ABSTRACT This study examined the development of counselor trainees’ ( n = 26) broaching skills over a 15‐week multicultural–social justice counseling course using pre‐ and posttest video vignette responses. Grounded in the Multidimensional Model of Broaching Behavior and the Multicultural Orientation framework, this study evaluated growth across five key dimensions: directness in broaching, validation of client experience, depth of exploration, conciseness and clarity, and comfort and confidence in broaching. Content analysis revealed meaningful gains in trainees’ ability to explicitly name race, acknowledge systemic discrimination, and foster safe, culturally responsive spaces for clients. The findings underscore that broaching is both a technical and relational skill that requires practice, reflection, and cultural humility. Implications for integrating broaching skill development into counselor education curricula and directions for future research are discussed.

Barriers to accessing veterinary-care for dog-owners are diverse and dynamic, and widely accepted as major canine welfare threats because of potential non-, under- or delayed treatment. Owner knowledge and perceptions are recognised as key influences on decisions to seek veterinary-care but are currently understudied. This study aimed to explore decision-making by UK dog-owners around seeking veterinary-care for common conditions in dogs and identify influences upon these decisions prior to the introduction of Artificial Intelligence technologies. An online vignette-based survey collected responses from UK dog-owners regarding disorder vignettes (n = 3) randomly selected from a bank of n = 30, that were developed from anonymised VetCompass clinical histories to describe common canine conditions in general practice. Framed as being the dog-owner for each vignette, participants suggested (i) the condition they believed the dog was affected by, (ii) their perceived urgency for seeking veterinary-care and (iii) information-sources used to influence their decisions. Post-vignette questions explored participants’ real-world dog-health information-sourcing behaviours for their own dog(s). Outcomes modelled included (1) accuracy of condition identification, and (2) appropriateness of urgency assessments compared to consensus from a panel of veterinary surgeons. Analyses included n = 5316 vignette responses from n = 1772 participants. Epilepsy, kennel cough, flea infestation and osteoarthritis were the most accurately identified disorders whereas mast cell tumour, glaucoma and gastrointestinal foreign body were the least accurately identified. Owners using internet-searching for health-information to aid vignette responses scored higher on accuracy than those who did not. Owners perceived conditions to require veterinary-care less urgently than veterinary surgeons in 28.4% of vignette responses; however, using online dog-health groups for information-sourcing reduced the risk of under-urgency. Owners were most accurate at identifying conditions with external clinical signs but often underestimated urgency of seeking veterinary care. Improved accessibility and utilisation of veterinary triage services, telemedicine and information-prescriptions for owners could improve canine welfare by supporting better dog-owner decision-making and optimising veterinary professional workload.

Abstract Social workers are on the frontlines of delivering psychological and social services to lesbian, gay, and bisexual (LGB) clients to help mitigate distress caused by stigma. Developing competence in LGB-affirmative practice, which includes acceptance of LGB identities and attention to the harmful effects of stigma-related stressors, is essential for effective service provision. However, research in this area has often relied on self-report surveys, which are prone to social desirability bias. Moreover, organizational factors such as religious affiliation, inclusion and diversity policies, and the presence of an LGB-friendly climate have received relatively little attention. This study aimed to assess LGB affirmative practice competence and examine its correlates in a non-probability sample of social workers practicing in Hong Kong and Taipei/New Taipei City. Between March and August 2024, a total of 321 social workers (mean age = 33.38, SD = 7.27; 67% female; 36% non-heterosexual) participated in an online survey and vignette-based assessment. The vignette responses were evaluated by multiple coders to assess participants’ case conceptualization and reflexivity in working with LGB clients. Findings revealed an overall low to moderate level of LGB affirmative practice competence among participants. Significant correlates included the number of LGB-related training hours received and the number of LGB clients served. The study demonstrates the utility of vignette-based assessments in measuring practice competence and suggests training and simulation as effective strategies for enhancing social workers’ LGB affirmative practice competence.

Fertility preservation in AYA oncology: Provider knowledge gaps, counseling practices, and barriers to care

Altruism may not be a unitary concept but may include behaviorally dissociable subfactors. Here, we examined the effects of social distance within and across group boundaries on three facets of altruism: help giving, peer punishment, and moral courage. Using real-life scenarios presented as vignettes, participants were asked to indicate the likelihood that they would engage in the described behaviors across three different social settings: a familiar low-distance in-group, an unfamiliar high-distance in-group, and a hostile out-group. We used the Inclusion of Others in Self (IOS) scale to measure perceived closeness to members of the described social group. We hypothesized that help giving would be most and moral courage least sensitive to variations in social distance. In both studies, results revealed no significant differences in help giving across variations in social distance but a higher self-reported likeliness to show morally courageous acts in the familiar and close in-group compared to the other groups. The results for peer punishment were only partially consistent, following a similar pattern to moral courage. IOS scores discriminated between high and low-distance in-groups, as expected, but did not discriminate well between a high-distance in-group and hostile out-group. On the other hand, facet-specific trait scores correlated significantly with vignette responses. When the three facets were considered together across all vignettes, in-group favoritism became apparent. The studies contribute to our understanding of the social context conditions of altruistic behaviors and call for the refinement of experimental and self-report measures in the study of altruistic behavior.

ABSTRACT This study explores secondary school teachers’ perspectives on gendered differences in student learning within Rwanda, focusing on STEM subjects. Despite the country’s strong emphasis on gender equity and equality in education, limited research has been conducted on this issue. The study involved 51 STEM teachers across seven Rwandan districts, using semi-structured interviews and vignette responses. Results revealed that most teachers do not believe boys and girls have distinct learning styles, emphasising that individual student needs and other factors, such as the teacher and subject, are more influential. However, many teachers observed gendered differences in socio-emotional traits, particularly girls’ lower levels of confidence in the classroom. Teachers recommended strategies to boost girls’ self-efficacy, including using role models and promoting gender equality through equal treatment and collaboration. Group work was highlighted as a key opportunity for empowering girls and challenging stereotypes, particularly concerning their abilities in STEM subjects.

Abstract Response styles pose great threats to psychological measurements. This research compares IRTree models and anchoring vignettes in addressing response styles and estimating the target traits. It also explores the potential of combining them at the item level and total‐score level (ratios of extreme and middle responses to vignettes). Four models were evaluated: three multidimensional IRTree models with different levels of using vignette data and a nominal response model (NRM) addressing extreme and midpoint response styles with item‐level vignette responses. Simulation results indicated that the IRTree model using item‐level vignette responses outperformed others in estimating the target trait and response styles to different extents, with performance improving as the number of vignettes increased. Empirical findings further demonstrated that models using item‐level vignette information yielded higher reliability and closely aligned target trait estimates. These results underscore the value of integrating anchoring vignettes with IRTree models to enhance estimation accuracy and control for response styles.

Does using the Lung Clearance Index (LCI) inform clinical decisions in children with cystic fibrosis?

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 F io2 , 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.

Objective: This study explored the extent to which college athletic coaches endorse mental illness microaggressions toward their student-athletes and the importance of mental toughness in sports, and how these impact support for help-seeking among student-athletes. Methods: Fifty-eight coaches at Northeastern U.S. colleges in the National Collegiate Athletic Association completed an online survey, including measures of mental illness microaggressions, mental toughness, and questions about vignettes portraying scenarios with a physically injured athlete and an athlete with anxiety. Results: Multivariate analyses revealed that endorsement of mental illness microaggressions was negatively related to willingness to refer an athlete with anxiety to counseling services and positively related to willingness to allow a physically injured athlete to return to play. However, mental toughness was not predictive of microaggressions or vignette responses. Conclusions: Endorsement of mental illness microaggressions appears to be related to how coaches respond to athletes experiencing a mental health issue or physical injury.

This study examined the processes that speech-language pathologists (SLPs) use during an augmentative and alternative communication (AAC) assessment with children with motor impairments to determine alternative access solutions. These children often are the most vulnerable to a poor fit of their AAC system, which alternative access is an integral part. Although there is an abundance of information as to what types of considerations should be made during these assessments, there is no guidance as to how the assessment is completed. The goal of this study is to build evidence about the process. A collective case design was used to gain detailed insights into the decision-making process. Interviews and vignette responses were two components of the data collection. Each of the five SLPs, or cases, who participated in the study transcripts was analyzed in isolation as part of a within-case analysis. Once each SLP's process was understood, a cross-case comparison was completed to ascertain similarities or differences across the five. The cross-case assertions are presented in this article. Although the SLPs individually reported a lack of defined process, a clear systemization became evident when considered collectively. The SLPs all focused on the child, isolated motor access skills, and used a process of experimentation over time to build their final recommendations. These results have implications for SLPs working with children with motor impairments who may benefit from AAC intervention. The shared framework can serve as a roadmap to other SLPs, especially those with less experience with these types of complex cases. The varying teaming approaches to support these cases are also discussed.

Children with a history of maltreatment have underestimated and undertreated pain; however, it is unknown if healthcare providers consider maltreatment when assessing children's pain. The current study aimed to address this issue by investigating healthcare providers' pain assessment practices, and specifically, their consideration of child maltreatment. Healthcare providers (N = 100) completed a survey, asking them to reflect upon their pediatric pain assessment practices (e.g., methods and questions used to assess pain) through self-report and case vignette questions. Participants who received continuing education about child maltreatment were more likely to consider maltreatment in several areas of their pediatric pain assessment practice, whereas participants who received continuing education about pediatric pain, were not. Participants were also more likely to report that they would consider maltreatment in vignette responses than in questions regarding their daily practice. Findings indicate healthcare providers use multidimensional methods when assessing children's pain, although it is unclear when or how they use open-ended vs. option posing questions. Healthcare providers also tended to consider the effects of child maltreatment on children's ability to communicate their pain more so when the history of maltreatment was known to them.

Text-based vignettes are widely used within qualitative social work research yet there is little guidance on how to construct and integrate them into the research process. This article discusses the uses, benefits and limitations of written vignettes as part of semi-structured interviews and focus groups with social workers and related professionals. It provides clear guidelines on how to design a vignette. This includes the choice of scenario, characteristics of the protagonist, type of vignette, research setting, length, vignettes in semi-structured interviews and pre-testing. Text-based vignettes have been successfully used in social work research on six continents in a variety of research contexts including single context, comparative, cross-sectional, longitudinal and replication studies. Written vignettes are a useful tool to elicit (professional) values, attitudes and decision-making processes in a time efficient manner that produces focused, in-depth knowledge without the need to use real practice examples that could potentially include sensitive data or breach confidentiality. Vignettes have been used to explore a wide range of topics including but not limited to adult safeguarding, care planning, child protection and multi-agency working together. There is some debate whether vignette responses mirror real-life actions. The value of vignette data goes beyond documenting real-world decision-making. It can uncover tacit social work knowledge and unquestioned beliefs to show how they interplay in decision-making.

Extracorporeal cardiopulmonary resuscitation (ECPR) for refractory ventricular fibrillation/ventricular tachycardia in out-of-hospital cardiac arrest has recently been recommended for selected patients with favorable prognostic features. We aimed to identify factors affecting the willingness of emergency physicians to implement extracorporeal cardiopulmonary resuscitation (ECPR). We conducted a factorial survey with nine experimental vignettes by combining three different scene time intervals and transportation time intervals. Emergency physicians reported willingness to implement ECPR (1–100 points). Respondent characteristics that could affect the willingness were studied. Multilevel analysis of vignettes and respondent factors was conducted using a mixed-effects regression model. We obtained 486 vignette responses from 54 emergency physicians. In the case of longer scene time intervals, there was a significant difference in the willingness scores at 9 and 12 min transportation time intervals. When the pre-hospital time interval was > 40 min, emergency physicians demonstrated lower willingness to implement ECPR. Clinical experience of 15–19 years showed a significant favorable effect on willingness to implement extracorporeal membrane oxygenation (ECMO). However, the mean willingness scores of EPs for ECMO implementation were more than 75 across all vignettes. In ECPR, the prehospital time interval is an important factor, and the willingness of emergency physicians to implement ECMO could be mutually affected by scene time intervals, transportation time intervals, and total prehospital time.

External succession through the private equity route has recently become a more common option for family firms. Drawing on the socioemotional wealth (SEW) perspective, we study what factors influence the selling decision of family firm owners and managers and look at the moderating role of family firm portfolios. Based on a unique vignette study conducted with 200 vignette responses by family firm owners and managers, we unveil that levels of SEW and financial performance influence the propensity to sell. Surprisingly, the existence of family firm portfolios only significantly moderates the relationship between innovation performance and the propensity to sell. Our research provides important implications for research on family firm external succession and the SEW literature, contributing insights on the factors influencing decisions on the private equity succession route

End-of-life Decision Making In Pediatric Heart Transplant Families: A Study Analyzing The Parental Perspective

Guided by family communication patterns theory and terror management theory this mixed-methods investigation explored how parents (N = 112) of young children (ages 3-6) described the way they would discuss death when it comes up in conversations. Responses were coded inductively, resulting in four themes: explanations that death is inevitable, explanations that death is in the distance, the use of religion to frame discussions of death, and finally, discussing afterlife connections to deceased family members. Logistic regression analyses were used to evaluate whether parents' conformity or conversation orientations were associated with the frequency with which parents discussed death with their child and the content of parent vignette responses. Quantitative analysis revealed parents' conversation orientations were associated with the frequency with which they discussed death with their child and conformity orientations were associated with parents' use of religion and discussing afterlife connections to deceased family members in their responses.

Ranking Important Factors for Using Postoperative Chemotherapy in Nonmuscle Invasive Bladder Cancer: Conjoint Analysis Results From the Michigan Urological Surgery Improvement Collaborative (MUSIC).

PCN164 Impact of Treatment and Patient Attributes on Oncologists Decision-Making in First-line Chronic Lymphocytic Leukemia (CLL) in the United States (US)

To derive testing and treatment thresholds for early-onset neonatal sepsis and compare them to thresholds used in the Kaiser-Permanente (KP) Sepsis Calculator. Using surveys distributed in the United States, Brazil and Italy, decision thresholds were derived via self-identified thresholds selected from structured lists (Method 1), and based on clinical vignette responses for testing and treatment with or without inclusion of associated relative risk (Methods 2 and 3). Using Method 1, both testing and treatment thresholds were higher than the KP calculator thresholds. Test thresholds were lower (Method 2) or equivalent (Method 3) to KP using clinical vignettes. No vignette reached the 50% cutoff necessary to define a treatment threshold. The test threshold used by the KP calculator is the same as the threshold chosen by clinicians given a vignette and risk estimate. The KP treatment threshold is lower than that derived using all 3 methods.