Vignette-based Survey Research Articles

The engagement of healthcare providers in implementing the selfBACK randomised controlled trial - A mixed-methods process evaluation.

People with low back pain (LBP) are often recommended to self-manage their condition, but it can be challenging without support. Digital health interventions (DHIs) have shown promise in supporting self-management of LBP, but little is known about healthcare providers' (HCPs) engagement in implementing these. We aimed to examine HCPs' engagement in patient recruitment for the selfBACK app clinical trial and explore their perceptions of the app. In a mixed-methods design, we conducted a process evaluation alongside the selfBACK trial, triangulating quantitative data from trial recruitment logs and a vignette-based survey, and qualitative data from trial procedure documents, interviews with HCPs, and survey free-text responses. From 2019 to 2020, we recruited 57 HCPs from Norway and 39 health clinics in Denmark and collected quantitative and qualitative data in parallel. Results were integrated using displays. Overall, 825 patients were recruited by the HCPs. The vignette-based survey showed high agreement among HCPs (n = 62) with the self-management plans generated by the app (84.1-88.9%) but also highlighted concerns about tailoring and content. Interviews with HCPs (n = 19) revealed challenges with recruitment due to busy schedules, competing tasks, and varying levels of interest and engagement in the study. The study identified factors that impact HCPs' engagement in recruiting patients for the selfBACK trial and highlighted overall positive views of the selfBACK app, although some concerns about the content and tailoring of the app were raised. Understanding HCP motivations and workload is crucial for the successful implementation of DHIs in clinical practice.

Mental health literacy among primary care providers in Hungary: a vignette-based survey

ObjectiveThis study examined mental health literacy and predictors of disorder recognition among primary care providers (PCPs) in Hungary.Methods208 PCPs in Hungary completed a survey assessing demographics, mental health stigma, and exposure to mental health (i.e., personal experiences and having a family member/friend with a mental health condition). Participants read six vignettes describing obsessive-compulsive disorder (OCD) harm/aggression subtype (OCD-Aggression), OCD order/symmetry subtype (OCD-Order), generalized anxiety disorder (GAD), social anxiety disorder (SAD), panic disorder (PD), and major depressive disorder (MDD) and were asked to identify each condition, perceived disorder causes, and provide treatment referrals. Descriptive analyses were used to characterize disorder recognition rates, perceived disorder causes, and treatment referrals. Binary logistic regression analyses were conducted to examine the degree to which demographic characteristics, mental health stigma, and exposure to mental health conditions predict accurate disorder recognition.ResultsIdentification rates for each vignette were: OCD-Aggression (27.9%), OCD-Order (75.5%), SAD (34.1%), GAD (76.0%), PD (78.8%), and MDD (91.3%). First-choice treatment referrals were a psychiatrist for OCD-Aggression (63.0%), OCD-Order (53.8%), and MDD (46.6%), a psychologist/therapist for SAD (58.7%) and GAD (48.6%), and a PCP for PD (39.9%). Mislabeling conditions was significantly associated with older age (for GAD, OCD-Aggression, PD and MDD), male gender (for GAD), greater mental health stigma (for OCD-Order), and lack of exposure to mental health conditions (for SAD).ConclusionsFindings highlight strengths (e.g., depression recognition) and limitations in knowledge of mental health conditions among PCPs in Hungary and identifies targets to address to improve mental health literacy.

Stigmatization of people with mental illness – a matter of milieu-specific worldviews? Results from a population-based survey in Germany

BackgroundDespite numerous awareness campaigns and anti-stigma programs, people with mental illness, particularly schizophrenia, are still stigmatized. Although the society is both cause and solution, societal-level conditions, such as society’s customs and policies that legitimize and perpetuate stigmatization is often neglected. We used a milieu approach to investigate how shared social, cultural and political orientations and expectations are associated with manifestations of the mental-illness related stigma.MethodsWe analyzed cross-sectional data from 3,042 adults aged ≥18 years from a national vignette-based representative survey on the stigma of mental illness in Germany from 2020. For milieu classification, we used an established population segmentation tool based on values and political preferences. Two stigma measures associated with the stereotype and status loss/discrimination components were assessed (i.e., the Social Distance Scale and a list of well-known stereotypes associated with depression or schizophrenia). Descriptive analyses and one-way ANOVAs with post-hoc pairwise contrasts between milieu groups were used to evaluate agreement on stereotypes and the desire for social distance towards people with depression or schizophrenia.ResultsNegative stereotypes about people with a depression (i.e., beliefs about being weak-willed) and schizophrenia (i.e., beliefs about dangerousness) tended to be more common in milieu groups leaning more toward the authoritarian pole. Milieu groups with a more liberal attitude on the socio-cultural dimension further expressed a lower desire for social distance towards people with depression (p<0.001). However, the extent of differentiation between the milieu groups was less pronounced regarding the desire for social distance towards people with schizophrenia than towards people with depression.ConclusionOur findings suggest that socio-cultural and socioeconomic dimensions of the society can be used for both describing heterogeneous societies and illuminating the underlying social structure of stigma. In addition to making blind spots more visible (i.e., schizophrenia), milieu-specific knowledge could be useful in deciding which intervention components are most appropriate for which milieu groups and how to apply them successfully.

Exploring the Impact of Public Service Motivation on Public Employee’s Coping Strategy With Clients: Nuanced Insights From Varied Contexts

This study analyzes the impacts of public service motivation (PSM) on the front-line public employees’ coping strategy, considering the moderating roles of two contextual factors: organizational performance pressure and clients’ help deservingness. Two vignette-based survey experiments were conducted separately in regulation and service settings (financial regulators and healthcare workers) in China. The findings indicate agreement across different settings on the positive effects of PSM on public employees’ intention to move against clients. However, the evidence regarding the moderating roles of organizational performance pressure and clients’ help deservingness points to more complexity, with the results varying in the regulation and service settings. In the regulation setting, organizational performance pressure crowds out financial regulators’ PSM, leading to declining intentions of moving against clients. However, in the service setting, clients’ help deservingness serves as a significant contextual factor, moderating the relationship between healthcare workers’ PSM and intentions on moving against clients.

Physicians’ views and knowledge on the antibiotic treatment of pneumonia in advanced dementia

BackgroundAntibiotic treatment (AT) for patients with advanced dementia and pneumonia is a complex issue. AT can prolong life, but it can also prolong suffering for the patient and the family. In this study we evaluated physicians’ attitudes to this issue.MethodsA vignette-based survey among community-based physicians (CBP) and hospital-based physicians (HBP) who work in southern Israel. The physicians were asked to complete a questionnaire on their knowledge and attitudes to AT, based on a case description of a patient with advanced dementia and pneumonia.Results211 physicians participated in the study including 134 CBP (63.5%) and 77 HBP (36.5%). 177 physicians chose the AT option for the patient presented in the case, with 59.7% of the HBP and 32.8% of the CBP choosing intravenous (IV) AT (p = 0.017). In contrast, in the same case, but with themselves as the patient, 68.8% of HBP and 32.8% of CBP chose the option of palliative care without AT, with only 14.3% of HBP and 10.4% of CBP choosing the option of hospitalization with IV AT. In two logistic regression models, physicians who chose IV AT for themselves were fourfold more likely to make a similar choice for their patients. Over 75% of the physicians were not knowledgeable about the administration of AT in accordance with the Dying Patient Act.ConclusionsThe results of this study indicate the need for an educational intervention among physicians to expand their knowledge and expertise on end-of-life treatment for patients with advanced dementia. In addition, we invite policy makers to convene a discussion on the possibility of changing the law to facilitate the conduct of studies of patients with advanced dementia. Such studies would make it possible to develop an evidence-based treatment strategy.

Investigating Older Adults' Perceptions of AI Tools for Medication Decisions: Vignette-Based Experimental Survey.

Given the public release of large language models, research is needed to explore whether older adults would be receptive to personalized medication advice given by artificial intelligence (AI) tools. This study aims to identify predictors of the likelihood of older adults stopping a medication and the influence of the source of the information. We conducted a web-based experimental survey in which US participants aged ≥65 years were asked to report their likelihood of stopping a medication based on the source of information using a 6-point Likert scale (scale anchors: 1=not at all likely; 6=extremely likely). In total, 3 medications were presented in a randomized order: aspirin (risk of bleeding), ranitidine (cancer-causing chemical), or simvastatin (lack of benefit with age). In total, 5 sources of information were presented: primary care provider (PCP), pharmacist, AI that connects with the electronic health record (EHR) and provides advice to the PCP ("EHR-PCP"), AI with EHR access that directly provides advice ("EHR-Direct"), and AI that asks questions to provide advice ("Questions-Direct") directly. We calculated descriptive statistics to identify participants who were extremely likely (score 6) to stop the medication and used logistic regression to identify demographic predictors of being likely (scores 4-6) as opposed to unlikely (scores 1-3) to stop a medication. Older adults (n=1245) reported being extremely likely to stop a medication based on a PCP's recommendation (n=748, 60.1% [aspirin] to n=858, 68.9% [ranitidine]) compared to a pharmacist (n=227, 18.2% [simvastatin] to n=361, 29% [ranitidine]). They were infrequently extremely likely to stop a medication when recommended by AI (EHR-PCP: n=182, 14.6% [aspirin] to n=289, 23.2% [ranitidine]; EHR-Direct: n=118, 9.5% [simvastatin] to n=212, 17% [ranitidine]; Questions-Direct: n=121, 9.7% [aspirin] to n=204, 16.4% [ranitidine]). In adjusted analyses, characteristics that increased the likelihood of following an AI recommendation included being Black or African American as compared to White (Questions-Direct: odds ratio [OR] 1.28, 95% CI 1.06-1.54 to EHR-PCP: OR 1.42, 95% CI 1.17-1.73), having higher self-reported health (EHR-PCP: OR 1.09, 95% CI 1.01-1.18 to EHR-Direct: OR 1.13 95%, CI 1.05-1.23), having higher confidence in using an EHR (Questions-Direct: OR 1.36, 95% CI 1.16-1.58 to EHR-PCP: OR 1.55, 95% CI 1.33-1.80), and having higher confidence using apps (EHR-Direct: OR 1.38, 95% CI 1.18-1.62 to EHR-PCP: OR 1.49, 95% CI 1.27-1.74). Older adults with higher health literacy were less likely to stop a medication when recommended by AI (EHR-PCP: OR 0.81, 95% CI 0.75-0.88 to EHR-Direct: OR 0.85, 95% CI 0.78-0.92). Older adults have reservations about following an AI recommendation to stop a medication. However, individuals who are Black or African American, have higher self-reported health, or have higher confidence in using an EHR or apps may be receptive to AI-based medication recommendations.

Community of trauma care partnering with stakeholders to improve injury outcomes: survey analysis and panel development

BackgroundIn June 2021, the Injury Research Engagement Project (I-REP) was established. In 2022, we preformed focus group analysis with patients/caregiver and researchers that resulted in themes in preferences, motivations, and...

Patients' psychosocial attributes and aggressiveness of cancer treatments near the end of life.

While the use of chemotherapy near the end of life (EOL) has been identified as a relevant criterion for assessing quality of cancer care and has been estimated as non-beneficial, a trend of aggressiveness in cancer care during the last period of life remains. Both patients' sociodemographic characteristics and physicians' practice setting are associated with this use. The role of patients' psychosocial characteristics has however been understudied. The objectives were to study oncologists' intention to recommend chemotherapy or therapeutic abstention in an EOL patient's case and to examine the factors associated with this decision. A clinical vignette-based questionnaire survey was conducted. While the case presented to the participating oncologists of a patient with EGFR-mutated lung cancer, progressing after osimertinib, ECOG 3, with leptomeningeal disease (N = 146), was strictly equivalent in terms of medical aspects and age, 4 patients' non-medical characteristics were manipulated: gender, marital status, parenthood, and psychosocial characteristics ("nice" patients, patients "making strong demands," or control patients). 77.4% of the oncologists surveyed stated that they would recommend chemotherapy in this situation. Only scenarios with nice patients or patients making strong demands were associated with less recommendation of chemotherapy (70.8% for the nice/making strong demands scenarios together vs 87.7%, for the control scenario P = .017). Medical oncologists with previous experience of similar cases were also less keen to recommend chemotherapy (73% vs 100%, P = .007). Of the 76.7% of respondents declaring that they would think of other therapeutic options, 49.1% mentioned "other treatments" without mentioning palliative care. Developing physicians' awareness of the psychosocial aspects at stake in their medical decisions in these sensitive situations may improve EOL care.

An International Factorial Vignette-Based Survey of Intubation Decisions in Acute Hypoxemic Respiratory Failure.

Intubation is a common procedure in acute hypoxemic respiratory failure (AHRF), with minimal evidence to guide decision-making. We conducted a survey of when to intubate patients with AHRF to measure the influence of clinical variables on intubation decision-making and quantify variability. Factorial vignette-based survey asking "Would you recommend intubation?" Respondents selected an ordinal recommendation from a 5-point scale ranging from "Definite no" to "Definite yes" for up to ten randomly allocated vignettes. We used Bayesian proportional odds modeling, with clustering by individual, country, and region, to calculate mean odds ratios (ORs) with 95% credible intervals (CrIs). Anonymous web-based survey. Clinicians involved in the decision to intubate. None. Between September 2023 and January 2024, 2,294 respondents entered 17,235 vignette responses in 74 countries (most common: Canada [29%], United States [26%], France [9%], Japan [8%], and Thailand [5%]). Respondents were attending physicians (63%), nurses (13%), trainee physicians (9%), respiratory therapists (9%), and other (6%). Lower oxygen saturation, higher Fio2, noninvasive ventilation compared with high-flow, tachypnea, neck muscle use, abdominal paradox, drowsiness, and inability to obey were associated with increased odds of intubation; diagnosis, vasopressors, and duration of symptoms were not. Nurses were less likely than physicians to recommend intubation. Within a country, the odds of recommending intubation changed between clinicians by an average factor of 2.60; within a region, the same odds changed between countries by 1.56. Respondents from Canada (OR, 0.53; CrI, 0.40-0.70) and the United States (OR, 0.63; CrI, 0.48-0.84) were less likely to recommend intubation than respondents from most other countries. In this international, multiprofessional survey of 2294 clinicians, intubation for patients with AHRF was mostly decided based on oxygenation, breathing pattern, and consciousness, but there was important variation across individuals and countries.

The effects of artificial intelligence and victims’ deservingness information on citizens’ blame attribution towards administrative errors

ABSTRACT This study examines how citizens attribute blame to government authorities for administrative errors made by artificial intelligence (AI) compared to human decision-makers. Based on blame attribution theory, we conducted a vignette-based survey experiment with 1,098 Chinese citizens, revealing that respondents assign less blame for errors caused by AI or AI-assisted decisions. Additionally, disclosing victims’ deservingness information heightened blame attribution. These findings contribute to the literature on administrative accountability, highlighting how citizens respond to AI-related errors and informing the growing use of AI in public sector decision-making.

The role of the family’s ethnicity and correlates in social workers’ risk perceptions: Evidence from a vignette study in Hungary

Studies have shown that children from some ethnic minority families are disproportionately represented in the child protection system. Ethnic-based treatment is problematic because it challenges whether child protection decision-making is based on the principle of ’the best interests of the child’. Roma children are also overrepresented in the child protection systems of many European countries, but little research has explored why this is so. The present study seeks to address this gap by examining child welfare workers’ perceptions of risk at the early stages of child protection decision-making. The main research question is whether they perceive higher levels of risk if the parents are Roma. Method: We use data from a vignette-based survey conducted among child welfare workers (N = 600) in Hungary in 2018. The factors influencing social workers’ risk perceptions are analysed using multilevel ordinal logistic regressions. The regression models of risk perception include case variables (harm to child, parents’ ethnicity, mother’s education, parents’ employment, housing conditions, living environment, parental alcoholism, mother’s willingness to cooperate), and the individual characteristics of the social worker. Ethnicity is examined individually as well as in interaction with other case characteristics. Results: Findings show that physical harm to the child, parental alcoholism, a messy living environment, and the non-cooperative behaviour of the mother increase the level of risk perceived by child welfare workers. There is no evidence of a statistical association between parental socioeconomic status and the social worker’s perception of risk. Family ethnicity also does not have a statistically significant impact on risk perception (main effect). However, some case characteristics affect risk perception differently when the family is of Roma origin (interaction effects). Physical abuse has a strong effect on the social worker’s perception of risk, but this effect is more modest when the family is of Roma origin. Likewise, the mother’s non-cooperative behaviour is a risk-increasing factor, but this effect disappears for Roma families. Conclusions: Although, no ethnic bias was found in social workers’ perception of risk, our findings indicate that the perception of risk for Roma families is less dependent on the circumstances of the case than for majority families. In some cases, this may lead to an unjustified overestimation of risk or, conversely, an underestimation when the family is Roma.

Unpacking EFL learners’ emotions and emotion-regulation strategies in digital collaborative academic reading projects: An integrated approach of vignette methodology and interview analysis

This study explored the manifestation of multifaceted emotions, sources of emotions, and emotion regulation strategies of college EFL learners participating in digital collaborative academic reading projects. Data were collected through a vignette-based survey that was comprised of 19 episodes of authentic emotion-inducing scenarios among 72 Chinese EFL learners, supplemented by semi-structured interviews with 16 participants. While the results showed a relatively balanced distribution of positive and negative emotions, anxiety, nervousness, and happiness were found to be the top three most commonly experienced emotions. The study identified three sources of positive emotions including topic interest, experiencing mastery and achievement, and recognition from other groups. The findings also revealed factors inducing negative emotions in digital collaborative academic reading: reading difficulties, challenges in interacting with group members, low-quality feedback from external groups, online learning environment and technology issues, and time pressure. Furthermore, the study extended the literature on emotion regulation by developing a comprehensive taxonomy of six categories of strategies (i.e., co-regulation, cognitive change, response regulation, attention deployment, task-related regulation, and situation modification) tailored to the context of digital collaborative academic reading. These findings can offer practical guidance for enhancing social-emotional interactions in technology-enhanced collaborative academic reading.

Diagnosing and managing irritable bowel syndrome with predominant diarrhoea in clinical practice: online survey among gastroenterologists and general practitioners.

Irritable bowel syndrome (IBS) represents the most common disorder of gut-brain interaction encountered in clinical practice. The Rome IV criteria define the disorder. Over the years, many guidelines proposed guidance during the diagnostic and therapeutic approach of patients with presumed IBS. This study investigates the management of IBS with predominant diarrhoea (IBS-D) by Belgian gastroenterologists (GE) and general practitioners (GP) in daily practice. An online vignette-based survey was conducted exploring the diagnostic and therapeutic approach of patients suffering from IBS with predominant diarrhoea (IBS-D) in primary and secondary care. 64 GE and 31 GP completed the survey. Abdominal pain and discomfort led to an IBS diagnosis in 88% and 84% of cases, respectively. The diagnosis rate dropped to 58.3% with diarrhoea as main presentation and 26.8% for patients aged 65. Additional tests were ordered by 89.5% of physicians, including biochemistry (77.9%), stool culture and parasites (59.3%), iFOBT (60.5%), breath testing (17.4%), imaging (12.8%), and endoscopy (9.3%). Upon normal results, 57% of physicians did not order further investigations. Both GP and GE preferred spasmolytics (64.3%) and dietary interventions (23.9%) as first-line treatment for IBS. Second-line treatment options included referral to a specialist or colleague (19.4%), dietary intervention (22.6%), neuromodulators (19.4%), and spasmolytics (14.5%). No GP initiated neuromodulators. In Belgium, abdominal pain or discomfort are equivalent cardinal symptoms when diagnosing IBS. During the further diagnostic and therapeutic approach most physicians order only limited additional non-invasive testing. Spasmolytics and dietary interventions are favoured in first-line. Upon failure, only GE prescribe neuromodulators, while GP opt for referral. These findings are consistent with the general principles and recommendations outlined in the recently published Belgian guideline for IBS.

Therapist Anxious Distress and Avoidance of Implementing Time-Out.

Therapist anxious distress when delivering child mental health treatment has been understudied as a factor that contributes to the underuse of some evidence-based interventions (EBIs), such as time-out for children with disruptive behaviors. This study investigated therapist anxious avoidance of time-out using a three-part, vignette-based survey design. Therapists (n = 198) read a vignette of an in-session time-out and reported on their personal anxious distress and likelihood of discontinuing the implementation of time-out. Therapists also provided open-ended descriptions of challenges to delivering time-out. Therapists reported moderate anxious distress at time points 1 and 2 and lower anxious distress at time 3 when the time-out had resolved. Most therapists endorsed some avoidance of time-out. Binomial logistic regression analysesindicated that increased anxious distress corresponded with an increased probability of avoiding time-out delivery in the future. Qualitative reports expanded on challenges to implementing time-out. Findings suggest the importance of addressing therapist anxious distress when implementing children's mental health treatments.

Assessing the effectiveness of HIV/STI risk communication displays among Melbourne Sexual Health Centre attendees: a cross-sectional, observational and vignette-based study

IntroductionIncreasing rates of sexually transmitted infections (STIs) over the past decade underscore the need for early testing and treatment. Communicating HIV/STI risk effectively can promote individuals’ intention to test, which...

Advance Medical Decision-Making Differs Across First- and Third-Person Perspectives

Background Advance healthcare decision-making presumes that a prior treatment preference expressed with sufficient mental capacity (“T1 preference”) should trump a contrary preference expressed after significant cognitive decline (“T2 preference”). This assumption is much debated in normative bioethics, but little is known about lay judgments in this domain. This study investigated participants’ judgments about which preference should be followed, and whether these judgments differed depending on a first-person (deciding for one’s future self) versus third-person (deciding for a friend or stranger) perspective. Methods A vignette-based survey was conducted (N = 1445 US Americans; gender-balanced sample), in a 3 (relationship: self, best friend, stranger) × 2 (T1 preference: treat, do not treat) × 2 (T2 contrary preference: ambiguous, unambiguous) design. Results Participants were more likely to defer to the incapacitated T2 preference of a third-party, while being more likely to insist on following their own T1 capacitated preference. Further, participants were more likely to conclude that others with substantial cognitive decline were still their “true selves,” which correlated with increased deference to their T2 preferences. Conclusions These findings add to the growing evidence that lay intuitions concerning the ethical entitlement to have decisions respected are not only a function of cognition, as would be expected under many traditional bioethical accounts, but also depend on the relationship of the decision to the decision-maker’s true self.

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.

Is there a religious bias? Attitudes towards military humanitarian intervention in Germany

Abstract Is individual support for internationally agreed military humanitarian interventions (MHIs) subject to a religious bias? Conducting a vignette-based survey experiment, the paper provides micro-level evidence for such a bias within a highly unlikely sample: German university students. Participants in our survey experiment were more compassionate and indeed more supportive of an MHI when the victims of war-related violence were Christians rather than Muslims. The paper thus contributes to the literature on support for MHIs in two important ways: first, whereas the existing literature has a strong focus on the United States, this paper studies individuals’ support in another Western country that regularly contributes to MHIs, namely Germany. Second, while the existing literature has mainly examined how other social factors, such as the race or gender of the victims, affect individuals’ support for MHIs, drawing on social identity theory, this paper claims that religious identification also has an impact. Moreover, by showing that the religion of the victims of war-related violence shapes individuals’ attitudes towards MHIs through compassion, the paper also speaks to more recent literature that demonstrates that individuals’ attitudes towards refugees depend on – among other things – their religion. Against the background of a general rise of identitarian politics in many Western societies, our findings seem to be of particular relevance.

Parental concerns about oral health of children: Is ChatGPT helpful in finding appropriate answers?

Artificial intelligence (AI) is becoming an important part of our lives owing to increased data availability and improved power of computing. One of the recently launched modalities of AI, ChatGPT, is being enormously used worldwide for different types of tasks. In medical context, its use is being explored for clinical queries, academia, research help, etc. Further, literature suggests that parents seek information about health of their children using different Internet resources and would surely turn toward ChatGPT for the same, as this chatbot model is easy to use, generates "one" response, and is available without any subscription. ChatGPT generates a response using text cues and applying different algorithms on prepublished literature but is still in its naïve state; hence, it is imperative to validate the generated responses. Accordingly, we planned this study to determine the clarity, correctness, and completeness of some Frequently asked questions (FAQs) about child's oral health, from a mother's perspective. The study design was a vignette-based survey and included a set of 23 questions, for which ChatGPT was interviewed from the perspective of an imaginary parent. The answers responded by ChatGPT were copied "verbatim," and a Google survey form was designed. The survey form was validated and then sent to 15 pediatric dentists, and the responses were mainly collected on the Likert's scale with a provision of one open-ended question aiming to determine "what they would have added" to this generated response as an expert in the field. The responses on Likert's scale were condensed and values ≥4 were considered 'adequate and acceptable' while scores ≤3, were considered 'inadequate'. The generated responses and comments mentioned by different respondents in the open-ended question were critiqued in reference to the existing literature. Overall, the responses were found to be complete and logical and in clear language, with only some inadequacies being reported in few of the answers.

Adolescents with Rett syndrome at critical care pathway junctures: Examining clinicians’ decision to initiate invasive long-term ventilation

BackgroundThe initiation of invasive long-term ventilation (I-LTV) for an adolescent with Rett Syndrome (RTT) involves many serious bioethical considerations. In moving towards a more inclusive model of patient participation, transparency surrounding the main influencing factors around this decision is important. ObjectiveWe aimed to identify the main drivers influencing a clinician's decision to support initiation of I-LTV for an adolescent with RTT. MethodWe used an anonymous online vignette-based factorial survey. The survey was distributed internationally through eight professional multi-disciplinary organisations to reach clinicians working in paediatrics. ResultsWe analysed 504 RTT vignettes completed by 246 clinicians using mixed effect regression modelling. The main three significant influencing factors identified were: parental agreement with the decision to support initiation, the family's support network, and proximity to a tertiary care centre. Additional comments from participants focused on family support, and the importance of on-going communication with the family. ConclusionAs the rights of those with disabilities improve and participation of adolescents in decision-making becomes more established, effective communications with the family around goals of care and particular sensitivity and reflective practice around methods of consensus building will likely contribute to a positive decision-making process at this difficult time.