research results.FindingsWe conducted a randomized vignette study with experienced nurses (n = 67), using a fictional study of antidepressant medication. The vignette described a randomized controlled trial and gave efficacy and adverse effect rates. Participants were randomly assigned to one of two authorship conditions, either (a) traditional authorship (n = 35) or (b) ghostwritten paper (n = 32), and then completed a perceived credibility scale. Our primary hypothesis was that the median perceived credibility score total would be lower in the group assigned to the ghostwritten paper. Our secondary hypotheses were that participants randomized to the ghostwritten condition would be less likely to (a) recommend the medication, and (b) want the psychiatrist in the vignette as their own clinician. We also asked respondents to estimate efficacy and adverse effect rates for the medication.There was a statistically significant difference in perceived credibility among those assigned to the ghostwriting condition. This amounted to a difference of 9.0 points on the 35-point perceived credibility scale as tested through the Mann–Whitney U test. There was no statistically significant difference between groups in terms of recommending the medication, wanting the featured clinician as their own, or in estimates of efficacy or adverse effects (p > .05 for all such comparisons).ConclusionIn this study, disclosure of ghostwriting resulted in lower perceived credibility ratings.