Patient factors associated with conveyance decision-making by Emergency Medical Services professionals in patients with a syncope: a cross-sectional factorial survey design.

BACKGROUND: The clinical decision-making of non-conveyance is perceived as complex and difficult by emergency medical services (EMS) professionals. Patients with a transient loss of consciousness (TLOC) based on syncope constitute a significant part of the non-conveyance population. Risk stratification is the basis of the clinical decision-making process by EMS professionals. This risk stratification is based on various patient factors. This study aimed to explore patient factors significantly associated with conveyance decision-making by EMS professionals in patients with a TLOC based on syncope. METHODS: A cross-sectional vignette study with a factorial survey design was conducted. Patient factors were derived from the "National Protocol Ambulance Care", and all possible combinations of these factors and underlying categories were combined, resulting in 256 unique vignettes (2*4*4*4*2 = 256). Patient factors presented either low-risk or high-risk factors for adverse events. Data were collected through an online questionnaire, in which participants received a random sample of 15 vignettes. For each vignette, the respondent indicated whether the patient would need to be conveyed to the emergency department or not. A multilevel logistic regression analysis with stepwise backward elimination was performed to analyse factors significantly associated with conveyance decision-making. In the logistic model, we modelled the probability of non-conveyance. RESULTS: 110 respondents were included, with 1646 vignettes being assessed. Mean age 45.5 (SD 9.3), male gender 63.6%, and years of experience 13.2 (SD 8.9). Multilevel analysis showed two patient factors contributing significantly to conveyance decision-making: 'red flags' and 'prehospital electrocardiogram (ECG)'. Of these patient factors, three underlying categories were significantly associated with non-conveyance: 'sudden cardiac death < 40 years of age in family history' (OR 0.33, 95% CI 0.22-0.50; p < 0.001), 'cardiovascular abnormalities, pulmonary embolism or pulmonary hypertension in the medical history' (OR 0.62, 95% CI 0.43-0.91; p = 0.01), and 'abnormal prehospital ECG' (OR 0.54, 95% CI 0.41-0.72; p < 0.001). CONCLUSION: Sudden cardiac death < 40 years of age in family history, medical history, and abnormal ECG are significantly negatively associated with non-conveyance decision-making by EMS professionals in patients with a TLOC based on syncope. Low-risk factors do not play a significant role in conveyance decision-making.

The hidden majority/minority consensus: Minorities show similar preference patterns of immigrant support as the majority population.

The acceptance of new arrivals has become an important topic regarding the social cohesion of the receiving countries. However, previous studies focused only on the native population's drivers of attitudes towards immigrants, disregarding that immigrant-origin inhabitants now form a considerable part of the population. To test whether the drivers for the willingness to support immigrants are the same for natives and immigrants and their descendants, we rely on a vignette study conducted in a representative German online panel (N = 3149) which contains an overrepresentation of immigrant-origin respondents. We presented participants with three vignettes of potential immigrants, varying, amongst other factors, economic prospects, safe and war-ridden countries of origin (to capture deservingness), as well as religious identity. While we find that minority members are generally slightly more welcoming towards immigrants than majority members, at their core are the same factors that drive attitudes to immigrants in both groups: economic cost, cultural similarity, and deservingness. However, we observe differences at the margins: Immigrant-origin respondents take into account economic prospects to a lesser degree than majority members do, and by trend, they are less likely to distinguish between immigrants from war-ridden and safe countries of origin. Furthermore, we can show that the preference for immigrants with the same religious identities not only occurs among majority members but also among minority members.

Assessing Provider Bias in General Practitioners' Assessment and Referral of Depressive Patients with Different Migration Backgrounds: Methodological Insights on the Use of a Video-Vignette Study.

Although the prevalence of common mental health conditions such as depression and anxiety, is higher among people with a migration background, these groups are generally underrepresented in all forms of institutionalized mental health care. At the root of this striking discrepancy might be unequal referral by health care practitioners. In this article we describe the development of a quasi-experimental video vignette methodology to assess potential forms of unequal diagnosing, treatment and referral patterns, based on clients' migration background and asylum status. The presented methodology also allows to explore whether potential differences are related to provider bias, i.e. underlying attitudes and expectations held by general practitioners. Potential assets and drawbacks of this methodology are discussed in detail.

Explicit prognostic disclosure to Asian women with breast cancer: A randomized, scripted video-vignette study (J-SUPPORT1601).

BACKGROUND: Nondisclosure of a poor prognosis to patients with advanced cancer remains a typical practice in Asia. Although the importance of prognostic communication has increasingly been recognized worldwide, little is known about whether explicit prognostic disclosure positively affects Asian patients with advanced cancer. The objective of this study was to examine the effects of explicit prognostic communication on patients with cancer recurrence. METHODS: In this randomized, video-vignette study, Japanese women with breast cancer who had undergone curative surgery viewed videos of prognostic communication between a patient with recurrent, incurable breast cancer and her oncologist. The videos differed only in the presence or absence of explicit prognostic disclosure. The primary outcome was participants' uncertainty (rated from 0 to 10), and the secondary outcomes included anxiety (measured on the State-Trait Anxiety Inventory-State: range, 20-80), satisfaction (Patient Satisfaction Questionnaire; range 0-10), self-efficacy (range, 0-10), and willingness to discuss advance care planning (range, 1-4). RESULTS: In total, 105 women participated (mean ± SD age, 53.8 ± 8.2 years). After viewing the video with more versus less explicit disclosure, participants showed significantly lower uncertainty (mean ± SE scores, 5.3 ±0.2 vs 5.7 ± 0.2, respectively; P = .032) and higher satisfaction (5.6 ± 0.2 vs 5.2 ± 0.2, respectively; P = .010) without increasing anxiety (changes in scores on the State-Trait Anxiety Inventory-State: 0.06 ± 0.5 vs 0.6 ± 0.5, respectively; P = .198). No significant differences were observed in self-efficacy (5.2 ± 0.2 vs 5.0 ± 0.2, respectively; P = .277) or willingness to discuss advance care planning (2.7 ± 0.1 vs 2.7 ± 0.1, respectively; P = .240). CONCLUSIONS: Explicit prognostic disclosure prompted better outcomes than nondisclosure in Japanese women with breast cancer. When asked about the prognosis by Asian patients with cancer, clinicians may be encouraged to respect their wishes and explicitly discuss the prognosis if deemed appropriate.

Which self-management strategies do health care professionals recommend to their cancer patients? An experimental investigation of patient age and treatment phase.

This vignette based study aimed to examine recommendations of health care professionals (HCPs) in promoting self-management strategies to cancer patients. Nine-hundred-forty-two physicians and nurses were asked to (1) indicate if they would recommend self-management strategies to a vignette cancer patient, and (2) to specify those in an open format. Vignettes included a manipulation of patient age (60 vs. 75 years) and treatment phase (currently treated versus treatment completed). Six categories emerged through coding a total of 2303 recommendations: physical activity (71.8%), nutrition (64.3%), psychological support (36.7%), medical support (29.2%), conscious living (17.2%) and naturopathy (12.3%). While psychological support was particularly recommended during treatment, physical activity was more frequently recommended after completion of treatment. Results suggest that HCPs recommend a variety of self-management strategies besides standard medical treatment. Patient's treatment phase and age seem to partly influence recommendation behavior, potentially indicating insecurities regarding acute treatment situations and age-related stereotypes.

Lack of consensus in the choice of termination of pregnancy for Turner syndrome in France.

BACKGROUND: The observed rate of termination of pregnancy (TOP) for Turner syndrome varies worldwide and even within countries. In this vignette study we quantified agreement among ten multidisciplinary prenatal diagnosis centers in Paris. METHODS: We submitted online three cases of Turner syndrome (increased nuchal translucency, normal ultrasound, aortic coarctation) to fetal medicine experts: one obstetrician, one pediatrician and one geneticist in each of the ten Parisian centers. Each case was presented in the form of a progressive clinical history with conditional links dependent upon responses. The background to each case was provided, along with the medical history of the parents and the counseling they got from medical staff. The experts indicated online whether or not they would accept the parents' request for TOP. We assessed the percentage of agreement for acceptance or refusal of TOP. We also used a multilevel logistic regression model to evaluate differences among obstetrician-gynecologists, pediatricians and cytogeneticists. RESULTS: Overall agreement among the experts to accept or refuse TOP was, respectively, 25 and 28%. The percentage of disagreement was 47%. The percentage of agreement to accept TOP was 33, 8 and 33% for obstetrician-gynecologists, pediatricians and cytogeneticists, respectively. The respective percentages of agreement to refuse TOP were 19, 47 and 26%. CONCLUSION: Our results show the lack of consensus with regard to decisions related to termination of pregnancy for Turner Syndrome. This lack of consensus in turn underscores the importance of multidisciplinary management of these pregnancies in specialized fetal medicine centers.

Lay Perspectives on Receiving Different Types of Genomic Secondary Findings: a Qualitative Vignette Study.

Genome-wide sequencing may generate secondary findings (SFs). It is recommended that validated, clinically actionable SFs are reported back to patients/research participants. To explore publics' perspectives on the best ways to do this, we performed a vignette study among Finnish adults. Our aim was to explore how lay people react to different types of hypothetical genomic SFs. Participants received a hypothetical letter revealing a SF predisposing to a severe but actionable disease-cardiovascular disease (familial hypercholesterolemia, long QT syndrome) or cancer (Lynch syndrome, Li-Fraumeni syndrome). Participants (N = 29) wrote down their initial reactions, and discussed (N = 23) these in focus groups. Data were analyzed using inductive thematic analysis. Reactions to hypothetical SFs varied according to perceived severity and familiarity of the diseases. SFs for cancer were perceived as more threatening than for cardiovascular diseases, but less distressing than risk for psychiatric or neurological disorders, which participants spontaneously brought up. Illness severity in terms of lived experience, availability of treatment, stigma, and individual's responsibility to control risk were perceived to vary across these disease types. In addition to clinical validity and utility, SF reporting practices need to take into account potential familiarity and lay illness representations of different diseases. Illness representations may influence willingness to receive SFs, and individuals' reactions to this information.

Changing attitudes towards obesity - results from a survey experiment.

BACKGROUND: This experimental study in a population-based sample aimed to compare attitudes towards obesity following three different causal explanations for obesity (individual behavior, environmental factors, genetic factors). METHODS: The data were derived from an online representative sample. A random subsample of n = 407 participants was included. Two independent variables were investigated: cause of obesity as described in the vignette and cause of obesity as perceived by the participant regardless of vignette. Quality features of the vignettes (accuracy and bias of the vignette) were introduced as moderators to regression models. Three stigma-related outcomes (negative attitudes, blame and social distance) served as dependent variables. RESULTS: Inaccuracy and bias was ascribed to the social environmental and genetic vignettes more often than to the individual cause vignette. Overall, participants preferred individual causes (72.6%). While personal beliefs did not differ between the genetic and environmental cause conditions (Chi2 = 4.36, p = 0.113), both were different from the distribution seen in the individual cause vignette. Negative attitudes as well as blame were associated with the belief that individuals are responsible for obesity (b = 0.374, p = 0.003; 0.597, p < 0.001), but were not associated with vignette-manipulated causal explanation. The vignette presenting individual responsibility was associated with lower levels of social distance (b = -0.183, p = 0.043). After including perceived inaccuracy and bias as moderators, the individual responsibility vignette was associated with higher levels of blame (emphasis: b = 0.980, p = 0.010; bias: b = 0.778, p = 0.001) and the effect on social distance vanished. CONCLUSIONS: This study shows that media and public health campaigns may solidify beliefs that obesity is due to individual causes and consequently increase stigma when presenting individual behavior as a cause of obesity. Public health messages that emphasize the role of social environmental or genetic causes may be ineffective because of entrenched beliefs.

Dutch Pain Specialists' Adherence to the Multidisciplinary Guideline on Treating Pain in Patients with Cancer: A Case Vignette Study.

BACKGROUND: Many patients with cancer suffer from pain, which is often not optimally treated. In 2008, the evidence-based, multidisciplinary Dutch guideline on the diagnosis and treatment of pain in this patient group was published. We assessed knowledge about and adherence to the guideline by pain specialists. METHODS: A cross-sectional case vignette survey describing a palliative patient with intractable pancreatic cancer and pain was sent to all 350 Dutch anesthesiologists registered as pain specialists at the Netherlands Association of Anesthesiology. Descriptive statistics were conducted. RESULTS: Ninety-three pain specialists completed the questionnaire (27%). The majority appeared to follow the guideline recommendations on pharmacological (99%) and invasive treatment (95%) in the diverse stages of the disease. However, the recommendation to use a one-dimensional pain scale to evaluate the effect of pain treatment and the recommendation to perform a multidimensional pain assessment if the patient in pain is in a deteriorating stage were only followed by a minority of the respondents (23% and 15%, respectively). CONCLUSIONS: Regarding most recommendations, Dutch pain specialists know and intend to follow the national multidisciplinary cancer pain guideline. Yet, only a minority of them perform structural pain assessment of the patient with cancer pain. However, as the response rate was low (27%), the results should be interpreted with caution and cannot be generalized to the entire population of pain specialists in the Netherlands. We recommend that, in the guideline update and implementation programs, more attention be given to thorough assessment of the patient with pain and cancer.

Urologists' referral attitude for sacral neuromodulation for treating refractory idiopathic overactive bladder syndrome: discrete choice experiment.

AIMS: To investigate urologists' referral attitude for sacral neuromodulation (SNM) for treating refractory idiopathic overactive bladder syndrome (OAB) and to quantify the weight they attribute to clinical parameters to refrain from SNM referral. METHODS: We set up a vignette study using a discrete-choice design. The questionnaires were distributed at two national urological meetings. RESULTS: One hundred eight urologists completed the questionnaire. Three parameters were significantly associated with the decision to refrain from referral: absolute contraindications for SNM (anatomical low bladder compliance, current urinary tract infection, progressive neurological disease, urinary tumors) had the strongest association (0.78, 95% CI 0.58 to 0.97; P < 0.001), followed by cardiac pacemaker (0.24, 95% CI 0.08 to 0.39; P = 0.003), and diabetes mellitus (0.19, 95% CI 0.06 to 0.32; P = 0.006). On the other hand, urologists considered fecal incontinence as an important parameter for referral (-0.16, 95% CI -0.29 to -0.04; P = 0.011). Current medication with antimuscarinics and polyuria played no role in the decision. Results in a subgroup of 24 neuro-urologists/functional urologists were similar but non-critical parameters were not associated with the decision to refrain from SNM referral. CONCLUSIONS: Besides absolute contraindications, other non-critical parameters such as cardiac pacemaker or diabetes mellitus influence urologists' decision to refrain from referral for SNM. We believe that the use of decision tools will help urologists identifying patients benefiting from SNM and therefore we call for broad dissemination of such tools into clinical practice.

The role of psychological formulation in inpatient settings in supporting staff empathy and therapeutic optimism for adults diagnosed with borderline personality disorder: A pre- and post-vignette study.

WHAT IS KNOWN ON THE SUBJECT?: Psychological formulation brings together a service user story and expertise, with psychological knowledge, research, and practitioners clinical experience to make sense of a service users' presentation (thinking about their difficulties but also strengths). Evidence into the effectiveness of formulation is largely anecdotal, qualitative, or small scale. Although this is very valuable research, there is not a lot of research which quantitatively evidences the role of formulation for service users or services. Quantitative evidence that does exist is also conflicting. Considering how widely psychological formulation is used, and the governing guidelines that recognize this as a core competency for psychological practitioners, it is important to continue to add to the evidence base. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Psychological formulation can increase staff empathy and hope. This could help service users to feel more understood and hopeful. Formulation; however, did not impact feelings of personal distress in staff. This research may suggest a need for the two distinct processes (i.e. team formulation and reflective practice) to support all components of empathy within inpatient services. Psychological formulation could support the provision of psychologically informed care within inpatient services, of which promotes effective care delivery. ABSTRACT: OBJECTIVES: National Health Service (NHS) values, such as empathy and therapeutic optimism, are integral when supporting service users with complex mental health presentations. There is some evidence to suggest that psychological formulation can increase empathy and optimism in healthcare professionals. This study, therefore, aimed to investigate whether a psychological formulation of a hypothetical service user with a complex presentation, typically labelled with a diagnosis of borderline personality disorder (BPD), increased empathy and therapeutic optimism in professionals working in mental health inpatient services. METHOD: Sixty-six mental health professionals working in NHS inpatient services took part in a pre- and post-vignette study. Participants were asked to read a case vignette about a hypothetical service user, with a diagnostic label of BPD, and complete questionnaires capturing levels of empathy and therapeutic optimism. Participants were then randomized into two conditions and either asked to read the same information again (control condition) or read a psychological formulation based on the same hypothetical service user (intervention condition). The findings were analysed using a series of ANCOVAs/ANCOHETs. RESULTS: Two constructs of empathy (i.e. perspective taking and empathic concern), and therapeutic optimism significantly increased following exposure to the psychological formulation when compared to the control group condition. CONCLUSION: This study warrants further replication. These initial findings; however, indicate that psychological formulation can significantly increase the ability to perspective take, display empathic concern, and hold therapeutic optimism towards service users with a presentation associated with a diagnosis of BPD.

Conspiracy beliefs and intention to use conventional, complementary and alternative medicines: Two vignette studies.

OBJECTIVE: Conspiracy beliefs (CBs) can have substantial consequences on health behaviours by influencing both conventional and non-conventional medicine uptake. They can target powerful groups (i.e. upward CBs) or powerless groups (i.e. downward CBs). Considering their repercussions in oncology, it appears useful to understand how CBs are related to the intentions to use conventional, complementary and alternative medicines (CAM). DESIGN AND METHODS: This paper includes two pre-registered online correlational studies on a general French population (Study 1 N = 248, recruited on social media Mage = 40.07, SDage = 14.78; 205 women, 41 men and 2 non-binaries; Study 2 N = 313, recruited on social media and Prolific, Mage = 28.91, SDage = 9.60; 154 women, 149 men and 10 non-binaries). We investigated the links between generic and chemotherapy-related CBs and intentions to use conventional, complementary and alternative medicines. Study 2 consisted of a conceptual replication of Study 1, considering the orientation of CBs. RESULTS: Generic CBs and chemotherapy-related CBs appear strongly and positively correlated, negatively correlated with intentions to take conventional medicine and positively with intentions to take CAM. The link between generic CBs and medication intention is fully mediated by chemotherapy-related CBs. When distinguished, upward CBs are a stronger predictor of chemotherapy-related CBs than downward CBs. CONCLUSIONS: The findings suggest that intentions to use medicine are strongly associated with CBs. This has several important implications for further research and practice, notably on the presence and effects of CBs on medication behaviours in cancer patients.

Terminological Confusion About Sedation in Palliative Care: Results of an International Online Vignette Survey.

Background: Terminological problems concerning sedation in palliative care and consequences for research and clinical decision making have been reported frequently. Objectives: To gather data on the application of definitions of sedation practices in palliative care to clinical cases and to analyze implications for high-quality definitions. Design: We conducted an online survey with a convenience sample of international experts involved in the development of guidelines on sedation in palliative care and members of the European Association for Palliative Care (EAPC). Participants were asked to apply four published definitions to four case vignettes. Data were analyzed using descriptive statistics. Results: A total of 32 experts and 271 EAPC members completed the survey. The definitions were applied correctly in n = 2200/4848 cases (45.4%). The mean number of correct applications of the definitions (4 points max.) was 2.2 ± 1.14 for the definition of the SedPall study group, 1.8 ± 1.03 for the EAPC definition, 1.7 ± 0.98 for the definition of the Norwegian Medical Association, and 1.6 ± 1.01 for the definition of the Japanese Society of Palliative Medicine. The rate of correct applications for the 16 vignette-definition pairs varied between 70/303 (23.1%) and 227/303 (74.9%). The content of definitions and vignettes together with free-text comments explains participants' decisions and misunderstandings. Conclusions: Definitions of sedation in palliative care are frequently incorrectly applied to clinical case scenarios under simplified conditions. This suggests that clinical communication and research might be negatively influenced by misunderstandings and inconsistent labeling or reporting of data. Clinical Trial Registration Number: DRKS00015047.

Reliability of Suicide Risk Estimates: A Vignette Study.

OBJECTIVE: Suicide risk assessments are obligatory when patients express a death wish in clinical practice. Yet, suicide risk estimates based on unguided risk assessments have been shown to be of low reliability. Since generalizability of previous studies is limited, the current study aimed to assess inter-rater and intra-rater reliability of risk estimates conducted by psychotherapists and psychology students using written case vignettes. METHOD: In total, N = 256 participants (psychology students, psychotherapists) were presented with 24 case vignettes describing patients at either low, moderate, severe or extreme risk of suicide. Participants were asked to assign a level of risk to each single vignette at a baseline assessment and again at a follow-up assessment two weeks later. RESULTS: Risk estimates showed a low inter-rater reliability, both for students (AC1 = .35) and for psychotherapists (AC1 = .44). Intra-rater reliability was moderate for psychotherapists (AC1 = .59) and rather low for psychology students (AC1 = .47). In general, intra- and intra-rater reliability were highest for vignettes displaying "low" and "extreme" risk. CONCLUSIONS: The results highlight that the reliability of unguided suicide risk assessments is questionable. Standardized risk assessment protocols are therefore recommended. Nonetheless, even reliable risk estimation does not imply predictive validity of risk estimates for future suicidal behavior.

Suicide risk estimates have been shown to be of low reliabilitySuicide risk estimates by psychotherapists and students also showed low inter-rater and intra-rater reliability in the current studyReliable risk estimation does not imply predictive validity of risk estimates for future suicidal behavior.

"We choose this CV because we choose diversity" - What do eye movements say about the choices recruiters make?

Introduction: A large body of research has established a consensus that racial discrimination in CV screening occurs and persists. Nevertheless, we still know very little about how recruiters look at the CV and how this is connected to the discriminatory patterns. This article examines the way recruiters view and select CVs and how they reason about their CV selection choices, as a first step in unpacking the patterns of hiring discrimination. Specifically, we explore how race and ethnicity signaled through the CV matter, and how recruiters reason about the choices they make. Methods: We recorded data from 40 respondents (20 pairs) who are real-life recruiters with experiences in recruitment of diverse employees in three large Swedish-based firms in the finance and retail sector in two large cities. The participating firms all value diversity, equity and inclusion in their recruitment. Their task was to individually rate 10 fictious CVs where race (signaled by face image) and ethnicity (signaled by name) were systematically manipulated, select the top three candidates, and then discuss their choices in pairs to decide on a single top candidate. We examined whether respondents' choices were associated with the parts of the CV they looked at, and how they reasoned and justified their choices through dialog. Results: Our results show that non-White CVs were rated higher than White CVs. While we do not observe any statistically significant differences in the ratings between different racial groups, we see a statistically significant preference for Chinese over Iraqi names. There were no significant differences in time spent looking at the CV across different racial groups, but respondents looked longer at Polish names compared to Swedish names when presented next to a White face. The dialog data reveal how respondents assess different CVs by making assumptions about the candidates' job and organizational fit through limited information on the CVs, especially when the qualifications of the candidates are evaluated to be equal.

Preferred study designs to support a comparative therapeutic strategy question in oncology: a vignette study.

OBJECTIVES: Some therapeutic strategy questions in oncology could be answered with studies using observational data. Target trial emulation is the application of design principles from randomized controlled trials (RCTs) to the analysis of observational data, to reduce design-induced biases. Our objective was to determine which type of study physicians would preferably plan to answer a comparative effectiveness question lacking evidence in oncology. METHODS: We launched an online survey among physicians specialized in oncology. We constructed a vignette-based inquiry where vignettes described study scenarios which could be conducted to answer the predefined question. We designed six vignettes described by study design (RCT or observational study with a trial emulation framework), main study characteristics, probability of the study succeeding and anticipated delay before results availability. Participants randomly assessed five pair-wise comparisons of the vignettes and were asked which study they would preferably plan by using a Likert scale ranging from -5 to 5. The main outcome was the evaluation of clinicians' preferences for each pairwise comparison. Mean and median preference scores were calculated. RESULTS: Two hundred thirteen participants, specialized in many tumor types, assessed at least one comparison with 82% reporting France as their country of affiliation. The interquartile range was -4 to 4 across pairwise comparisons. The median preference score was in disfavor of the monocentric RCT for the five comparisons where it appeared. The median preference score was strongly in favor of the multicentric national emulated trial when compared to the monocentric emulated trial 4 [IQR 2.5-4]. The mean preference score was the highest for the large European observational study 1.14 (SD 3.33), while the mean preference score was the lowest for the monocentric RCT -1.86 (SD 2.93). CONCLUSION: No study design was strongly preferred, but the monocentric RCT was the least favored study in pair-wise comparisons. The planification of the new research is a compromise between scientific soundness, feasibility, cost, and time before obtaining results. We need to have the right answers to the right questions at the right time.

Managers' sick leave recommendations for employees with common mental disorders: a cross-sectional video vignette study.

BACKGROUND: To better understand the initial phases of sickness absence due to common mental disorders (CMD), the aim of the present video vignette study was to test the following three hypotheses: (1) Managers who have negative attitudes towards employees with CMD will not recommend sick leave. (2) Managers with experience of CMD recommend sick leave to a significantly higher extent than managers lacking this experience. (3) Managers with previous experience of recommending sick leave for people with CMD will recommend sick leave to a significantly higher extent also based on the vignettes. METHODS: An online survey, including a CMD-labelled video vignette, was sent to 4737 Swedish managers (71% participated, n = 3358). For aims (1) and (2), a study sample consisting of 2714 managers was used. For aim (3), due to the design of the survey questions, a subsample (n = 1740) was used. RESULTS: There was no significant association between negative attitudes towards employee depression and managers' recommendation of employee sick leave with the vignette case. The bivariate analysis showed that personal experience of CMD was associated with managers' recommendation of employee sick leave. In the adjusted regression model, it became non-significant. Previous experience of recommending sick leave to one employee and to several employees was associated with recommending sick leave, also when adjusting for gender, level of education, years of managerial experience, and management training on CMDs CONCLUSIONS: The likelihood of a manager recommending sick leave after watching a CMD-labelled video vignette was higher if the manager had previous experience of this situation in real life. This study highlights the importance of including managerial behaviours and attitudes to better understand sick leave among employees with CMD.

Public Chronic Pain Stigma and the Role of Pain Type and Patient Gender: An Experimental Vignette Study.

Research exploring the specific manifestations of chronic pain (CP) public stigma is scarce. One potential factor influencing public stigma manifestations may be the CP type, that is, the presence (secondary CP) or absence (primary CP) of a clearly identifiable pathophysiology. Furthermore, patient gender may play a key role, whereby pain-related gender stereotypes may evoke distinct gender role expectations towards men and women experiencing CP. The aim of the research was 2-fold. First, by means of an experimental vignette design, the general population's cognitive, affective, and behavioral responses were investigated, both towards primary versus secondary CP and towards men versus women. Second, a potential interaction was examined between CP type and patient gender. The research is divided into 2 separate samples: individuals with CP (N = 729) and individuals without CP (N = 283). Factorial ANOVA models were estimated with CP type, patient gender, and participant gender included as factors, age as control variable. The findings support, partly, the general hypothesis of higher (perceived) public stigma towards individuals with primary (vs secondary) CP. No main effects of patient gender were observed. Gender bias in stigmatizing manifestations only emerged in certain contextual circumstances (ie, pain type and participant gender). Different interaction effects (with a combination of gender, patient gender, or CP type) were significant for the distinctive outcome variables. Interestingly, throughout the findings, different patterns of results are found in both samples. The study contributes to the literature on CP stigma, as well as the psychometric examination of items assessing stigmatizing manifestations. PERSPECTIVE: This study examined the role of contextual factors chronic pain type and patient gender into cognitive, affective, and behavioral stigmatizing manifestations coming from the general population towards individuals with chronic pain through an experimental vignette study. The study contributes to the chronic pain stigma literature, as well as the psychometric examination of items assessing stigmatizing manifestations.

Withdrawing biologics in non-systemic JIA: what matters to pediatric rheumatologists?

OBJECTIVE: Approximately one third of children with JIA receive biologic therapy, but evidence on biologic therapy withdrawal is lacking. This study aims to increase our understanding of whether and when pediatric rheumatologists postpone a decision to withdraw biologic therapy in children with clinically inactive non-systemic JIA. METHODS: A survey containing questions about background characteristics, treatment patterns, minimum treatment time with biologic therapy, and 16 different patient vignettes, was distributed among 83 pediatric rheumatologists in Canada and the Netherlands. For each vignette, respondents were asked whether they would withdraw biologic therapy at their minimum treatment time, and if not, how long they would continue biologic therapy. Statistical analysis included descriptive statistics, logistic and interval regression analysis. RESULTS: Thirty-three pediatric rheumatologists completed the survey (40% response rate). Pediatric rheumatologists are most likely to postpone the decision to withdraw biologic therapy when the child and/or parents express a preference for continuation (OR 6.3; p < 0.001), in case of a flare in the current treatment period (OR 3.9; p = 0.001), and in case of uveitis in the current treatment period (OR 3.9; p < 0.001). On average, biologic therapy withdrawal is initiated 6.7 months later when the child or parent prefer to continue treatment. CONCLUSION: Patient's and parents' preferences were the strongest driver of a decision to postpone biologic therapy withdrawal in children with clinically inactive non-systemic JIA and prolongs treatment duration. These findings highlight the potential benefit of a tool to support pediatric rheumatologists, patients and parents in decision making, and can help inform its design.

Predicting coping with expectation violations: combining the ViolEx Model and the Covariation Principle.

An experimental vignette study examined whether three specific situational cues predict ways of coping with violated expectations. The situational cues (consistency, distinctiveness, consensus) were derived from the Covariation Principle. The assessed coping strategies were based on the ViolEx Model-assimilation (activities to fulfill one's expectation), accommodation (expectation change) and immunization (ignoring the discrepant information). A sample of 124 adults (mean age = 23.60 years; 49.19 percent psychology students) were randomly assigned to an experimental and control condition. Participants of the experimental condition read several vignettes about expectation violations with systematically manipulated situational cues, while participants of the control condition received the same vignettes without such cues. Participants had to rate the usefulness of each coping strategy per vignette. The situational cues mostly led to response shifts in coping tendencies: Situations with low consistency cues mostly led to immunization, whereas high consistency led to assimilation in the case of high distinctiveness and to accommodation in the case of low distinctiveness. Consensus cues only played a minor part in the coping process. The results show that situational characteristics influence people's coping behavior, regardless of their dispositional preferences for certain coping strategies.