Changing clinical behaviour by making guidelines specific.
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Family Practice↗
Biomedical subjects
Susan Michie
Publications and source records attributed to Susan Michie.
Evidence into practice: a theory based study of achieving national health targets in primary care.
RATIONALE, AIMS AND OBJECTIVES: This study investigates reasons why general practices achieve nationally set milestones to different extents. It compares the beliefs, self-reported behaviours and organizational context of general practitioners (GPs) who have been successful in achieving milestones set out in the UK's National Service Framework (NSF) for Coronary Heart Disease (CHD) with those who have been less successful. METHODS: Sixteen London GPs were interviewed, eight 'high implementers' (having met five or more of six CHD NSF milestones) and eight 'low implementers' (having met one or two milestones). Practices were matched for practice size across the groups as far as possible. The interview consisted of open-ended questions, based on theoretical constructs identified as key to implementation research in a previous project. Interviews were transcribed and analysed with Interpretative Phenomenological Analysis (IPA). RESULTS: There were three main areas that differentiated high and low implementers: beliefs about evidence-based practice, control over professional practice and consequences of achieving the milestones. Low implementers: (i) expressed less belief in evidence-based guidelines as the basis of their practice; (ii) were more concerned about their lack of control over the development and implementation of the guidelines (lack of ownership), and over their own practice (lack of autonomy); and (iii) perceived more negative consequences and fewer positive consequences, both for themselves and for patient care. CONCLUSIONS: This study demonstrates the application of psychological theory in trying to understand and improve professional practice. The results suggest areas that could be targeted in developing interventions to increase guideline implementation in primary care.
Coronary Disease↗
To be reassured or to understand? A dilemma in communicating normal cervical screening results.
BACKGROUND: Receiving negative test results may be associated with two problems: (a). not being reassured and wanting further, unnecessary screening; and (b). not understanding residual risk and not attending future recommended screening. AIM: To test two hypotheses: (1). Emphasizing test accuracy and low residual risk when giving negative test results reduces a desire for further unnecessary screening, while also reducing a correct understanding of the meaning of the result. (2). The effect of emphasizing low risk on desire for future screening is mediated by lack of reassurance. DESIGN: Experimental, vignette-based study, with a 2 x 2 factorial design. METHOD: A sample of 184 women was asked to imagine that they had recently undergone a cervical screening test and received a normal result. They were given one of four hypothetical letters from their GP,differing in whether or not it emphasized test accuracy and low residual risk of developing cervical cancer. Participants completed a questionnaire assessing perceived risk, reassurance about test results, desire for further screening within six months and understanding of the test results. RESULTS: Emphasizing test accuracy and low residual risk increases desire for inappropriate screening while reducing the understanding of residual risk. These effects are interactive, in that presenting both together has a larger effect than the sum of the two individual effects. The effect of emphasizing low risk on desire for future screening was mediated by reassurance. CONCLUSION: Emphasizing low residual risk and test accuracy is a double-edged sword: it reduces a desire for unnecessary screening, but also reduces correct understanding of the result.
Adolescent↗
Understanding why negative genetic test results sometimes fail to reassure.
A proportion of those receiving negative results following predictive genetic testing desire future bowel screening. This is despite a negative result meaning a general population risk of 1:7500 and despite bowel screening being experienced as aversive and clinically unnecessary. This study aimed to investigate perceptions of risk, illness, and tests amongst those receiving negative results following predictive genetic testing. Interviews with nine people receiving negative genetic test results for familial adenomatous polyposis (FAP) were analyzed using the qualitative method, interpretative phenomenological analysis (IPA). Those not reassured by negative genetic test results perceived a continuing risk to themselves and to their children. Two sets of perceptions emerged that might explain this: (1). perceptions of the genetic basis of the condition (FAP). Although the condition was perceived to be genetic, genetic status was seen as transient, so a result today could not predict the future. The condition was also seen as caused by factors other than genes, so information about only one risk factor could not be reassuring. (2). Perceptions of the genetic test. There was a lack of conviction in the ability of the genetic test, based on a blood sample, to predict a disease located in the bowel. These results suggest that some individuals receiving negative test results are not reassured because of their representations of the cause of their condition and the nature of the tests they undergo. It may be that eliciting and, when appropriate, changing people's representations prior to testing may enable those receiving negative results to be more reassured about their residual risk.
Adenomatous Polyposis Coli↗
Patient-centredness in chronic illness: what is it and does it matter?
The evidence as to whether patient-centredness is associated with beneficial physical and psychological outcomes is inconsistent. This review of published research on health care communication in chronic illness investigates whether (i) studies of patient-centred consultations use distinctive concepts, (ii) different concepts are differentially associated with health outcomes. Studies of patients with a chronic illness consulting a health professional were included if they measured health professional-patient interaction and a physical or psychological outcome. Thirty studies were identified, falling into two, reliably distinct, categories. In the first, health professionals took the patient's perspective and in the second, they sought to "activate" the patient. The 10 studies taking the latter approach were more consistently associated with good physical health outcomes than were the 20 studies taking the former approach. The suggestion that different types of patient-centredness have different associations with physical health outcomes should be investigated further in experimental studies.
Chronic Disease↗
Informed choice: understanding knowledge in the context of screening uptake.
This study evaluates a scale measuring knowledge about a screening test and investigates the association between knowledge, uptake and attitudes towards screening. One thousand four hundred ninety-nine pregnant women completed the knowledge scale of the multidimensional measure of informed choice (MMIC). Three hundred forty-five of these women and 152 professionals providing antenatal care also rated the importance of the knowledge items. Item characteristic curves show that, with one exception, the knowledge items reflect a spread of difficulty and are able to discriminate between people. All items were seen as essential or helpful by both women and health professionals, with two items seen as particularly important and one as unimportant. There were some differences between health professionals, women with low risk results and women with high risk results. Knowledge was not associated with uptake, attitude, or the extent to which uptake was consistent with women's attitudes towards undergoing the test.
Attitude to Health↗
Variation in uptake of serum screening: the role of service delivery.
The present study aimed to determine the extent to which variation in the uptake of serum screening for Down syndrome reflects variation in the way the test is offered. A higher uptake of serum screening was seen at hospitals that offered the blood test as part of a routine visit than at those where screening required a separate visit. The type of screening test offered and whether a reminder was sent were not associated with uptake. Given the consensus that undergoing screening should be the result of an informed choice, further research is needed to determine which methods of offering serum screening facilitate and which impede informed choice.
Delivery of Health Care↗
The multi-dimensional measure of informed choice: a validation study.
The aim of this prospective study is to assess the reliability and validity of a multi-dimensional measure of informed choice (MMIC). Participants were 225 pregnant women in two general hospitals in the UK, women receiving low-risk results following serum screening for Down syndrome. The MMIC was administered before testing and the Ottawa Decisional Conflict Scale was administered 6 weeks later. The component scales of the MMIC, knowledge and attitude, were internally consistent (alpha values of 0.68 and 0.78, respectively). Those who made a choice categorised as informed using the MMIC rated their decision 6 weeks later as being more informed, better supported and of higher quality than women whose choice was categorised as uninformed. This provides evidence of predictive validity, whilst the lack of association between the MMIC and anxiety shows construct (discriminant) validity. Thus, the MMIC has been shown to be psychometrically robust in pregnant women offered the choice to undergo prenatal screening for Down syndrome and receiving a low-risk result. Replication of this finding in other groups, facing other decisions, with other outcomes, should be assessed in future research.
Choice Behavior↗
Predictive genetic testing: high risk expectations in the face of low risk information.
The aims of this cross-sectional, questionnaire study were (1) to estimate the proportion of those receiving negative ("low risk") results following predictive genetic testing who expect to undergo clinically unnecessary future screening and (2) to examine the factors associated with this expectation. Of 127 adults receiving negative results following predictive genetic testing for familial adenomatous polyposis (FAP), 54 people (42%) were expected to attend for future bowel screening. The main predictor was doubt about the accuracy of genetic test results. Expecting to attend was also associated univariately with perceiving the chance of developing FAP as higher, being more worried about this, perceiving the test result to be more uncertain and threatening, and holding a behavioral model of the cause of FAP. Attendance for health screening may be influenced by people's perception of the accuracy of genetic tests that they have undergone. Future research should investigate test presentation and influences on test perception.
Adult↗
Likelihood of attending bowel screening after a negative genetic test result: the possible influence of health professionals.
This study was undertaken to determine the extent to which the reported likelihood of attending future bowel screening following negative genetic testing results for familial adenomatous polyposis (FAP) varies between the type of health professional providing care and the country of testing. The study subjects were 103 unaffected adults at risk for FAP who received negative results following predictive DNA testing. Our study indicates that the reported likelihood of attending bowel screening was higher in those given results by nongenetics physicians, rather than by genetics professionals; the reported likelihood of attending bowel screening under these circumstances was also higher in the UK than in Australia. Both of these results were affected by the perceived chances of developing FAP, and, in the case of the country of testing, by the perceived accuracy of the genetic test result and the perceived seriousness of the disease. How and what health professionals communicate with patients about genetic testing may explain the differences between type of health professional and country of testing and attitudes toward bowel screening. If this is the case, training in communication may change patients' perceptions and, in turn, their behavioral intentions and actions following a negative test result.
Adenomatous Polyposis Coli↗
Predictive genetic testing: mediators and moderators of anxiety.
Mediators and moderators of anxiety following predictive genetic testing were investigated in a cross-sectional study of 208 individuals at risk for familial adenomatous polyposis (FAP). Receiving a positive test result was associated with increased anxiety. The relationship between test result and anxiety was mediated by how threatened individuals felt by their test results. The impact of a positive test result was greater for those who felt distressed about FAP in their families, perceived FAP to be more serious, and perceived the genetic test to be more accurate. The results suggest that assessing, and possibly modifying, people's appraisals of the condition and of its impact on the family and of the threat of the genetic test may help to reduce subsequent anxiety. This has implications for the practice of genetic counseling.
Adolescent↗
Genetic information leaflets: influencing attitudes towards genetic testing.
PURPOSE: This article explores how a "neutral" genetics information leaflet influenced people's attitudes to be more positive toward predictive genetic testing. This is of concern, given the desire within clinical genetics and population based testing to provide information that informs choice without directing toward, or against, testing. METHOD: Four studies are reported. The first two investigated presentation (glossy and colored vs. black and white), and method of reading (read only vs. read followed by probing questions). The second two investigated content, using "think aloud," "card sort," and delayed recall tasks. RESULTS: Those receiving a glossy leaflet expressed more positive attitudes and more interest in undergoing testing than those receiving a black and white leaflet, and those who were asked questions about what they had read were more positive about genetic testing than those who only read the leaflet. Recall one week later varied from 72% to 28%, depending on type of information. Information that described the advantages of genetic testing or discussed genes and genetic testing in relation to disease were well recalled and rated positively. Attitudes toward information ranged from 100% positive (e.g., what diseases genetic tests are available for) to 0% positive (e.g., the meaning of a positive result). CONCLUSION: These results show that quite small changes within a leaflet can change attitudes toward genetic testing. This is of concern, given the association between attitudes toward a behavior and undergoing that behavior. The form, method of presentation, and content of genetic information leaflets should be evaluated for impact on attitude and decisions before they are used clinically.
Adolescent↗