The Right Tool is What They Need, Not What We Have: A Taxonomy of Appropriate Levels of Precision In Patient Risk Communication

While patients often receive risk information, exactly what constitutes being “informed” about health risks is often unclear. Patients have specific needs, such as avoiding being surprised by a possible outcome and making complex risk tradeoff decisions. Yet, all risk information is not equally informative for those needs. In this paper, I present a taxonomy of seven risk concepts that vary in their inherent precision and evaluability. Congruent with the “less is more” concept, I argue that risk communications should use formats that are tailored to message recipients’ specific informational needs. Simpler formats can be used when patients only need to order risks, while more complex numerical probability statements will be necessary when patients need to assess differences in risk magnitude and put those differences into meaningful context. Selecting need-congruent formats when designing communications about risks to patients is a novel approach that may better support patients’ healthcare decision making.American Cancer Society (MRSG-06-130-01-CPPB)The John M. Eisenberg Center for Clinical Decisions and Communications Science at Baylor College of Medicine with funding support from the Agency for Healthcare Research and Quality under Contract No. HHSA290200810015CPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98434/1/Zikmund-Fisher_WhatTheyNeedNotWhatWeHave_AcceptedMCRR.pdf11

Use of tamoxifen and raloxifene for breast cancer chemoprevention in 2010

PURPOSE: Two selective estrogen receptor modulators (SERMs), tamoxifen and raloxifene, have been shown in randomized clinical trials to reduce the risk of developing primary invasive breast cancer (IBC) in high-risk women. In 1998, the U.S. Food and Drug Administration (FDA) used these studies as a basis for approving tamoxifen for primary breast chemoprevention in both premenopausal and postmenopausal women at high risk. In 2007, the FDA approved raloxifene for primary breast cancer chemoprevention for postmenopausal women. METHODS: Data from the year 2010 National Health Interview Survey (NHIS) were analyzed to estimate the prevalence of tamoxifen and raloxifene use for chemoprevention of primary breast cancers among U.S. women. RESULTS: Prevalence of use of chemopreventive agents for primary tumors was 20,598 (95% CI, 518–114,864) for U.S. women aged 35 to 79 for tamoxifen. Prevalence was 96,890 (95% CI, 41,277–192,391) for U.S. women aged 50 to79 for raloxifene. CONCLUSION: Use of tamoxifen and raloxifene for prevention of primary breast cancers continues to be low. In 2010, women reporting medication use for breast cancer chemoprevention were primarily using the more recently FDA-approved drug raloxifene. Multiple possible explanations for the low use exist, including lack of awareness and/or concern about side effects among primary care physicians and patients

Studying Children's Intrapersonal Emotion Regulation Strategies from the Process Model of Emotion Regulation

peerreview_statement: The publishing and review policy for this title is described in its Aims & Scope. aims_and_scope_url: http://www.tandfonline.com/action/journalInformation?show=aimsScope&journalCode=vgnt2

Development of the social brain from age three to twelve years

Human adults recruit distinct networks of brain regions to think about the bodies and minds of others. This study characterizes the development of these networks, and tests for relationships between neural development and behavioral changes in reasoning about others' minds ('theory of mind', ToM). A large sample of children (n = 122, 3-12 years), and adults (n = 33), watched a short movie while undergoing fMRI. The movie highlights the characters' bodily sensations (often pain) and mental states (beliefs, desires, emotions), and is a feasible experiment for young children. Here we report three main findings: (1) ToM and pain networks are functionally distinct by age 3 years, (2) functional specialization increases throughout childhood, and (3) functional maturity of each network is related to increasingly anti-correlated responses between the networks. Furthermore, the most studied milestone in ToM development, passing explicit false-belief tasks, does not correspond to discontinuities in the development of the social brain.National Science Foundation (U.S.) (Award 1122374)National Science Foundation (U.S.) (Award 095518)National Institutes of Health (U.S.) (Award R01-MH096914-05

Children reading to dogs: a systematic review of the literature

Background Despite growing interest in the value of human-animal interactions (HAI) to human mental and physical health the quality of the evidence on which postulated benefits from animals to human psychological health are based is often unclear. To date there exist no systematic reviews on the effects of HAI in educational settings specifically focussing on the perceived benefits to children of reading to dogs. With rising popularity and implementation of these programmes in schools, it is essential that the evidence base exploring the pedagogic value of these initiatives is well documented. Methods Using PRISMA guidelines we systematically investigated the literature reporting the pedagogic effects of reading to dogs. Because research in this area is in the early stages of scientific enquiry we adopted broad inclusion criteria, accepting all reports which discussed measurable effects related to the topic that were written in English. Multiple online databases were searched during January-March 2015; grey literature searches were also conducted. The search results which met the inclusion criteria were evaluated, and discussed, in relation to the Oxford Centre for Evidence Based Medicine levels of evidence; 27 papers were classified as Level 5, 13 as Level 4, 7 as Level 2c and 1 as Level 2b. Conclusion The evidence suggests that reading to a dog may have a beneficial effect on a number of behavioural processes which contribute to a positive effect on the environment in which reading is practiced, leading to improved reading performance. However, the evidence base on which these inferences are made is of low quality. There is a clear need for the use of higher quality research methodologies and the inclusion of appropriate controls in order to draw causal inferences on whether or how reading to dogs may benefit children’s reading practices. The mechanisms for any effect remain a matter of conjectur

Effects of explaining on children's preference for simpler hypotheses

Research suggests that the process of explaining influences causal reasoning by prompting learners to favor hypotheses that offer "good" explanations. One feature of a good explanation is its simplicity. Here, we investigate whether prompting children to generate explanations for observed effects increases the extent to which they favor causal hypotheses that offer simpler explanations, and whether this changes over the course of development. Children aged 4, 5, and 6 years observed several outcomes that could be explained by appeal to a common cause (the simple hypothesis) or two independent causes (the complex hypothesis). We varied whether children were prompted to explain each observation or, in a control condition, to report it. Children were then asked to make additional inferences for which the competing hypotheses generated different predictions. The results revealed developmental differences in the extent to which children favored simpler hypotheses as a basis for further inference in this task: 4-year-olds did not favor the simpler hypothesis in either condition; 5-year-olds favored the simpler hypothesis only when prompted to explain; and 6-year-olds favored the simpler hypothesis whether or not they explained