Subgroups of cognitively affected and unaffected breast cancer survivors after chemotherapy: a data-driven approach.

PURPOSE: It is assumed that a segment of breast cancer survivors are cognitively affected after chemotherapy. Our aim is to discover whether there is a qualitatively different cognitively affected subgroup of breast cancer survivors, or whether there are only quantitative differences between survivors in cognitive functioning. METHODS: Latent profile analysis was applied to age-corrected neuropsychological data -measuring verbal memory, attention, speed, and executive functioning- from an existing sample of 62 breast cancer survivors treated with chemotherapy. Other clustering methods were applied as sensitivity analyses. Subgroup distinctness was established with posterior mean assignment probability and silhouette width. Simulations were used to calculate subgroup stability, posterior predictive checks to establish absolute fit of the subgrouping model. Subgrouping results were compared to traditional normative comparisons results. RESULTS: Two subgroups were discovered. One had cognitive normal scores, the other -45%- had lower scores. Subgrouping results were consistent across clustering methods. The subgroups showed some overlap; 6% of survivors could fall in either. Subgroups were stable and described the data well. Results of the subgroup clustering model matched those of a traditional normative comparison method requiring small deviations on two cognitive domains. CONCLUSIONS: We discovered that almost half of breast cancer survivors after chemotherapy form a cognitively affected subgroup, using a data-driven approach. This proportion is higher than previous studies using prespecified cutoffs observed. IMPLICATIONS FOR CANCER SURVIVORS: A larger group of cancer survivors may be cognitively affected than previously recognized, and a less strict threshold for cognitive problems may be needed in this population.

Binary classification threatens the validity of cognitive impairment detection.

OBJECTIVE: Neuropsychological literature reports varying prevalence of cognitive impairment within patient populations, despite assessment with standardized neuropsychological tests. Within the domain of oncology, the International Cognition and Cancer Task Force (ICCTF) proposed standard cutoff points to harmonize the operationalization of cognitive impairment. We evaluated how this binary classification affects agreement between two highly comparable test batteries. METHOD: Two hundred non-central nervous system (non-CNS) cancer patients who finished treatment (56% females; median age 53 yrs) completed traditional tests and their online equivalents in a counterbalanced design. Following ICCTF standards, impairment was defined as a score of ≥ 1.5 standard deviations (SDs) below normative means on two tests and/or ≥ 2 SDs below normative means on one test. Agreement of classification between traditional and online assessment was evaluated using Cohen's κ. Additional Monte Carlo simulations were conducted to demonstrate how different cutoff points and test characteristics affect agreement. RESULTS: The correlation between total scores of traditional and online assessment was .78. Proportions of impaired patients did not differ between assessment methods: 40% using traditional tests and 38% using online equivalents, χ²(1) = .17, p < .68. Nevertheless, within-person agreement in impairment classification between traditional and online assessment was merely fair (K = .35). Monte Carlo simulations showed similarly low agreement scores (K = .41 for 1.5 SD; K = .33 for 2 SD criterion). CONCLUSIONS: Our results show that binary classification can lead to a situation where two highly similar batteries fail to identify the same individuals as impaired. Additional simulations suggest that within-person agreement between assessment methods using binary classification is inherently low. Modern statistical tools may help to improve validity of impairment detection. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Effect of Source Type and Protective Message on the Critical Evaluation of News Messages on Facebook: Randomized Controlled Trial in the Netherlands.

BACKGROUND: Disinformation has become an increasing societal concern, especially due to the speed that news is shared in the digital era. In particular, disinformation in the health care sector can lead to serious casualties, as the current COVID-19 crisis clearly shows. OBJECTIVE: The main aim of this study was to experimentally examine the effects of information about the source and a protective warning message on users' critical evaluation of news items, as well as the perception of accuracy of the news item. METHODS: A 3 (unreliable vs reliable vs no identified source) × 2 (with protective message vs without) between-subject design was conducted among 307 participants (mean age 29 (SD 10.9] years). RESULTS: The results showed a significant effect of source information on critical evaluation. In addition, including a protective message did not significantly affect critical evaluation. The results showed no interaction between type of source and protective message on critical evaluation. CONCLUSIONS: Based on these results, it is questionable whether including protective messages to improve critical evaluation is a way to move forward and improve critical evaluation of health-related news items, although effective methodologies to tackle the spread of disinformation are highly needed. TRIAL REGISTRATION: ClinicalTrials.gov NCT05030883; https://clinicaltrials.gov/ct2/show/NCT05030883.

Continued influence of misinformation in times of COVID-19.

Health-related misinformation, especially in times of a global health crisis, can have severe negative consequences on public health. In the current studies, we investigated the persuasive impact of COVID-19-related misinformation, and whether the valence of the misinformation and recipients' degree of overconfidence affect this impact. In two pre-registered experimental studies, participants (N = 403; N = 437) were exposed to either a positive or a negative news article describing a fictional hospital's high COVID-19 recovery/mortality rates. Half of the participants subsequently received a correction. Attitudes towards the hospital were measured before and after exposure. Results of both studies showed that, as expected, corrections reduced the persuasive impact of misinformation. But whereas some persuasive impact remained for corrected negative misinformation (a continued influence effect), it reversed for corrected positive information, causing people to have more negative attitudes towards the hospital than before exposure to any information (a backfire effect). These results corroborate prior suggestions that continued influence effects are asymmetric: negative misinformation is harder to neutralise than positive misinformation. Participants' overconfidence degrees did not have a moderating role in misinformation effects. Even though corrections decrease the persuasive impact of health-related misinformation, continued influence remains for negative misinformation.

Standardized item selection for alternate computerized versions of Rey Auditory Verbal Learning Test(-based) word lists.

INTRODUCTION: Despite an increasing need for new Rey Auditory Verbal Learning Test (RAVLT)-based word lists in computerized testing, no criteria or standardized procedures exist for its development. To lay a foundation for future development of new and alternate computerized RAVLT(-based) word lists, we present cross-lingual word criteria, developed new lists using the criteria and evaluated performance on the lists using online assessment. METHOD: Based on psycholinguistic literature, we identified relevant word selection criteria. To validate the criteria, we developed two new American-English word lists and one new Dutch list, and administered the RAVLT using visual presentation of the new or original list in an online American (n = 248) and Dutch sample (n = 246) of healthy people. We compared performance of the new and original word lists on trial scores and serial position effects using Bayesian correlations and analyses of variance. Additionally, we compared proportions of correct responses per item, corrected for serial position. RESULTS: We identified 13 relevant word selection criteria. The criteria led to two new highly comparable American-English word lists with lower trial scores compared to the original American-English list, indicating that the criteria helped to develop parallel lists with fewer associations between items. The new Dutch word list showed similar trial scores, serial position effects, and proportions of correct responses per item corrected for serial position compared to the original Dutch version. CONCLUSIONS: The systematic use of word selection criteria can facilitate development of new parallel word lists, including in new language areas. Future studies should evaluate the use of the word criteria for the other sections of the RAVLT (such as delayed recall and recognition), performance using original test modalities (auditory presentation and recall of words) as well as performance in clinical samples.

Computational Modeling of Neuropsychological Test Performance to Disentangle Impaired Cognitive Processes in Cancer Patients.

There is a need to better identify impaired cognitive processes to increase our understanding of cognitive dysfunction caused by cancer and cancer treatment and to improve interventions. The Trail Making Test is frequently used for evaluating information-processing speed (part A) and executive function (part B), but interpretation of its outcomes is challenging because performance depends on many cognitive processes. To disentangle processes, we collected high-resolution data from 192 non-central nervous system cancer patients who received systemic therapy and 192 cancer-free control participants and fitted a Shifted-Wald computational model. Results show that cancer patients were more cautious than controls (Cohen d = 0.16). Patients were cognitively slower than controls when the task required task switching (Cohen d = 0.16). Our results support the idea that cancer and cancer treatment accelerate cognitive aging. Our approach allows more precise assessment of cognitive dysfunction in cancer patients and can be extended to other instruments and patient populations.

How to Correct for Computer Experience in Online Cognitive Testing?

Objective: Since computerized cognitive test performance may be influenced by computer experience, correction for this measure might be needed. This study examined how to correct for computer experience by examining its influence on online and traditional tests. Method: 248 healthy adults completed an online neuropsychological test battery and 70 adults completed traditional equivalents of the tests. Computer experience was assessed by a performance-based and a self-report measure. Regression analyses were applied to examine their influence on the online and traditional tests. Results: After correction for demographics, the performance-based measure was associated with online and traditional, predominantly speed-based, tests. The self-report measure was also associated with speed-based online tests but not with most traditional tests. Conclusions: Correcting computerized neuropsychological tests using a performance-based measure of computer experience would be unwise, because this measure also seems to tap into cognitive functions. A correction using a self-report measure might be better and is appropriate.

Online Self-Administered Cognitive Testing Using the Amsterdam Cognition Scan: Establishing Psychometric Properties and Normative Data.

BACKGROUND: Online tests enable efficient self-administered assessments and consequently facilitate large-scale data collection for many fields of research. The Amsterdam Cognition Scan is a new online neuropsychological test battery that measures a broad variety of cognitive functions. OBJECTIVE: The aims of this study were to evaluate the psychometric properties of the Amsterdam Cognition Scan and to establish regression-based normative data. METHODS: The Amsterdam Cognition Scan was self-administrated twice from home-with an interval of 6 weeks-by 248 healthy Dutch-speaking adults aged 18 to 81 years. RESULTS: Test-retest reliability was moderate to high and comparable with that of equivalent traditional tests (intraclass correlation coefficients: .45 to .80; .83 for the Amsterdam Cognition Scan total score). Multiple regression analyses indicated that (1) participants' age negatively influenced all (12) cognitive measures, (2) gender was associated with performance on six measures, and (3) education level was positively associated with performance on four measures. In addition, we observed influences of tested computer skills and of self-reported amount of computer use on cognitive performance. Demographic characteristics that proved to influence Amsterdam Cognition Scan test performance were included in regression-based predictive formulas to establish demographically adjusted normative data. CONCLUSIONS: Initial results from a healthy adult sample indicate that the Amsterdam Cognition Scan has high usability and can give reliable measures of various generic cognitive ability areas. For future use, the influence of computer skills and experience should be further studied, and for repeated measurements, computer configuration should be consistent. The reported normative data allow for initial interpretation of Amsterdam Cognition Scan performances.

Reliability and validity of a self-administered tool for online neuropsychological testing: The Amsterdam Cognition Scan.

INTRODUCTION: To facilitate large-scale assessment of a variety of cognitive abilities in clinical studies, we developed a self-administered online neuropsychological test battery: the Amsterdam Cognition Scan (ACS). The current studies evaluate in a group of adult cancer patients: test-retest reliability of the ACS and the influence of test setting (home or hospital), and the relationship between our online and a traditional test battery (concurrent validity). METHOD: Test-retest reliability was studied in 96 cancer patients (57 female; Mage = 51.8 years) who completed the ACS twice. Intraclass correlation coefficients (ICCs) were used to assess consistency over time. The test setting was counterbalanced between home and hospital; influence on test performance was assessed by repeated measures analyses of variance. Concurrent validity was studied in 201 cancer patients (112 female; Mage = 53.5 years) who completed both the online and an equivalent traditional neuropsychological test battery. Spearman or Pearson correlations were used to assess consistency between online and traditional tests. RESULTS: ICCs of the online tests ranged from .29 to .76, with an ICC of .78 for the ACS total score. These correlations are generally comparable with the test-retest correlations of the traditional tests as reported in the literature. Correlating online and traditional test scores, we observed medium to large concurrent validity (r/ρ = .42 to .70; total score r = .78), except for a visuospatial memory test (ρ = .36). Correlations were affected-as expected-by design differences between online tests and their offline counterparts. CONCLUSIONS: Although development and optimization of the ACS is an ongoing process, and reliability can be optimized for several tests, our results indicate that it is a highly usable tool to obtain (online) measures of various cognitive abilities. The ACS is expected to facilitate efficient gathering of data on cognitive functioning in the near future.

Online cognition: factors facilitating reliable online neuropsychological test results.

OBJECTIVE: Online neuropsychological test batteries could allow for large-scale cognitive data collection in clinical studies. However, the few online neuropsychological test batteries that are currently available often still require supervision or lack proper psychometric evaluation. In this paper, we have outlined prerequisites for proper development and use of online neuropsychological tests, with the focus on reliable measurement of cognitive function in an unmonitored setting. METHOD: First, we identified several technical, contextual, and psychological factors that should be taken into account in order to facilitate reliable test results of online tests in the unmonitored setting. Second, we outlined a methodology of quality assurance needed in order to obtain reliable cognitive data in the long run. RESULTS: Based on factors that distinguish the online unmonitored test setting from the traditional face-to-face setting, we provide a set of basic requirements and suggestions for optimal development and use of unmonitored online neuropsychological tests, including suggestions on acquiring reliability, validity, and norm scores. CONCLUSIONS: When properly addressing factors that could hamper reliable test results during development and use, online neuropsychological tests could aid large-scale data collection for clinical studies in the future. Investment in both proper development of online neuropsychological test platforms and the performance of accompanying psychometric studies is currently required.

Anonymity versus privacy: selective information sharing in online cancer communities.

BACKGROUND: Active sharing in online cancer communities benefits patients. However, many patients refrain from sharing health information online due to privacy concerns. Existing research on privacy emphasizes data security and confidentiality, largely focusing on electronic medical records. Patient preferences around information sharing in online communities remain poorly understood. Consistent with the privacy calculus perspective adopted from e-commerce research, we suggest that patients approach online information sharing instrumentally, weighing privacy costs against participation benefits when deciding whether to share certain information. Consequently, we argue that patients prefer sharing clinical information over daily life and identity information that potentially compromises anonymity. Furthermore, we explore whether patients' prior experiences, age, health, and gender affect perceived privacy costs and thus willingness to share information. OBJECTIVE: The goal of the present study is to document patient preferences for sharing information within online health platforms. METHODS: A total of 115 cancer patients reported sharing intentions for 15 different types of information, demographics, health status, prior privacy experiences, expected community utility, and privacy concerns. RESULTS: Factor analysis on the 15 information types revealed 3 factors coinciding with 3 proposed information categories: clinical, daily life, and identity information. A within-subject ANOVA showed a strong preference for sharing clinical information compared to daily life and identity information (F1,114=135.59, P=.001, η(2)=.93). Also, adverse online privacy experiences, age, and health status negatively affected information-sharing intentions. Female patients shared information less willingly. CONCLUSIONS: Respondents' information-sharing intentions depend on dispositional and situational factors. Patients share medical details more willingly than daily life or identity information. The results suggest the need to focus on anonymity rather than privacy in online communities.

Playing in or out of character: user role differences in the experience of interactive storytelling.

Interactive storytelling (IS) is a promising new entertainment technology synthesizing preauthored narrative with dynamic user interaction. Existing IS prototypes employ different modes to involve users in a story, ranging from individual avatar control to comprehensive control over the virtual environment. The current experiment tested whether different player modes (exerting local vs. global influence) yield different user experiences (e.g., senses of immersion vs. control). A within-subject design involved 34 participants playing the cinematic IS drama "Emo Emma"( 1 ) both in the local (actor) and in global (ghost) mode. The latter mode allowed free movement in the virtual environment and hidden influence on characters, objects, and story development. As expected, control-related experiential qualities (effectance, autonomy, flow, and pride) were more intense for players in the global (ghost) mode. Immersion-related experiences did not differ over modes. Additionally, men preferred the sense of command facilitated by the ghost mode, whereas women preferred the sense of involvement facilitated by the actor mode.

Exploring replay value: shifts and continuities in user experiences between first and second exposure to an interactive story.

While replay value is a common term in interactive entertainment, psychological research on its meaning in terms of user experiences is sparse. An exploratory experiment using the interactive drama "Façade" was conducted (n=50) to examine shifts and continuities in entertainment-related user experiences between first and second exposure to the same system. A questionnaire with brief scales measuring various user-experience dimensions (interaction-related facets such as usability, flow, and presence, as well as narrative-related facets such as suspense and curiosity) was administered after the first and the second round of exposure. Findings suggest that replay produces gains in action-related experience components such as presence and effectance, whereas narrative-related experiences such as curiosity and suspense remain stable across exposures. Implications for theorizing on interactive entertainment experiences are discussed.

It is all about being popular: the effects of need for popularity on social network site use.

Prior research on predictors of social network site (SNS) use has mainly focused on the Big Five, narcissism, and self-esteem. Results have been inconsistent, and variance explained was rather low. Need for popularity (NfP) might be a better predictor of SNS use, because SNSs are ideal venues for people with a high NfP. Study 1 tested NfP, self-esteem, need to belong, entitlement, and vanity as predictors for a range of SNS behaviors; Study 2 replaced entitlement and vanity with narcissism and added the Big Five as predictors. SNS behaviors assessed were grooming, strategic self-presentation, profile enhancement, disclosure of feelings, routine use of SNS, and number of friends. Results showed that NfP was the strongest and most consistent predictor of SNS behaviors. This pattern indicates that NfP plays an important role in SNSs.

Information about chemotherapy-associated cognitive problems contributes to cognitive problems in cancer patients.

OBJECTIVE: Although increasing attention is directed at identifying biological mechanisms underlying cognitive changes observed in cancer patients without central nervous system disease following chemotherapy, psychological factors that can contribute to these cognitive changes are much less studied. METHODS: In an online experiment, the influence of informing patients about the association between cognitive problems and chemotherapy on self-reported cognitive functioning and neuropsychological test performance was investigated. RESULTS: Cancer patients treated with chemotherapy (n = 150) reported higher levels of cognitive complaints after receiving such information (M = 21.20) than without such information (M = 18.98; p = 0.032). No difference was found for patients without (a history of) chemotherapy (n = 86; M = 18.85 vs. 20.08; NS). A similar interaction pattern was observed on a word-learning test. Patients treated with chemotherapy recalled fewer words after being informed about the association between cognitive problems and chemotherapy (M = 24.44) than without such information (M = 27.63; p = 0.010). No difference was found for patients not treated with chemotherapy (M = 26.35 vs. 25.38; NS). CONCLUSION: Patient information may induce a stereotype threat, which affects self-reported cognitive function and neuropsychological test performance in cancer patients for whom this information is relevant.