Patients' Positions on the Degree of Trust to be Placed in Physicians.

Patient-physician relationship is ideally based on mutual trust. Trust usually takes times to build but can quite instantaneously be destroyed as a result of a single action or a single misperception. This study examined the way patients conceptualize the relationship between trust in a physician and perceived competency, honesty and openness, and personal involvement in care. One hundred sixty-seven patients aged 18-85 years were presented with a set of 27 three-item realistic vignettes that described situations in which participants could find themselves if hospitalized because of illness or accident. These scenarios resulted from the complete crossing of the three factors mentioned above. Participants were asked to assess the level of trust they would feel in each case. Through cluster analysis, three positions were found. For a minority of participants, trust was either unconditionally high (4%) or always quite low (8%). For a majority (75%), however, trust depended interactively on competency and honesty, on the one hand, and involvement, on the other hand; that is, the impact of competency and honesty on trust always depended on the level of involvement in care. In particular, when involvement had a low level, trust was always quite low, irrespective of the levels of both other factors. These findings are fully consistent with the view that, for a majority of patients, trust is inherently brittle: A breach in any one of participants' expectations regarding physicians' professionalism is enough to result in a more than proportional reduction in trust level.

Judging the possibility of the onset of diabetes mellitus type 2 from reported behavioral changes and from family history.

BACKGROUND: Undiagnosed type 2 diabetes is common and can lead to unrecognized health complications. Given that earlier detection can reduce the damage to vital organs, it is important for all persons to be able to make the connection between certain new manifestations in their bodies and the possibility of diabetes. This study examined the extent to which people use the behavioral changes they observe in others (or in themselves), as well as relevant family history, to judge the possibility of the onset of diabetes. METHODS: One hundred and fifty-six adults living in France examined a set of realistic vignettes describing a person with (or without) signs suggestive of diabetes (e.g., increased thirst, family antecedents) and judged the possibility of the disease in each case. RESULTS: Overall, 36% of participants focused on reported symptoms when judging the possibility of diabetes, 37% focused on family history, and 29% were not able to use the information or tended systematically to minimize the possibility of diabetes. CONCLUSIONS: People in France and probably around the world need a greater awareness not only of the factors putting them at risk of diabetes, but also of the specific signs and symptoms suggesting that they might be developing it.

Young Indians' Willingness to Make a Living Organ Donation.

BACKGROUND: The large unmet need in India for organs to transplant calls for an increase in living organ donations. This study examined the positions of Indian university students on making a living organ donation. METHODS: A convenience sample of 339 students from Karnatak University rated willingness to be a living donor in 48 scenarios consisting of all combinations of 5 factors: recipient's identity (close family member vs stranger), level of surgical risk for the donor, possible long-term health consequences for the donor, probability of transplant success, and likelihood of finding other donors (the subject is one of the rare compatible donors or one donor among others). RESULTS: Cluster analyses showed the existence of 4 qualitatively distinct positions called nondonors (9%); family donors (21%), for whom willingness was very high when recipients were family members and very low when they were strangers; universal donors (30%), for whom willingness was also quite high when a stranger was involved; and conditional donors (23%), who took a risk-benefit perspective. CONCLUSIONS: These finding suggest that the fundamental reason for the current shortage of organs in India is neither psychological nor cultural but more likely organizational.

Positions of French Nurses Regarding the use of Hypnotherapy to Relieve Pain in Postoperative Settings.

The objective of this study was to carry out a detailed mapping of the different personal positions of French nurses concerning the practice of hypnotherapy. Factorial design was used to assess the impact of 4 situational factors: type of postoperative care and degree of pain associated with it (chemotherapy, wound cleansing and bandaging, or body grooming that leads to pain on mobilization); whether paracetamol (also known as acetaminophen) was administrated along with hypnosis or not; professional credentials of the hypnotherapist; and patient's identity (adult, young person, elderly person, or young person with learning difficulties). A combination of scenario technique and cluster analysis was implemented. Participants were 91 registered nurses and, for comparison, 19 nurse's aides, 9 physicians, 5 psychologists, and 77 laypersons. Seven qualitatively different positions were found. Only a minority of French nurses were convinced that hypnotherapy is an indisputably acceptable practice in postoperative care. Most of them were indifferent to the issue as long as pain medication was used. Nurses' views appeared to be similar to physicians' views.

Assessing hospitalized patients' quality of life from external indices: the perspectives of lay people and health professionals.

PURPOSE: We examined the way people assess hospitalized patients' quality of life from what they immediately observe when entering the patient's room, from what they learn by conversing with the patient, and from what they know about the patient's social life. METHODS: A sample of 474 adults (among them 7 physicians, 57 nurses, and 42 nurse's aides) aged 18-90 years was presented with 54 realistic scenarios depicting the situation of a terminally ill patient, and created by orthogonally combining the levels of four factors: chronic pain (e.g., requiring powerful painkillers), social support (e.g., some visits), mental status (e.g., alterations of consciousness), and physical autonomy. In each case, they assessed the patient's health-related quality of life. RESULTS: Through cluster analysis, three different positions related to what is important when judging the quality of life of a hospitalized patient were found. They were labeled Almost Always Low (40%), Depends on Personal and Social Circumstances (49%), and Depends Mainly on Social Support (11%). Health professionals did not differ fundamentally from lay people in their positions regarding what determines the health-related quality of life of their patients. CONCLUSION: Many people take a particularly pessimistic view of the quality of life of people whose health is unlikely to improve. Others think that, in certain circumstances, a certain quality of life can be preserved but for this to happen, the situation must be nearly ideal. A minority expressed a position consistent with the insistence of voluntary patient-visiting associations on the importance of providing hospitalized patients with social support.

French People's Views on the Allocation of Organs for Transplantation.

BACKGROUND: French laypeople's views on the allocation of organs for transplantation were examined. METHODS: A total of 199 adults make judgments of priority for a liver transplant in 48 realistic scenarios composed of all combinations of 4 factors: 1. probability of success, 2. life expectancy without transplant, 3. level of responsibility for liver failure (eg, substance abuse in the past), and 4. social situation (eg, young mother with 2 young children). In all scenarios, the patients were in need of liver transplant. The ratings were subjected to cluster analysis and analyses of variance. RESULTS: Six qualitatively different positions were found that were termed Probability of Success and Life Expectancy (6%), Family Responsibilities (8%), Family Responsibilities and Risky Behavior (28%), Risky Behavior and Family Responsibilities (22%), Risky Behavior (11%), and Always a Priority (25%). Regular church attendees expressed more often the Risky Behavior and Family Responsibilities position and less often the Always a Priority position than atheists. Female participants expressed more often the Risky Behavior position than male participants. CONCLUSIONS: The French laypeople in our sample think that when assessing priority for transplant, criteria additional to medical urgency or the estimated utility in terms of expected life span after transplant should be taken into account. These criteria are the patient's lack of responsibility for the liver failure (ie, not causing it by drinking or using drugs) and the extent of the patient's social responsibilities (with active employment and dependents to care for).

French People's Views Regarding Xenotransplantation.

BACKGROUND: French laypeople's views on xenotransplantation were examined. METHODS: A convenience sample of 224 adults (among them, 37 nurses) judged of the acceptability of xenotransplantation in 50 realistic scenarios composed of various combinations of 4 factors: 1. the type of graft (eg, pig cardiac valve), 2. the level of urgency (eg, critical condition with very high risk of death in the short term), 3. the patient's or the family's level of consent (eg, the members of the family are divided on the issue), and 4. whether the transplantation was temporary or definitive. The ratings were subjected to cluster analysis and analyses of variance. RESULTS: Seven qualitatively different positions were found that were termed Never acceptable (12%), Urgency (4%), Family consent (33%), Religious concerns (15%), Family consent and urgency (10%), Depends on all circumstances (4%), and Always acceptable (11%). Vegans and vegetarians expressed the Never acceptable position more often than nonvegetarians. Health professionals expressed the Family consent position more often than the public. Regular church attendees expressed the Religious concerns position more often than atheists did. CONCLUSIONS: Few participants, mostly vegetarians, were opposed to xenotransplantation on principle. About one-third expressed positive views regarding xenotransplantation, either irrespective of circumstances or at least in those cases in which the patient's death is imminent and the family is not opposed for religious reasons. About one-half expressed positive views but deferred to the wishes of the family. The type of xenograft proposed had practically no effect on participants' views.

Infant vaccination against malaria in Mozambique and in Togo: mapping parents' willingness to get their children vaccinated.

Background: Malaria is one of the most widespread and deadly diseases worldwide and large majority of malaria cases and deaths occurs in Africa. Efforts to develop an effective vaccine against malaria are underway and several vaccine prototypes are on different clinical trial phases.Objective: As many sub-Saharan African countries have shown interest in introducing large-scale infant vaccination against malaria when a definitively approved vaccine will be available, the present study aimed at mapping Mozambican parents' willingness to get their children vaccinated and comparing the results with findings from a similar study we conducted in Togo (209 participants).Methods: In Mozambique, 227 parents indicated their willingness to get their children vaccinated (using an 11-point scale) against malaria under different conditions varying as a function of the main constructs of health-protective theories: perceived risk of getting malaria, perceived severity of malaria, effectiveness of the vaccine, cost of the vaccine, and neighbors' attitude toward vaccination. The participant responses were subjected to cluster analysis, ANOVA and Ch2 test.Results: Six qualitatively different positions were found, which were labeled Cost (12%); Neighbors, Risk, and Cost (28%); Treatment, Risk, and Cost (10%); Always Vaccinate (7%); Risk and Cost (13%); and Risk, Treatment, Effectiveness, and Cost (22%). These positions were associated with participants' socio-demographic characteristics.Conclusion: A similar variety of parental positions on malaria vaccination was found in Mozambique and in Togo, which suggests that malaria vaccination campaigns in sub-Saharan African countries must be tailored in design and implementation to match the diversity of parents' needs and views.

What motivates individuals to volunteer in Ebola epidemic response? A structural approach in Guinea.

BACKGROUND: The 2014-2016 Ebola epidemic in West Africa placed greater demands on the affected countries' already scarce health workforce. Consequently, governments in the most affected West African countries made appeals for volunteers to join Ebola response programs. Those volunteers played an important yet high-risk role in aiding the victims of the Ebola epidemic and in limiting its spread. However, little is known as to what motivated those volunteers to commit themselves to the Ebola response programs. This information is important for planning for volunteer recruitment strategies during future epidemics. The aim of the present study, therefore, was to identify and assess the motivations that led individuals to volunteer for Ebola response programs in West Africa. METHODS: The study participants were 600 persons who volunteered through the Guinean Ebola response program during the 2014-2016 epidemic. From February to May 2016, they were presented with a questionnaire that contained 50 assertions referring to possible motives for volunteering in the Ebola response program and indicated their degree of agreement with each of them on a scale of 0-10. The responses were analyzed using factor analysis. RESULTS: Seven separable volunteer motivations were identified. "Feeling of patriotic duty" (M = 9.02) and "Feeling of moral responsibility" (M = 8.12) clearly emerged as the most important. Second-tier motivations were "Compliance with authority" (M = 6.66), "Desire to use one's skills for a collective good" (M = 6.49), "Seeking personal growth" (M = 5.93), "Desire to gain community recognition" (M = 5.13), and "Hoping for a career reorientation" (M = 4.52). CONCLUSIONS: These findings strongly suggest that volunteer recruitment, if needed in future Ebola epidemics, must adopt a multifaceted motivational approach rather than focus on one single motivator. Putting relatively more emphasis on motivational messages referring to patriotic values, as well as to moral responsibility, would likely increase volunteering.

Romanian Laypeople's and Health Professionals' Views Regarding Living Organ Donation.

BACKGROUND: Romanian laypeople's and health professionals' views on living organ donation were examined. METHODS: From July 2015 to May 2016, 263 adults (among them 31 physicians and 20 nurses) judged the acceptability of living organ donation in 42 realistic scenarios composed of varying levels of 6 factors: 1. type of organ, 2. whether it could have been obtained from a cadaver, 3. donor-recipient relationship, 4. donor's level of autonomy, 5. financial compensation, and 6. patients' level of responsibility for their illness. In all scenarios, the patients were in need of either a kidney or liver transplantation. RESULTS: The ratings were subjected to cluster analysis and analyses of variance. Seven qualitatively different positions were found that were termed never acceptable (12%), free market (44%), compensation (12%), altruism (6%), always acceptable (16%), responsibility (4%), and undetermined (6%). Physicians were more frequently in the free market or in the compensation clusters (81%) than laypeople (51%). CONCLUSION: Only a few participants held the altruism model, even though this model has been promoted as the normative model by the World Health Organization and by most national legislations, including the legislation in Romania. Instead, the free market position and its variant-the compensation position-can be considered the majority positions (66%) in Romania.

Why patients want to take or refuse to take antibiotics: an inventory of motives.

BACKGROUND: Inappropriate use of antibiotics is a worldwide issue. In order to help public health institutions and each particular physician to change patterns of consumption among patients, it is important to understand better the reasons why people accept to take or refuse to take the antibiotic drugs. This study explored the motives people give for taking or refusing to take antibiotics. METHODS: Four hundred eighteen adults filled out a 60-item questionnaire that consisted of assertions referring to reasons for which the person had taken antibiotics in the past and a 70-item questionnaire that listed reasons for which the person had sometimes refused to take antibiotics. RESULTS: A six-factor structure of motives to take antibiotics was found: Appropriate Prescription, Protective Device, Enjoyment (antibiotics as a quick fix allowing someone to go out), Others' Pressure, Work Imperative, and Personal Autonomy. A four-factor structure of motives not to take antibiotics was found: Secondary Gain (through prolonged illness), Bacterial Resistance, Self-defense (the body is able to defend itself) and Lack of trust. Scores on these factors were related to participants' demographics and previous experience with antibiotics. CONCLUSION: Although people are generally willing to follow their physician's prescription of antibiotics, a notable proportion of them report adopting behaviors that are beneficial to micro-organisms and, as a result, potentially detrimental to humans.

Willingness to get vaccinated against Ebola: A mapping of Guinean people positions.

OBJECTIVE: To map the different personal positions of Guinean people regarding vaccination against Ebola. METHODS: From January to April 2016, 304 adults in Guinea were presented with 48 vignettes depicting situations in which getting vaccinated would be possible. These situations varied as a function of the constructs of health-protective behavior theories. The participants indicated the likelihood they would get vaccinated in each case. RESULTS: Seven qualitatively different positions were found: Always Vaccinate (38%), Never Vaccinate (25%), Hesitant (19%), Depends on Cost Only (7%), Depends on Neighbors' Attitude and Cost (5%), Mainly Depends on Risk (4%), and Mistrust of Cheap Vaccines (2%). CONCLUSION: The diversity of Guinean people's positions implies that Ebola vaccination campaigns in Guinea, and probably in other sub-Saharan African countries, must not be "one size fits all," but must be multifaceted and tailored in design and implementation to match the diversity of these people's needs and views.

Duty to provide care to Ebola patients: the perspectives of Guinean lay people and healthcare providers.

AIM: To examine the views of Guinean lay people and healthcare providers (HCPs) regarding the acceptability of HCPs' refusal to provide care to Ebola patients. METHOD: From October to December 2015, lay people (n=252) and HCPs (n=220) in Conakry, Guinea, were presented with 54 sample case scenarios depicting a HCP who refuses to provide care to Ebola patients and were instructed to rate the extent to which this HCP's decision is morally acceptable. The scenarios were composed by systematically varying the levels of four factors: (1) the risk of getting infected, (2) the HCP's working conditions, (3) the HCP's family responsibilities and (4) the HCP's professional status. RESULTS: Five clusters were identified: (1) 18% of the participants expressed the view that HCPs have an unlimited obligation to provide care to Ebola patients; (2) 38% held that HCPs' duty to care is a function of HCPs' working conditions; (3) 9% based their judgments on a combination of risk level, family responsibilities and working conditions; (4) 23% considered that HCPs do not have an obligation to provide care and (5) 12% did not take a position. CONCLUSION: Only a small minority of Guinean lay people and HCPs consider that HCPs' refusal to provide care to Ebola patients is always unacceptable. The most commonly endorsed position is that HCPs' duty to provide care to Ebola patients is linked to society's reciprocal duty to provide them with the working conditions needed to fulfil their professional duty.

Haitian people's expectations regarding post-disaster humanitarian aid teams' actions.

The way people at the receiving end of humanitarian assistance perceive this intervention may provide invaluable bottom-up feedback to improve the quality of the intervention. We analyzed and mapped Haitians' views regarding international humanitarian aid in cases of natural disaster. Two hundred fifty participants-137 women and 113 men aged 18-67-who had suffered from the consequences of the earthquake in 2010 were presented with a series of vignettes depicting a humanitarian team's action and were asked to what extent these actions corresponded to what ought to be expected from an international aid mission. Four factors were considered in the vignettes (a) whether the team worked in close association with local institutions, (b) whether it was composed of competent people who were prepared for their mission, (c) whether they treated people as a function of immediate needs, and (d) whether they behaved in a respectful way. Through cluster analysis, five qualitatively different positions were found: (a) Complete hostility to any kind of humanitarian aid (6%); (b) Strong hostility to humanitarian aid in the case of disrespectful attitudes or behaviors (4%); (c) Technical competence is the only factor that matters (25%); (d) Both manifestation of respect for the population and technical competence matter (38%) and (e) Undetermined (27%). Most Haitians expect humanitarian teams to be technically competent, but even very competent aid is not considered adequate if provided in an arrogant and disrespectful manner.

Acceptability of vaccination against HIV: A mapping of Togolese people's positions.

In anticipation of a future HIV vaccine, we mapped the different personal positions regarding HIV vaccination of people in Togo. In early 2014, 363 adults indicated their willingness to receive a future HIV vaccine under different conditions varying as a function of five factors: perceived susceptibility to HIV, vaccine effectiveness, perceived severity of AIDS, vaccine cost, and family's influence. We found five qualitatively different positions: unconditional acceptance (49%), depends on cost/effectiveness ratio (20%), depends on cost (18%), total indecision (10%), and complete reluctance (3%). Accordingly, HIV vaccination strategies in Togo and elsewhere in Africa need to be multifaceted and tailored.

Allocation of antiretroviral drugs to HIV-infected patients in Togo: perspectives of people living with HIV and healthcare providers.

AIM: To explore the way people living with HIV and healthcare providers in Togo judge the priority of HIV-infected patients regarding the allocation of antiretroviral drugs. METHOD: From June to September 2015, 200 adults living with HIV and 121 healthcare providers living in Togo were recruited for the study. They were presented with stories of a few lines depicting the situation of an HIV-infected patient and were instructed to judge the extent to which the patient should be given priority for antiretroviral drugs. The stories were composed by systematically varying the levels of four factors: (a) the severity of HIV infection, (b) the financial situation of the patient, (c) the patient's family responsibilities and (d) the time elapsed since the first consultation. RESULTS: Five clusters were identified: 65% of the participants expressed the view that patients who are poor and severely sick should be treated as a priority, 13% prioritised treatment of patients who are poor and parents of small children, 12% expressed the view that the poor should be treated as a priority, 4% preferred that the sickest be treated as a priority and 6% wanted all patients to get treatment. CONCLUSIONS: WHO's guideline regarding antiretroviral therapy allocation (the sickest first as the sole criterion) currently in use in many African countries does not reflect the preferences of Togolese people living with HIV. For most HIV-infected patients in Togo, patients who cannot get treatment on their own should be treated as a priority.

Mapping French people and health professionals' positions regarding the circumstances of morphine use to relieve cancer pain.

BACKGROUND: Cancer patients suffer in part because some health professionals prescribe or administer amounts of analgesics, namely opioids, which are too small or too widely spaced to be fully effective. Patients' reluctance to use opioids for pain treatment is often mentioned as a reason not to apply the official guidelines, but very few studies have been conducted on people's attitudes about opioid use to relieve cancer pain. METHODS: One hundred twenty lay participants and 30 health professionals (7 physicians and 23 nurses) were presented with a set of vignettes describing a terminally ill woman with cancer who is in pain. The vignettes were composed according to a four within-subject factor design: (a) level of pain reported by the patient, (b) patient's explicit request for additional administration of analgesics, (c) the physicians' final decision (e.g., to use a stronger analgesic combining paracetamol and codeine), and (d) the way the decision was made (collectively or not). Participants were asked to assess the extent to which the physician's decision was, in their view, acceptable. RESULTS: Seven qualitatively different positions were found among participants. They were called as follows: tend to disagree with any decision (9%), increase the strength of the painkiller in any case (16%), give morphine preferentially (9%), partly depends on pain level (23%), fully depends on pain level (6%), depends on decision process and on pain level (22%), and tend not to disagree with any collective decision (25%). CONCLUSIONS: Overall, 91% of participants agreed with the use of morphine in terminally ill cancer patients when the pain level was high (score of 7) and the decision to increase the strength of the painkiller was taken collectively. This percentage dropped to 69% when the team was not involved in the decision and to 40% when the pain level was lower (score of 4). If opposition to the use of morphine exists, it is not opposition to morphine itself but opposition to the circumstances of its use.

Mapping people's views regarding the acceptability of surrogate motherhood.

The aims of the present study were to map French laypersons' views regarding the acceptability of maternal surrogacy and to delineate the circumstances under which surrogacy is considered, by different groups of people, as especially problematic. Participants (N = 236) were presented with a number of scenarios depicting the circumstances in which a couple has contracted with a surrogate mother and were asked to indicate the extent to which such a contract may present a moral problem. The scenarios were created by varying four factors: the type of surrogacy (traditional or gestational), the surrogate mother's level of autonomy, the family context in which the surrogate mother lives, and whether surrogacy was commercial or altruistic. Three qualitatively different personal positions were found: (a) a majority group for which surrogacy always (30%) or often (34%) presents a moral problem, (b) a minority group (14%) for which maternal surrogacy does not systematically present a moral problem, and