Do low-numeracy people avoid shared decision making?

Objectives: Doctors have been increasingly encouraged to involve patients in decision making rather than pursuing the paternalistic model in which they make the decisions for their patients. But do patients want to participate in making decisions about their health? Is there a relationship between their preferences for shared decision making and numeracy skills? Are those preferences different in countries with different medical systems, and for different age groups? Extant studies cannot answer these questions because most are based on nonprobabilistic, highly selective patient samples that prevent generalizations to a broader population. Design: In a survey on probabilistic national samples in the United States and Germany, we interviewed participants with low numeracy skills (Germany: n = 127, mean numeracy = 37; United States: n = 117, mean numeracy = 36) and high numeracy skills (Germany: n = 133, mean numeracy = 96; U.S.: n = 121, mean numeracy = 91). Main Outcome Measures: Usual and preferred role in medical decision making. Results: A significant number of people with low numeracy in both the United States (35%, SE = 8.2) and Germany (30%, SE = 6.1) preferred to be more passive than they currently were. High-numeracy people, in contrast, were mostly satisfied with their current role. On average, Americans were more active than Germans. Middle-aged participants preferred to be more active compared to both younger and older ones. Conclusions: Shared decision-making preferences are related to numeracy skills, country, and age. Education efforts to increase numeracy, as well as using nonquantitative communication formats, may foster involvement of low-numeracy patients in decisions about their health. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Advance directives and withdrawal of dialysis in the United States, Germany, and Japan

OBJECTIVE: To determine the role of advance directives in decisions to withdraw chronic dialysis in the United States, Germany, and Japan. DESIGN: Survey by questionnaire. PARTICIPANTS: Seventy-two American, 87 German, and 73 Japanese nephrologists. MAIN OUTCOME MEASURES: Each nephrologist's total number of (1) dialysis patients, (2) cases of withdrawal of dialysis, (3) patients with advance directives, and (4) uses of such directives. Nephrologists also stated whether they would continue or stop dialysis in 8 hypothetical cases. RESULTS: American, German, and Japanese nephrologists reported withdrawing dialysis for 5.1%, 1.6%, and 0.7% of their patients in the last year, respectively. Thirty percent of American patients had advance directives, and such directives were used in decision making for 3.2% of all patients. Only 0.3% of German and Japanese patients had advance directives, and such directives were used in decision making for 0.09% of patients. When asked about a hypothetical mentally incompetent patient whose family requests withdrawal of dialysis, American nephrologists were much more likely to stop dialysis in the absence of an advance directive than German or Japanese nephrologists. However, almost all nephrologists from the 3 countries would stop dialysis when a family request to withdraw was supported by a patient advance directive. CONCLUSIONS: There is a high prevalence of advance directives among American dialysis patients, and such directives frequently play a role in decision making. German and Japanese nephrologists appear willing to follow advance directives, but the low prevalence of such directives limits the frequency of their use.     

Obligations to self and society in the United States and Germany.

"A questionnaire covering various value sentiments and a picture-story test for measuring n Achievement and n Affiliation were administered to 87 German and 74 United States male students preparing for college who had been carefully matched for age (around 18 years) and socio-economic background (largely upper middle class). A factor analysis of the questionnaire results yielded two factors that could be matched in the two countries and a third set of items that shifted from one factor to the other across countries. The 'switchover' items which dealt largely with decency and obligation to others were associated with Factor A ('rational striving') in Germany and were more strongly accepted by the Germans than by the Americans, as were also the Factor A items. In the United States, the switch-over items were associated with Factor B ('resigned cynicism') suggesting that acceptance of statements about strong obligations to others tend to be associated in the United States with a kind of deviant 'Un-American' passive resignation." (17 ref.) From Psyc Abstracts 36:01:1GB45M. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

What Folklore Tells Us about Risk and Risk Taking: Cross-Cultural Comparisons of American, German, and Chinese Proverbs

Two studies attempted to discriminate between a situational-economic and a cultural explanation for the recently reported finding that Chinese from the People's Republic of China (PRC) are more risk-seeking than Americans. Both studies compared American and Chinese proverbs related to risk and risk-taking. The first study added Germany as a control group for its socioeconomic similarity to the United States but its closer resemblance to the PRC in its social safety-net and cultural collectivism. Members of each culture rated American, Chinese, and German risk-related proverbs, respectively, on implied advice (to take or avoid risk) and applicability to financial or social risks. Results were consistent with the cultural explanation of national differences in risk taking: (a) Chinese and German proverbs were judged to provide more risk-seeking advice than American proverbs; (b) American proverbs were judged less applicable to risks in the social domain than Chinese and German proverbs; (c) regardless of national origin of proverbs, Chinese perceived proverbs to advocate greater risk-seeking than American raters, but only for financial and not for social risks. Copyright 1998 Academic Press.     

Individualistic and collectivistic worldviews: Implications for understanding perceptions of racial discrimination in African Americans and British Caribbean Americans.

Cultural worldviews and perceived racial discrimination were examined among Americans (n = 106) and British Caribbean Americans (n = 95), both of African descent, who were recruited through university student organizations, community organizations, and snowball sampling. Consistent with public perceptions of differences in the experience of race among these 2 groups, multiple regression analyses revealed African Americans were more likely than British Caribbean Americans to perceive racial discrimination in the United States. In addition, a cultural worldview focus on individuality and equality (i.e., horizontal individualism) moderated the relationship between ethnic group and perceived racial discrimination. British Caribbean Americans who endorsed greater agreement with horizontal individualism were less likely to perceive racial discrimination. The same worldview was unrelated to African Americans' perceptions of racial discrimination. The results are discussed with respect to within-group heterogeneity among persons of African descent. Implications for counseling persons of African descent and future research directions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of inpatient mental health services by members of ethnic minority groups.

National data on psychiatric hospitalization point to marked ethnic-related differences. Blacks and Native Americans are considerably more likely than Whites to be hospitalized; Blacks are more likely than Whites to be admitted as schizophrenic and less likely to be diagnosed as having an affective disorder; Asian Americans/Pacific Islanders are less likely than Whites to be admitted, but remain for a lengthier stay, at least in state and county mental hospitals. Differences are clearcut, but they ignore a major source of care: psychiatric hospitalization in placements other than psychiatric units and hospitals. Explanations for observed minority-White differences in hospitalization can be evaluated only partially or not at all: Such explanations included ethnic-related differences in socioeconomic standing and in the prevalence of major psychopathology; differential stigma, or capacity to tolerate or support a dysfunctional significant other; access and use of alternative services; and bias in the behavior of gatekeepers, especially practitioners assigning diagnostic labels and making involuntary commitment decisions. More research is needed to help explain these striking differences in utilization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Age differences in trade-off decisions: Older adults prefer choice deferral.

Our primary purpose in this study was to examine age differences in using choice deferral when young and older adults made trade-off decisions. Ninety-two young and 92 older adults were asked to make a trade-off decision among four cars or to use choice deferral (i.e., not buy any of these cars and keep looking for other cars). High and low emotional trade-off difficulty were manipulated between participants through different attribute labels of available cars. Older adults were more likely than young adults to choose deferral. Older adults who used deferral reported less retrospective negative emotion than those who did not. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Physician decision making and cardiac risk: Effects of knowledge, risk perception, risk tolerance, and fuzzy processing.

Despite training, professionals sometimes make serious errors in risky decision making. The authors investigated judgments and decisions for 9 hypothetical patients at 3 levels of cardiac risk, comparing student and physician groups varying in domain-specific knowledge. Decisions were examined regarding whether they deviated from guidelines, how risk perceptions and risk tolerances determined decisions, and how the latter differed for knowledge groups. More knowledgeable professionals were better at discriminating levels of risk according to external correspondence criteria but committed similar errors in disjunctive probability judgments, violating internal coherence criteria. Also, higher knowledge groups relied on fewer dimensions of information than did lower knowledge groups. Consistent with fuzzy-trace theory, experts achieved better discrimination by processing less information and made sharper all-or-none distinctions among decision categories. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Thai and American perspectives on over- and undercontrolled child behavior problems: Exploring the threshold model among parents, teachers, and psychologists.

When a child has psychological problems, what determines whether adults will consider the problems serious or whether they will seek professional help? One determinant may be cultural: Prevailing social values may help set adult thresholds for concern over child problems. We explored this possibility, comparing adults in Thailand and the United States, two countries where social values and perspectives on childhood differ markedly. Thai and American parents, teachers, and clinical psychologists made judgments about two children, one with overcontrolled problems (e.g., shyness, fear) and one with undercontrolled problems (e.g., disobedience, fighting). Consistent with some of the literature on Thai Buddhist values, Thais (compared with Americans) rated problems of both types as less serious, less worrisome, less likely to reflect personality traits, and more likely to improve with time. Cross-national differences in perceived seriousness were more pronounced for parents and teachers than for psychologists, suggesting that professional culture may mitigate the effects of national culture. Evidently, adults' judgments about child clinical problems can differ markedly as a function of their cultural context. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Culture and Social Support: Who Seeks It and Why?

Are Asians and Asian Americans more or less likely to seek social support for dealing with stress than European Americans? On the one hand, the collectivist orientation of Asian countries might favor the sharing of stressful problems; on the other hand, efforts to maintain group harmony might discourage such efforts. In 2 studies, Koreans (Study 1) and Asians and Asian Americans in the United States (Study 2) reported using social support less for coping with stress than European Americans. Study 3 examined potential explanations for these effects and revealed that relationship concerns accounted for the cultural differences in use of support seeking. Discussion centers on the potential benefits and liabilities of seeking social support. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The influence of meat consumption on dietary data, iron status and serum lipid parameters in young women

The outcome of adjusting health care spending to the overall economic performance of the country has become a major issue of health care policy of the industrialized nations. How can progress in medicine be consistently financed under the restriction of fixed contributions to mandatory sickness funds? Medical Technology Assessment is an interdisciplinary concept that proposes solutions to this issue. This article discusses the concept of Medical Technology Assessment and shows how Medical Technology Assessment should be implemented into the health care system. This article depicts how Medical Technology Assessment is implemented in the United States of America, in the United Kingdom and in the Netherlands. It also discusses which institutions take steps towards Medical Technology Assessment in Germany. The second article examines how to implement Medical Technology Assessment into the German health care system.     

Widowhood and illness: A comparison of social network characteristics in France, Germany, Japan, and the United States.

This study examined social network characteristics of adults aged 70 to 90 years in relation to widowhood and illness in France, Germany, Japan, and the United States. Participants were drawn from representative samples from each of the 4 countries (total N?=?1,331). Resource deficit profiles based on whether respondents were widowed, ill, both, or neither were directly related to social network characteristics for German and Japanese adults, were differentially related by gender and age for French adults, and were not related to social networks of Americans. Country, gender, and age differences in total network size, proportion of close network members, and frequency of contact with network members are reported. Similarities and differences found in the associations between normative late-life deficits and social network characteristics in the 4 countries point to the importance of investigating sociocultural factors that mediate the impact of resource loss and afford life quality in very old age. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Decisions and attitudes concerning child sexual abuse: does the gender of the perpetrator make a difference to child protection professionals?

OBJECTIVE: An investigation was conducted into whether child protection investigators, specifically social workers and the police, are as likely to take seriously a case of child sexual abuse if it had been perpetrated by a female rather than a male. Also, to examine whether the decisions relating to female-perpetrated abuse were predicted by participants' sex role perceptions of women and their attitudes concerning women's sexualized behavior towards children. METHOD: Participants advocated decisions in response to four hypothetical case of child sexual abuse in which the perpetrator was either male or female. The female perpetrators were then rated on femininity and masculinity characteristics and attitudes concerning women's sexualized behavior toward children were assessed. RESULTS: Following male--rather than female--perpetrated sexual abuse, case registration and imprisonment of the perpetrator was considered more appropriate by all participant groups; male social workers also considered social services involvement and investigation as more appropriate. A substantial number of decisions concerning female perpetrated abuse were predicted by participants' attitudes. CONCLUSION: While child protection professionals considered child sexual abuse perpetrated by females to be a serious issue warranting intervention, a number of advocated decisions suggested that they did not consider female-perpetrated abuse to be as serious as male-perpetrated abuse. The implication is that victims of sexual abuse perpetrated by a woman may be less likely to receive the protection afforded victims of male-perpetrated abuse. Furthermore, professionals' practices may be inadvertently perpetuating the view that female child sexual abuse is rare or less harmful than abuse carried out by males.     

Decision style in depression: The contribution of perceived risks versus benefits.

The present study investigated the contribution of cognitive and social factors to the decision style of depressed persons. During two sessions (Times 1 and 2), depressed and nondepressed college students were asked to imagine themselves making decisions about common life situations that afforded potential benefits but that also entailed potential risks. The decision scenarios varied in content. For each situation, subjects evaluated several potential risks and benefits and indicated what decisions they would make. In both sessions and for all types of decision scenarios, the depressed assigned greater weight to risks than did the nondepressed. Furthermore, for decisions about initiating social contact and establishing intimacy, the depressed expressed a greater reluctance to take the target action than did the nondepressed, and their perceptions of risks appeared to influence their estimated decisions more strongly. The Time 2 study also revealed that most of these differences applied equally when individuals were thinking about themselves or another person. However, risk perceptions were found to contribute more to the decision style of the depressed, relative to the nondepressed, only when their thoughts were focused on themselves and not when their thoughts were focused on another person. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dose and contrast medium reduction in intravenous digital subtraction angiography by bolus sequence]

OBJECTIVES: To study variations in the way pediatricians would evaluate and manage an infant with an apparent life-threatening event. SUBJECTS AND METHODS: A survey was mailed to the chief residents of all pediatric residency training programs in the United States in which respondents were presented with a simulated case and asked how they would manage an infant who had experienced an apparent life-threatening event that did not require resuscitation. The survey also explored each physician's tolerance of uncertainty, knowledge of apparent life-threatening events, experience, fear of litigation, responsiveness to parental demands, and propensity to order tests. MAIN OUTCOME MEASURES: Presumed decisions to prescribe antibiotics and/or order home apnea monitoring in a simulated case of an infant who had experienced an apparent life-threatening event not requiring resuscitation. RESULTS: Logistic regression analysis revealed 2 characteristics that made significant and independent contributions to respondents' presumed decision to prescribe antibiotics: (1) experience with an adverse outcome, and (2) propensity to order diagnostic tests. Presumed decisions to order a home apnea monitor were notably affected by fear of litigation. CONCLUSIONS: These findings suggest that differences in pediatricians' characteristics contribute to variations in care. Efforts to make management more uniform must consider that decisions are influenced by a host of different characteristics and experiences.     

HIV-infected women's decisions to take antiretrovirals

Despite the potential benefits of antiretrovirals, HIV-infected women may not be accepting or adhering to recommended drug therapies. To help women make informed decisions surrounding antiretroviral therapy, health care professionals need insight into how HIV-infected women decide to take or not to take antiretroviral drugs. The purpose of this study was to describe the influences affecting decisions made by women in the southern United States to accept and adhere to antiretroviral therapy. Focus group data with subsequent dimensional analysis were used to discover themes surrounding antiretroviral decisions among 22 women in two predominantly rural, southeastern states. The focus groups included some women who were currently taking antiretrovirals, some who had taken them in the past, and some who had never taken them. The analyses revealed four overarching themes that influenced women's decisions regarding antiretrovirals: health professionals, beliefs about antiretrovirals, side effects, and attitudes of peers and family.     

Is longing only for Germans? A cross-cultural comparison of Sehnsucht in Germany and the United States.

Sehnsucht, the longing or yearning for ideal yet seemingly unreachable states of life, is a salient topic in German culture and has proven useful for understanding self-regulation across adulthood in a German sample (e.g., Scheibe, Freund, & Baltes, 2007). The current study tested whether findings for German samples could be generalized to the more individualistic and agentic U.S. American culture. Four samples of U.S. American and German participants (total N = 1,276) age 18 to 81 years reported and rated their 2 most important life longings and completed measures of subjective well-being and health. Measurement equivalence was established at the level of factor loadings for central life longing characteristics. German and U.S. American participants did not differ in self-reported ease of identifying personal life longings or their intensity. In comparison to Germans, however, U.S. Americans associated life longings less with utopian, unattainable states and reported less salience of the concept in everyday life. Associations with measures of adaptation suggest that life longings can be both functional and dysfunctional for development in both cultures. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Perceiving affordances for fitting through apertures.

Affordances--possibilities for action--are constrained by the match between actors and their environments. For motor decisions to be adaptive, affordances must be detected accurately. Three experiments examined the correspondence between motor decisions and affordances as participants reached through apertures of varying size. A psychophysical procedure was used to estimate an affordance threshold for each participant (smallest aperture they could fit their hand through on 50% of trials), and motor decisions were assessed relative to affordance thresholds. Experiment 1 showed that participants scale motor decisions to hand size, and motor decisions and affordance thresholds are reliable over two blocked protocols. Experiment 2 examined the effects of habitual practice: Motor decisions were equally accurate when reaching with the more practiced dominant hand and less practiced nondominant hand. Experiment 3 showed that participants recalibrate motor decisions to take changing body dimensions into account: Motor decisions while wearing a hand-enlarging prosthesis were similar to motor decisions without the prosthesis when data were normalized to affordance thresholds. Across experiments, errors in decisions to reach through too-small apertures were likely due to low penalty for error. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diabetic nephropathy and end-stage renal disease in Mexican Americans

Hispanics are the second largest minority group in the United States. Mexican Americans (MAs) are the largest subgroup at 14 million in 1990. MAs have a two- to threefold increased prevalence of non-insulin-dependent diabetes mellitus. Population-based studies of MAs with non-insulin-dependent diabetes have shown that these patients may be more likely than non-Hispanic whites to develop proteinuria and are more likely to develop end-stage renal disease. The reasons for this excess risk are yet to be completely elucidated, but may be due to worse glycemic control, worse blood pressure control when hypertension does occur, worse access to medical care, and/or genetics. When MAs are treated for diabetic end-stage renal disease, they have better survival. Much less data are available for other Hispanic subgroups. From a public health perspective, higher incidence and longer survival as well as relatively young and rapidly growing population predict an increasing burden for MAs if prevention measures are not instituted soon.