Shared decision-making. A primer for clinicians

Importance Shared decision-making is a widely promoted approach, yet clinicians, typically supportive in principle, find it difficult to implement because of concerns and barriers they commonly encounter in practice. Objective To generate a primer that describes shared decision-making from the perspective of clinicians. Methods We collaborated with clinicians, patient representatives, and health service researchers. We invited members of the International Society of Shared Decision Making to co-produce a primer for clinicians using a series of jointly edited online documents. We shared drafts with other clinicians and patients. Finally, we integrated the contributions until we had arrived at a consensus. Findings Twenty-five people from 13 countries contributed; 9 had medical qualifications, 4 had nursing qualifications, and 12 others had a range of backgrounds. A total of 30 patients and clinicians provided further comments. The description differs from previous versions because it addresses the barriers that clinicians frequently mention. It describes how to overcome common challenges by emphasizing the importance of a clear invitation at initiation; it suggests how to manage patients’ resistance to shouldering decisional responsibility; reinforces the need to allow time for deliberation, especially with other stakeholders; and reassures clinicians that consensus, albeit welcome, need not be the goal of shared decision-making. Conclusions and Relevance This primer portrays a reflective clinician who is aware of power asymmetry, patient vulnerability, risk communication, health literacy, agenda setting, and goal clarification. It envisages a clinician who is curious about personal perspectives and who can offer collaborative, iterative, and deliberative steps

JAM-boree: An Application of Observation Oriented Modeling to Judgments of Associative Memory

Null hypothesis significance testing is criticised for emphatically focusing on using the appropriate statistic for the data and an overwhelming concern with low p-values. Here, we present a new technique, Observation Oriented Modeling (OOM), as an alternative to traditional techniques in the social sciences. Ten experiments on judgements of associative memory (JAM) were analysed with OOM to show data analysis procedures and the consistency of JAM results across several types of experimental manipulations. In a typical JAM task, participants are asked to rate the frequency of word pairings, such as LOST-FOUND, and are then compared to actual normed associative frequencies to measure how accurately participants can judge word pairs. Three types of JAM tasks are outlined (traditional, paired, and instructional manipulations) to demonstrate how modelling complex hypotheses can be applied through OOM to this type of data that would be conventionally analysed with null hypothesis significance testing

I Knew-It-All-Along, Just Not on My Own

Do the multiple steps of a math problem increase the likelihood of hindsight bias in students? It is a ubiquitious phenomenon whereby the outcome seems obvious. Students were randomly assigned either to a foresight group, in which they solved the multiple steps of a paired comparison t-test, or a hindsight group, in which they did not solve the steps of the paired comparison t-test but the correct answers were present. They were then asked to make chance and difficulty estimations for each step. Students in the hindsight condition believed they had a greater chance of a correct solution and that it was easier than foresight students. Teachers using the same instructive approach may foster hindsight bias in students and themselves and perhaps, the lecture format as well. </jats:p

Hypothesize Once, Plan Twice

Preregistration has been touted as the solution to the “reproducibility crisis” (Wagenmakers, Wetzels, Borsboom, van der Maas, &amp;amp; Kievit, 2012) and part of the “renaissance” in the social sciences (Nelson, Simmons, &amp;amp; Simonsohn, 2018). For preregistration, researchers describe the study plan before the data is collected or the analyses have been examined. The focus of preregistration has been on solving prediction versus postdiction (i.e., hypothesizing after results are known or HARKING; Kerr, 1998) and negating flexibility in statistical analyses (i.e., p-hacking and questionable research practices; Simmons, Nelson, &amp;amp; Simonsohn, 2011). We suggest that instead of solely focusing on preregistration, researchers should concentrate on adequate plans for research detailing a strong relationship between hypotheses, methods, data, and analyses. While preregistration encourages this process, more effort should focus on the research blueprint to engage in meaningful and, potentially, reproducible science.</p

Supplemental Instruction: Understanding Academic Assistance in Underrepresented Groups

Student retention rates are increasingly important in higher education. Higher education institutions have adopted various programs in the hopes of increasing graduation rates and grade point averages (GPAs). One of the most effective attempts at improvement has been the Supplemental Instruction (SI) program. We examined our SI program relative to three facets: attendance, attendance\u27s influence on final scores, and graduation rates for students who had participated in these courses. These questions were also investigated focusing on specific comparison groups, as we looked into how these effects differed for minority students and nontraditional students compared with those of White and traditional peers. Overall, SI attendance led to positive outcomes— increased final course grades and graduation rates—even after adjusting for previous achievement

The Influence of Effortful Thought and Cognitive Proficiencies on the Conjunction Fallacy: Implications for Dual-Process Theories of Reasoning and Judgment

Human judgment often violates normative standards, and virtually no judgment error has received as much attention as the conjunction fallacy. Judgment errors have historically served as evidence for dual-process theories of reasoning, insofar as these errors are assumed to arise from reliance on a fast and intuitive mental process, and are corrected via effortful deliberative reasoning. In the present research, three experiments tested the notion that conjunction errors are reduced by effortful thought. Predictions based on three different dual-process theory perspectives were tested: lax monitoring, override failure, and the Tripartite Model. Results indicated that participants higher in numeracy were less likely to make conjunction errors, but this association only emerged when participants engaged in two-sided reasoning, as opposed to one-sided or no reasoning. Confidence was higher for incorrect as opposed to correct judgments, suggesting that participants were unaware of their errors. </jats:p