Teaching epistemic integrity to promote reliable scientific communication.

In an age of mass communication, citizens need to learn how to detect and transmit reliable scientific information. This need is exacerbated by the transmission of news through social media, where any individual has the potential to reach thousands of other users. In this article, we argue that fighting the uncontrolled transmission of unreliable information requires improved training in broad epistemic integrity. This subcategory of research integrity is relevant to students in all disciplines, and is often overlooked in integrity courses, in contrast to topics such as fraud, plagiarism, collaboration and respect for study subjects. Teaching epistemic integrity involves training epistemic skills (such as metacognitive competences, capacity to use helpful heuristics, basic statistical and methodological principles) and values (such as love of truth, intellectual humility, epistemic responsibility). We argue that this topic should be addressed in secondary school, and later constitute a fundamental component of any university curriculum.

The quizzical failure of a nudge on academic integrity education: a randomized controlled trial.

BACKGROUND: Studies on academic integrity reveal high rates of plagiarism and cheating among students. We have developed an online teaching tool, Integrity Games ( https://integgame.eu/ ), that uses serious games to teach academic integrity. In this paper, we test the impact of a soft intervention - a short quiz - that was added to the Integrity Games website to increase users' interest in learning about integrity. Based on general principles of behavioral science, our quiz highlighted the intricacy of integrity issues, generated social comparisons, and produced personalized advice. We expected that these interventions would create a need for knowledge and encourage participants to spend more time on the website. METHODS: In a randomized controlled trial involving N = 405 students from Switzerland and France, half of the users had to take a short quiz before playing the serious games, while the other half could directly play the games. We measured how much time they spent playing the games, and, in a post-experimental survey, we measured their desire to learn about integrity issues and their understanding of integrity issues. RESULTS: Contrary to our expectations, the quiz had a negative impact on time spent playing the serious games. Moreover, the quiz did not increase participants' desire to learn about integrity issues or their overall understanding of the topic. CONCLUSIONS: Our quiz did not have any measurable impact on curiosity or understanding of integrity issues, and may have had a negative impact on time spent on the Integrity games website. Our results highlight the difficulty of implementing behavioral insights in a real-world setting. TRIAL REGISTRATION: The study was preregistered at https://osf.io/73xty .

Nudging accurate scientific communication.

The recent replicability crisis in social and biomedical sciences has highlighted the need for improvement in the honest transmission of scientific content. We present the results of two studies investigating whether nudges and soft social incentives enhance participants' readiness to transmit high-quality scientific news. In two online randomized experiments (Total N = 2425), participants had to imagine that they were science journalists who had to select scientific studies to report in their next article. They had to choose between studies reporting opposite results (for instance, confirming versus not confirming the effect of a treatment) and varying in traditional signs of research credibility (large versus small sample sizes, randomized versus non-randomized designs). In order to steer participants' choices towards or against the trustworthy transmission of science, we used several soft framing nudges and social incentives. Overall, we find that, although participants show a strong preference for studies using high-sample sizes and randomized design, they are biased towards positive results, and express a preference for results in line with previous intuitions (evincing confirmation bias). Our soft framing nudges and social incentives did not help to counteract these biases. On the contrary, the social incentives against honest transmission of scientific content mildly exacerbated the expression of these biases.

Advance Care Planning in Switzerland: Chances and challenges of delivering high-quality ACP in a small high-income, multilingual, federally organized country.

We describe the development of ACP in Switzerland during the last decade in the German- and French-speaking cantons and on the national level. In 2013, a revision of the Swiss civil law came into force, declaring advance directives (ADs) as binding. Since then, ACP has been researched and implemented primarily by universities and university hospitals. Despite the foundation of the national association "ACP Swiss" in 2020, several national initiatives, and a roadmap for a national implementation, many challenges and barriers still remain. There is, however, reasonable hope to implement high-quality ACP throughout Switzerland within the next ten years.

Effect of an app for promoting advance care planning and motivating patients to write their advance directives.

BACKGROUND: Accordons-nous, a smartphone app, was developed to support patients in the advance care planning (ACP) process. The app raises awareness and facilitates communication on this sensitive topic. It helps patients express their values and preferences for care and write their advance directives (AD). OBJECTIVE: Measure the impact of distributing Accordons-nous on patients' propensity to engage in the ACP process, compared with the distribution of a leaflet. A secondary objective was to test the effect of socio-demographic factors (age, health status, gender, level of education) on propensity to engage in ACP. METHODS: Pre-post randomized control study. Participants were patients approached in medical waiting rooms. They received the app (treatment) or an information leaflet (control). They responded to two questionnaires: one at recruitment and a second 3-4 weeks later. Improvement on four variables relevant to ACP was measured: reported contemplation of an event relevant to ACP; decision about treatment in case of that event; discussion about it with relatives or health care professionals; writing advance directives. Statistical analysis included between-group comparisons of pre-post differences with 2-sample tests for equality of proportions and logistic regression models. RESULTS: Four hundred seventy three participants were recruited and full responses obtained from 312. Overall, the intervention (control and treatment together) had a positive effect on the mean reported ACP engagement for all variables: new or renewed contemplation 54%; increase in decision 8%, discussion 11%, and writing 1%, compared to the baseline. Compared to the control (leaflet), the treatment group (app) had a larger effect size for all variables: between-group difference in contemplation + 11% (logistic regression, p = .05), decision + 1% (but p > .05 on this variable), discussion + 5% (p = .05), and writing AD + 5% (p = .03). Moreover, greater age was positively correlated with having written AD at inclusion (21% among retired compared to 2% among young adults) and with the propensity to write AD after our intervention (logistic regression, p = .001). Other factors tested (frequency of consultations, gender, level of education) had no effect on participants' ACP engagement. CONCLUSIONS: When distributed without specific counselling, the tool increased reported ACP engagement, although effect sizes remain modest. Further studies are needed to investigate whether the app could generate greater ACP engagement if used by professionals in dedicated ACP consultations.

"The person in power told me to"-European PhD students' perspectives on guest authorship and good authorship practice.

Questionable authorship practices in scientific publishing are detrimental to research quality and management. The existing literature dealing with the prevalence, and perceptions, of such practices has focused on the medical sciences, and on experienced researchers. In contrast, this study investigated how younger researchers (PhD students) from across the faculties view fair authorship attribution, their experience with granting guest authorships to more powerful researchers and their reasons for doing so. Data for the study were collected in a survey of European PhD students. The final dataset included 1,336 participants from five European countries (Denmark, Hungary, Ireland, Portugal, and Switzerland) representing all major disciplines. Approximately three in ten reported that they had granted at least one guest authorship to "a person in power". Half of these indicated that they had done so because they had been told to do so by the person in power. Participants from the medical, natural and technical sciences were much more likely to state that they had granted a guest authorship than those from other faculties. We identified four general views about what is sufficient for co-authorship. There were two dominant views. The first (inclusive view) considered a broad range of contributions to merit co-authorship. The second (strongly writing-oriented) emphasised that co-authors must have written a piece of the manuscript text. The inclusive view dominated in the natural, technical, and medical sciences. Participants from other faculties were more evenly distributed between the inclusive and writing oriented view. Those with an inclusive view were most likely to indicate that they have granted a guest authorship. According to the experiences of our participants, questionable authorship practices are prevalent among early-career researchers, and they appear to be reinforced through a combination of coercive power relations and dominant norms in some research cultures, particularly in the natural, technical, and medical sciences.

A Mobile App for Advance Care Planning and Advance Directives (Accordons-nous): Development and Usability Study.

BACKGROUND: Advance care planning, including advance directives, is an important tool that allows patients to express their preferences for care if they are no longer able to express themselves. We developed Accordons-nous, a smartphone app that informs patients about advance care planning and advance directives, facilitates communication on these sensitive topics, and helps patients express their values and preferences for care. OBJECTIVE: The first objective of this study is to conduct a usability test of this app. The second objective is to collect users' critical opinions on the usability and relevance of the tool. METHODS: We conducted a usability test by means of a think-aloud method, asking 10 representative patients to complete 7 browsing tasks. We double coded the filmed sessions to obtain descriptive data on task completion (with or without help), time spent, number of clicks, and the types of problems encountered. We assessed the severity of the problems encountered and identified the modifications needed to address these problems. We evaluated the readability of the app using Scolarius, a French equivalent of the Flesch Reading Ease test. By means of a posttest questionnaire, we asked participants to assess the app's usability (System Usability Scale), relevance (Mobile App Rating Scale, section F), and whether they would recommend the app to the target groups: patients, health professionals, and patients' caring relatives. RESULTS: Participants completed the 7 think-aloud tasks in 80% (56/70) of the cases without any help from the experimenter, in 16% (11/70) of the cases with some help, and failed in 4% (3/70) of the cases. The analysis of failures and difficulties encountered revealed a series of major usability problems that could be addressed with minor modifications to the app. Accordons-nous obtained high scores on readability (overall score of 87.4 on Scolarius test, corresponding to elementary school level), usability (85.3/100 on System Usability Scale test), relevance (4.3/5 on the Mobile App Rating Scale, section F), and overall subjective endorsement on 3 I would recommend questions (4.7/5). CONCLUSIONS: This usability test helped us make the final changes to our app before its official launch.

Coercive Measures in Psychiatry: A Review of Ethical Arguments.

Introduction: Coercion is frequent in clinical practice, particularly in psychiatry. Since it overrides some fundamental rights of patients (notably their liberty of movement and decision-making), adequate use of coercion requires legal and ethical justifications. In this article, we map out the ethical elements used in the literature to justify or reject the use of coercive measures limiting freedom of movement (seclusion, restraint, involuntary hospitalization) and highlight some important issues. Methods: We conducted a narrative review of the literature by searching the PubMed, Embase, PsycINFO, Google Scholar and Cairn.info databases with the keywords "coercive/compulsory measures/care/treatment, coercion, seclusion, restraint, mental health, psychiatry, involuntary/compulsory hospitalization/admission, ethics, legitimacy." We collected all ethically relevant elements used in the author's justifications for or against coercive measures limiting freedom of movement (e.g., values, rights, practical considerations, relevant feelings, expected attitudes, risks of side effects), and coded, and ordered them into categories. Results: Some reasons provided in the literature are presented as justifying an absolute prohibition on coercion; they rely on the view that some fundamental rights, such as autonomy, are non-negotiable. Most ethically relevant elements, however, can be used in a balanced weighting of reasons to favor or reject coercive measures in certain circumstances. Professionals mostly agree that coercion is only legitimate in exceptional circumstances, when the infringement of some values (e.g., freedom of movement, short-term autonomy) is the only means to fulfill other, more important values and goals (e.g., patient's safety, the long-term rebuilding of patient's identity and autonomy). The results of evaluations vary according to which moral elements are prioritized over others. Moreover, we found numerous considerations (e.g., conditions, procedural values) for how to ensure that clinicians apply fair decision-making procedures related to coercion. Based on this analysis, we highlight vital topics that need further development. Conclusion: Before using coercive measures limiting freedom of movement, clinicians should consider and weigh all ethically pertinent elements in the situation and actively search for alternatives that are more respectful of patient's well-being and rights. Coercive measures decided upon after a transparent, carefully balanced evaluation process are more likely to be adequate, understood, and accepted by patients and caregivers.

General public's view on opt-in, opt-out, and mandated choice organ donation policies: a qualitative study involving Swiss French-speaking citizens favourably disposed towards organ donation.

BACKGROUND: All over the world, patients die while waiting for a transplant. Facing this difficulty, countries struggle to find efficient procedures and policies. One policy that has recently been enforced in many countries is the presumed consent (opt-out) system for organ donation. In such a system, every individual is considered as a potential organ donor except in cases of expressed refusal during her or his lifetime. Based on the input of a citizen's initiative, the Swiss parliament has made a proposal for a soft presumed consent policy.It was accepted by both chambers at the national level, but will possibly be challenged by a referendum, and give rise to a public vote. OBJECTIVE: Ahead of the democratic debate, our aim was to sound out what issues are perceived as relevant by ordinary citizens when they evaluate different policies regulating organ donation. What are their main worries and decision criteria? METHODS: We conducted semi-structured taped interviews with ordinary citizens during which we asked their views on three different systems: the current opt-in system, the opt-out presumed consent system described in a soft and in a hard version, and the mandatory decision system. We analysed transcripts by coding, and grouping code families up to four levels. We achieved saturation with fifteenth interviews. RESULTS: All our participants happened to be favourably disposed towards organ donation. Participants considered it important to choose a policy that contributes to overcoming the current shortage of organs, but not by any means. They were mostly concerned about individual rights and liberties, and more specifically about the importance of respecting the deceased's will and to promote lifetime advanced directives on organ donation. The role and rights of relatives were recurrent topics on which participants expressed divergent opinions. Participants often concluded that no legal system is perfect and spent much time discussing elements that were relevant to organ donation in general but not specifically linked to a given legal system. CONCLUSION: This study provides useful information about citizens' concerns regarding organ donation. In preparation of public debates on an opt-out policy, our results reveal what issues are likely to tilt the public opinion.

Do Primary Care Physicians Contribute to the Immunization Status of Their Adult Patients? A Story of Patients' Overconfidence Coupled With Physicians' Passivity.

Context: Immunization coverage counts among the priorities of public health services. To identify factors that motivate or fail to motivate patients to update their vaccination status would help to design future strategies and awareness campaigns. Objective: Our aim was to assess the impact of primary care physicians on the immunization status of their adult patients, and to explore possible explanations. Methods: We invited students and collaborators of Geneva University to bring their paper vaccination records to receive an assessment of their immunization status and personalized vaccination recommendations. Participants completed a first questionnaire at the recruitment phase, and a second 2-3 months later. We assessed their immunization status with the viavac algorithms based on the Swiss national immunization plan. Results: Having a primary care physician did not correlate with better immunization status: only 22.5% patients who reported having a physician and 20% who reported having no physician were up-to-date (n = 432; p > 0.5). A linear regression indicates that the frequency of medical consultations did not affect patients' immunization status either. Even the participants who recently showed their vaccination record to their primary care physician did not have a better vaccination status. We explored possible explanatory factors and found evidence for the patients' overconfidence about their own immunization status: 71.2% of the participants who predicted that they were up-to-date were wrong about their actual status, and 2-3 months after having received their immunization assessment, 52.8% of the participants who "remembered" having received the assessment that they were up-to-date were wrong: they had in fact received the opposite information that they were not up-to-date. This substantial proportion of wrong beliefs suggests that adult patients are unworried and overconfident about their own immunization status, which is likely to induce a passive resistance toward vaccination updating. Conclusions: This study indicates that the vaccination coverage and beliefs of adults about their immunization status is suboptimal, and that primary care physicians need further support to improve their health-protection mandate through routine immunization check-ups. We highlight that the current covid vaccination campaigns offer a rare opportunity to update patients' immunization status and urge physicians to do so.

The Undeserving Sick? An Evaluation of Patients' Responsibility for Their Health Condition.

The recent increased prevalence of diseases related to unhealthy lifestyles raises difficulties for healthcare insurance systems traditionally based on the principles of risk-management, solidarity, and selective altruism: since these diseases are, to some extent, predictable and avoidable, patients seem to bear some responsibility for their condition and may not deserve full access to social medical services. Here, we investigate with objective criteria to what extent it is warranted to hold patients responsible for their illness and to sanction them accordingly. We ground our analysis on a series of minimal conditions for 'practical' and for 'moral' responsibility attribution. By applying these criteria consistently, we highlight that individual responsibility applies to risk-taking life choices rather than stigmatized sickness. We explain that responsibility is a matter of degree, that it varies across life-history, and can be affected by factors beyond the patients' grasp. We point out that scientific knowledge about the effect of these factors generates responsibilities for other parties such as public health agencies and private industry. The upshot of our analysis is that health policies targeting the 'liable' undeserving sick are mostly unwarranted, and tend to increase unequal treatment of already vulnerable groups: the unlucky sick.

[An ethical evaluation of presumed consent for organ donation in Switzerland]. / Une évaluation éthique du consentement présumé pour le don d'organes en Suisse.

Following a current trend in European countries, Switzerland is about to decide to adopt (or reject) a presumed consent legislation for organ donation. In such a system, every citizen is considered as a potential organ donor except in case of expressed refusal during lifetime. The presumed consent system raises ethical and practical issues that need to be carefully understood and weighed before deciding on its fate. This article reviews the most pressing ethical issues and provides the empirical data necessary for assessing the presumed consent legislation in Switzerland. At the end of the analysis, the reader will be able to form her own informed opinion on the issue.

A l'image d'autres pays européens, la Suisse est sur le point de décider d'adopter (ou de rejeter) une législation du consentement présumé pour le don d'organes. Dans un tel système, tout citoyen est considéré comme donneur potentiel, sauf en cas de refus exprimé de son vivant. Le consentement présumé soulève des enjeux éthiques et pratiques qu'il importe de comprendre et pondérer soigneusement avant de statuer sur son sort. Cet article fournit les principales clefs d'analyse ainsi que les données empiriques nécessaires à cet exercice. Au terme de l'analyse, le lecteur pourra se forger une opinion informée et réfléchie sur le sujet.

Overcoming the limits of empathic concern: the case for availability and its application to the medical domain.

Empathic concern is essential to our social lives because it motivates helping behavior. It has, however, well-known shortcomings such as its limitation in scope. Here, we highlight a further shortcoming of empathic concern: it contributes little to understanding the relevant features of complex social situations (e.g. the causes of somebody's distress), and unaided by further cognitive inputs, likely fails to produce effective helping. We then elaborate on the conditions needed for an accurate assessment of others' situations: the ability to pay attention and try to understand others for their own sake. We explain that when combining these abilities with the valuing aspect of empathic concern, we obtain "availability", an understudied mental state which plays a crucial role in helping motivation. We provide a detailed definition of that notion and show how availability can be trained and exercised by health professionals in order to improve their care and relationships with patients.

No Evidence for Moral Reward and Punishment in an Anonymous Context.

Human social interactions are regulated by moral norms that define individual obligations and rights. These norms are enforced by punishment of transgressors and reward of followers. Yet, the generality and strength of this drive to punish or reward is unclear, especially when people are not personally involved in the situation and when the actual impact of their sanction is only indirect, i.e., when it diminishes or promotes the social status of the punished or rewarded individual. In a real-life study, we investigated if people are inclined to anonymously punish or reward a person for her past deeds in a different social context. Participants from three socio-professional categories voted anonymously for early career violinists in an important violin competition. We found that participants did not punish an immoral violin candidate, nor did they reward another hyper-moral candidate. On the contrary, one socio-professional category sanctioned hyper-morality. Hence, salient moral information about past behavior did not elicit punishment or reward in an impersonal situation where the impact of the sanction was indirect. We conclude that contextual features play an important role in human motivation to enforce moral norms.

The evolution of utility functions and psychological altruism.

Numerous studies show that humans tend to be more cooperative than expected given the assumption that they are rational maximizers of personal gain. As a result, theoreticians have proposed elaborated formal representations of human decision-making, in which utility functions including "altruistic" or "moral" preferences replace the purely self-oriented "Homo economicus" function. Here we review mathematical approaches that provide insights into the mathematical stability of alternative utility functions. Candidate utility functions may be evaluated with help of game theory, classical modeling of social evolution that focuses on behavioral strategies, and modeling of social evolution that focuses directly on utility functions. We present the advantages of the latter form of investigation and discuss one surprisingly precise result: "Homo economicus" as well as "altruistic" utility functions are less stable than a function containing a preference for the common welfare that is only expressed in social contexts composed of individuals with similar preferences. We discuss the contribution of mathematical models to our understanding of human other-oriented behavior, with a focus on the classical debate over psychological altruism. We conclude that human can be psychologically altruistic, but that psychological altruism evolved because it was generally expressed towards individuals that contributed to the actor's fitness, such as own children, romantic partners and long term reciprocators.

Choosy moral punishers.

The punishment of social misconduct is a powerful mechanism for stabilizing high levels of cooperation among unrelated individuals. It is regularly assumed that humans have a universal disposition to punish social norm violators, which is sometimes labelled "universal structure of human morality" or "pure aversion to social betrayal". Here we present evidence that, contrary to this hypothesis, the propensity to punish a moral norm violator varies among participants with different career trajectories. In anonymous real-life conditions, future teachers punished a talented but immoral young violinist: they voted against her in an important music competition when they had been informed of her previous blatant misconduct toward fellow violin students. In contrast, future police officers and high school students did not punish. This variation among socio-professional categories indicates that the punishment of norm violators is not entirely explained by an aversion to social betrayal. We suggest that context specificity plays an important role in normative behaviour; people seem inclined to enforce social norms only in situations that are familiar, relevant for their social category, and possibly strategically advantageous.