Patients' subjective well-being: Determinants and its usage as a metric of healthcare service quality.

It is commonly suggested that patients' subjective well-being (SWB) can be affected by pre-treatment conditions and treatment experiences, and hence SWB can be used to measure and improve healthcare quality. With data collected in a hospital in the UK (N = 446), we investigated the determinants of patients' SWB and evaluated its use in healthcare research. Our findings showed strong relationships between pre-treatment conditions and patients' SWB: anxiety and depression negatively predicted SWB across all three domains, mobility positively predicted the life satisfaction and happiness domains, while the ability to self care and pain and discomfort also predicted SWB in some domains. In contrast, patients' satisfaction with the treatment only played minor roles in determining SWB, much less so the characteristics of their nurses. The general lack of associations between treatment experiences and patient's SWB highlighted the challenges of using SWB to measure healthcare quality and inform policy making.

Les Misérables: An analysis of low SWB across the world.

Global trends indicate that the prevalence of low subjective wellbeing is on the rise, though not all regions are equal in terms of both absolute levels and their trajectories. In this paper, we explore the relative importance of individual- and country-level factors in predicting low SWB. Put differently, we ask if a person found themselves behind a veil of ignorance, should they want to know who they will be or what country they will live in to better understand their risk of having low wellbeing. To answer this question, we leverage data from the most extensive wellbeing survey in the world-the Gallup World Poll. We explore people's likelihood of reporting low evaluative wellbeing (that their life is close to the worst possible life on the Cantril ladder) and low experiential wellbeing (reporting having felt angry, sad, stressed, and worried for most of the day yesterday). Using multilevel models on both measures, we show that individual factors have the greatest explanatory power across both measures, but that country level factors are almost four times more important in explaining the variation in low evaluative wellbeing than low experiential wellbeing around the world. We also present evidence that individual and country-level factors interact, suggesting that a complex system of people and places determines people's likelihood of reporting low SWB.

Do Misconceptions About Health-Related Quality of Life Affect General Population Valuations of Health States?

OBJECTIVES: Healthcare resource allocation decisions are often informed by the expected gains in patients' quality-adjusted life-years. Misconceptions about ill-health's consequences for quality of life (QOL) may however affect evaluations of health states by the general population and hence affect resource allocation decisions informed by quality-adjusted life-years. We examine whether people selectively misestimate the QOL consequences of moderate anxiety or depression compared with other dimensions of health, and we test whether informing people of actual changes in QOL associated with health states changes appraisals of their relative undesirability. METHODS: UK general population participants (N = 1259; in 2017) expressed preferences over moderate problems: anxiety or depression, self-care, and pain or discomfort. A randomized control trial design was used whereby a control group was given a functional description of each health state, and 2 intervention groups were additionally given information on the actual differences in either life satisfaction (LS) or day affect (DA) associated with experiencing each health state. RESULTS: The LS (DA) group reported a higher preference for avoiding living with moderate anxiety or depression, being 13.4% (13.9%) more likely to choose it as most undesirable. CONCLUSION: Informing people of the change in LS or DA associated with health states before they appraise them is a feasible way to obtain informed preferences.

Mental Health Reform: Design and Implementation of a System to Optimize Outcomes for Veterans and Their Families.

The social, health, and economic burden of mental health problems in the veteran community is heavy. Internationally, the array of services and support available to veterans and their families are extensive but vary in quality, are often disconnected, complex to navigate, and lack clear coordination. This paper describes a conceptual framework to guide the design and implementation of a system of services and supports to optimize the mental health and wellbeing of all veterans and their families. The framework recognizes the diversity of veterans across intersecting identities that uniquely shape experiences of posttraumatic mental health and wellbeing. It brings together several strands of research: the values and principles that should underpin the system; the needs of diverse veterans and their families; challenges in the current services and supports; evidence-based interventions; and principles of effective implementation. Central to the future system design is a next generation stepped model of care that organizes best and next practice interventions in a coherent system, matches service provision to level of need and addresses access and navigation. Practical guidance on implementation provides an aspirational and flexible structure for system evolution, and a template for all stakeholders-individuals, groups, agencies and organizations-to effect system change.

Moving to Personalized Medicine Requires Personalized Health Plans.

When individuals, families, and employers select health plans in the United States, they are typically only shown the financial structure of the plans and their provider networks. This variation in financial structure can lead patients to have health plans aligned with their financial needs, but not with their underlying nonfinancial preferences. Compounding the challenge is the fact that managed care organizations have historically used a combination of population-level budget impact models, cost-effectiveness analyses, medical necessity criteria, and current medical consensus to make coverage decisions. This approach to creating and presenting health plan options does not consider heterogeneity in patient and family preferences and values, as it treats populations as uniform. Similarly, it does not consider that there are some situations in which patients are price-insensitive. We seek to highlight the challenges posed by presenting health plans to patients in strictly financial terms, and to call for more consideration of nonfinancial patient preferences in the health plan design and selection process.

Corrigendum: The Welleye: A Conceptual Framework for Understanding and Promoting Wellbeing.

[This corrects the article DOI: 10.3389/fpsyg.2021.716572.].

"Better the devil you know": Are stated preferences over health and happiness determined by how healthy and happy people are?

Most people want to be both happy and healthy. But which matters most when there is a trade-off between them? This paper addresses this question by asking 4000 members of the UK and US public to make various choices between being happy or being physically healthy. The results suggest that these trade-offs are determined in substantial part by the respondent's own levels of happiness and health, with unhappy people more likely to choose unhappy lives and unhealthy people more likely to choose unhealthy ones: "better the devil you know, than the devil you don't". Age also plays an important role; older people are more likely to choose being healthy over being happy. Information about adaptation to physical health conditions matters too, but less so than respondent characteristics. These results further our understanding of public preferences with important implications for policymakers concerned with satisfying those preferences.

The dark side of belief in Covid-19 scientists and scientific evidence.

We draw from an interdisciplinary literature on convictions to examine the manifestations and consequences of firmly held beliefs in Covid-19 (C19) science. Across three studies (N = 743), we assess participants' beliefs in C19 experts, and beliefs in supported and unsupported empirical evidence. Study 1 establishes the basic theoretical links and we show that an individual's belief in science on C19 is associated with dispositional belief in science and moralization of C19 mitigation measures. Our subsequent two studies show how stronger belief in C19 science influences distrust in unmasked individuals past the mandates, and greater endorsement of pandemic mitigation authoritarianism. We document the dark side that emerges when belief in C19 science extends beyond the generally desirable scientific literacy and manifests as a conviction that public health experts are the only ones who can handle the pandemic, and that even unsupported claims about C19 are supported by scientific evidence (e.g., risk of outdoor transmission is high). We also highlight our political ideology findings showing that both liberals and conservatives mis-calibrate C19 risks in different ways, and we conclude with discussing how examining the darker side of scientific beliefs can inform our understanding of people's reactions to the pandemic.

The duration of daily activities has no impact on measures of overall wellbeing.

It is widely assumed that the longer we spend in happier activities the happier we will be. In an intensive study of momentary happiness, we show that, in fact, longer time spent in happier activities does not lead to higher levels of reported happiness overall. This finding is replicated with different samples (student and diverse, multi-national panel), measures and methods of analysis. We explore different explanations for this seemingly paradoxical finding, providing fresh insight into the factors that do and do not affect the relationship between how happy we report feeling as a function of how long it lasts. This work calls into question the assumption that spending more time doing what we like will show up in making us happier, presenting a fundamental challenge to the validity of current tools used to measure happiness.

Combined chemotherapy and endoscopic ultrasound-guided intratumoral 32P implantation for locally advanced pancreatic adenocarcinoma: a pilot study.

BACKGROUND: This study evaluated clinical outcomes of combined chemotherapy and endoscopic ultrasound (EUS)-guided intratumoral radioactive phosphorus-32 (32P) implantation in locally advanced pancreatic adenocarcinoma (LAPC). METHODS: Consecutive patients with newly diagnosed LAPC were recruited over 20 months. Baseline computed tomography and 18F-2-fluoro-2-deoxy-D-glucose (18FDG) positron emission tomography-computed tomography were performed and repeated after 12 weeks to assess treatment response. Following two cycles of conventional chemotherapy, patients underwent EUS-guided 32P implantation followed by six chemotherapy cycles. RESULTS: 12 patients with LAPC (median age 69 years [interquartile range 61.5-73.3]; 8 male) completed treatment. Technical success was 100 % with no procedural complications. At 12 weeks, median reduction in tumor volume was 8.2 cm3 (95 % confidence interval 4.95-10.85; P = 0.003), with minimal or no 18FDG uptake in nine patients (75 %). Tumor downstaging was achieved in six patients (50 %), leading to successful resection in five (42 %), including four R0 resections (80 %). CONCLUSIONS: EUS-guided 32P implantation was feasible, well tolerated, and resulted in a 42 % surgical resection rate. Further evaluation in a larger randomized multicenter trial is warranted.