Randomized trial of community health worker-led decision coaching to promote shared decision-making for prostate cancer screening among Black male patients and their providers

Black men are disproportionately affected by prostate cancer, the most common non-cutaneous malignancy among men in the USA. The United States Preventive Services Task Force (USPSTF) encourages prostate-specific antigen (PSA) testing decisions to be based on shared decision-making (SDM) clinician professional judgment, and patient preferences. However, evidence suggests that SDM is underutilized in clinical practice, especially among the most vulnerable patients. The purpose of this study is to evaluate the efficacy of a community health worker (CHW)-led decision-coaching program to facilitate SDM for prostate cancer screening among Black men in the primary care setting, with the ultimate aim of improving/optimizing decision quality.

Paying the Right Amount to Challenge Trial Participants – We Need to Use Behavioral Science Insights to Sell What’s Right

Paying the Right Amount to Challenge Trial Participants – We Need to Use Behavioral Science Insights to Sell What’s Right

Sometimes doing what’s right depends on anticipating how people will react when you do the right thing. Consider two aspects of challenge trial payments discussed by Lynch and colleagues (2021). The first is the importance of promoting public trust in challenge trial payments. Lynch and colleagues point out that even if there is not any actual ethical impropriety in challenge trial payments, the public might worry that payments are taking advantage of vulnerable research participants, either by paying them too much or too little. Such public concerns could negatively affect the ability to carry out such trials. Lynch and colleagues suggest that their framework for ethical payment in research can help justify payment amounts to the public. We agree with their framework, but believe that the framework on its own will not necessarily be enough to counter public perceptions around over or under payment.

Two Minds, One Patient: Clearing up Confusion About “Ambivalence”

Two Minds, One Patient: Clearing up Confusion About “Ambivalence”

Patients who experience difficulty making medical decisions are often referred to as “ambivalent.” However, the current lack of attention to the nuances between a cluster of phenomena that resemble ambivalence means that we are not always recognizing what is really going on with a patient. Importantly, different kinds of “ambivalence” may call for different approaches. In this paper, we present a taxonomy of ambivalence-related phenomena, provide normative analysis of some of the effects of—and common responses to—such mental states, and sketch some practical strategies for addressing ambivalence. In applying lessons from the philosophical literature and decision theory, our aim is to provide ethicists and clinicians with the tools to better understand and effectively intervene in cases of ambivalence.