Pathways to informed choices: The impact of freedom of choice and two-sided messages on psychological reactance and vaccination intentions among individuals who express concerns
Author links open overlay panelToni Claessens, Simone Krouwer, Heidi Vandebosch, Karolien Poels
Vaccine, 6 October 2023; 41(42) pp 6272-6280
Abstract
Background
Reducing the spread of infectious diseases through vaccination faces the challenge of vaccine hesitancy: referring to questions, concerns and doubts arising when making a vaccine-related decision. A motivational state often arising within people exposed to health messages supporting informed decision making is psychological reactance, functioning as a driver to behavior opposed to the one recommended through the health message. Hence, there is a pressing need for communication strategies effective in counteracting reactance to health messages.
Methods
This study tested two communication strategies that can potentially reduce psychological reactance and ameliorate evaluations of the message and subsequent behavioral vaccination intentions in the context of COVID-19. These were: (1) explicitly reminding individuals of their freedom of choice (to either accept or refuse the vaccine) and (2) providing a two-sided message, including, apart from evidence-based information on the necessity of vaccines, a set of concerns, and questions (about the vaccines) which are refuted immediately. A total of 234 participants who indicated having concerns about the COVID-19 vaccine participated in a 2 (freedom of choice: no choice vs. choice) × 2 (message sidedness: one-sided vs. two-sided) between-subjects online experiment where they received an informational brochure about COVID-19 vaccination.
Results
The results show that emphasizing freedom of choice significantly increased perceived credibility of the message, perceived information utility, and ultimately, vaccination intentions. A decrease in psychological reactance mediated these effects. Message sidedness did only show a significant direct effect on perceived information utility. No interaction effect was found.
Conclusion
These findings indicate the importance of freedom of choice in reducing psychological reactance, which in its turn can lead to an increase of positive message evaluations and vaccination intentions among individuals who express concerns. The opportunities of message sidedness as an efficacious vaccination communication strategy should be further investigated.
Month: November 2023
Informed choice and routinization of the second-trimester anomaly scan: a national cohort study in the Netherlands
Informed choice and routinization of the second-trimester anomaly scan: a national cohort study in the Netherlands
Research
Eline E.R. Lust, Kim Bronsgeest, Lidewij Henneman, Neeltje Crombag, Caterina M. Bilardo, Elsbeth H. van Vliet-Lachotzki, Robert-Jan H. Galjaard, Esther Sikkel, Monique C. Haak & Mireille N. Bekker
BMC Pregnancy and Childbirth, 26 September 2023; 23(694)
Open Access
Abstract
Background
Since 2007 all pregnant women in the Netherlands are offered the second-trimester anomaly scan (SAS) in a nationwide prenatal screening program. This study aims to assess the level of informed choice of women opting for the SAS and to evaluate the presence of routinization 16 years after its implementation. It further explores decisional conflict and women’s decision making.
Methods
This prospective national survey study consisted of an online questionnaire which was completed after prenatal counseling and before undergoing the SAS. Informed choice was measured by the adapted multidimensional measure of informed choice (MMIC) and was defined in case women were classified as value-consistent, if their decision for the SAS was deliberated and made with sufficient knowledge.
Results
A total of 894/1167 (76.6%) women completed the questionnaire. Overall, 54.8% made an informed choice, 89.6% had good knowledge, 59.8% had deliberated their choice and 92.7% held a positive attitude towards the SAS. Women with low educational attainment (p=0.004) or respondents of non-Western descent (p=0.038) were less likely to make an informed choice. Decisional conflict was low, with a significantly lower decisional conflict score in women that made an informed choice (p<0.001). Most respondents (97.9%) did not perceive pressure to undergo the SAS.
Conclusions
Our study showed a relatively low rate of informed choice for the SAS, due to absence of deliberation. Therefore, some routinization seem to be present in the Netherlands. However, most women had sufficient knowledge, did not perceive pressure and experienced low decisional conflict.
Navigating Informed Consent and Patient Safety in Surgery: Lessons for Medical Students and Junior Trainees
Navigating Informed Consent and Patient Safety in Surgery: Lessons for Medical Students and Junior Trainees
August A. Culbert, Alejandro Bribriesco, Michael S. O’Connor, Eric Kodish
The Journal of Clinical Ethics, Fall 2023; 34(4)
Abstract
In the operating room, patient safety is of paramount importance. Medical students and junior trainees, despite their primary role as students, may play active roles in assessing patient safety and reporting suspected errors. Active consent is one layer of patient safety that is continuously assessed by several team members. This article examines an instance where patient consent may have been violated. Through the lens of trainee and senior perspectives, we discuss the ethical principles at stake and provide recommendations for medical student and junior trainee involvement in patient care when an error is suspected.
Midshaft clavicle fractures treatment: proposal of informed consent for a shared-treatment decision
Midshaft clavicle fractures treatment: proposal of informed consent for a shared-treatment decision
Remo Goderecci, Stefano Di Filippantonio, Norman Ciprietti, Alessio Ciuffoletti
Lo Scalpello, August 2023
Abstract
Fractures of clavicle frequently occur in young active patients and the middle-third of the shaft is the most involved segment. Traditionally mid-shaft clavicle fractures have been treated mainly non-operatively. The literature of the first decade of the 2000s strongly supported a routine indication of surgical treatment for the fracture of this segment, resulting in a clear change of attitude compared to previous years. However, most recent systematic reviews demonstrated an uncertain superiority of surgery over conservative treatment in the acute management of these fractures. In fact, both types of treatment can result in complications that need to be balanced for the individual patient in order to determine the best indication; in addition, increasing attention is being given to the patient’s involvement in the decision-making process for the therapeutic choice, which also influences final treatment satisfaction. Herein, we propose an informed consent that is clearly understandable to the patient in which all the points relating to the two types of treatment (conservative vs surgical) are discussed: from a review of the literature, we report the factors and relative percentages that can influence the final result. We believe that this document can be a useful tool in the clinic for an informed and shared choice of treatment with the patient suffering from a fracture of the middle third of the clavicle, potentially influencing surgical practice from a legal point of view.
Editor’s note: Lo Scalpello is published by the Italian Journal of Orthopaedics and Traumatology.
Green bioethics, patient autonomy, and informed consent in health care
Green bioethics, patient autonomy, and informed consent in health care
Original Research
David B Resnik, Jonathan Pugh
Journal of Medical Ethics, 13 October 2023
Abstract
Green bioethics is an area of research and scholarship that examines the impact of health care practices and policies on the environment and emphasizes environmental values, such as ecological sustainability and stewardship. Some green bioethicists have argued that health care providers should inform patients about the environmental impacts of treatments and advocate for options that minimize adverse impacts. While disclosure of information pertaining to the environmental impacts of treatments could facilitate autonomous decision-making and strengthen the patient-provider relationship in situations where patients have clearly expressed environmental concerns, it may have the opposite effect in other situations if it serves to make patients feel like they are being judged or manipulated. We argue, therefore, that there is not a generalizable duty to disclose environmental impact information to all patients during the consent process. Providers who practice green bioethics should focus on advocating for system-level changes in health care financing, organization, and delivery and use discretion when bringing up environmental concerns in their encounters with patients.
Animal products in neurosurgery – navigating informed consent
Animal products in neurosurgery – navigating informed consent
Review Article
Patrick Donnelly, Rui Soares, Andy Eynon, Paul Grundy, Andrew Durnford
British Journal of Neurosurgery, 21 September 2023
Abstract
Informed consent is an ethical and legal requirement integral to modern surgical practice. Clinicians have a duty to consider, disclose and discuss risks and concerns relevant to an individual patient. With medical advances there are now a significant number of animal-derived products and adjuncts available for use in modern neurosurgical practice, which may be relevant when consenting patients for specific procedures if such products are used. This paper highlights commonly used products in neurosurgery that contain animal-derived constituents with the aim of facilitating an informed discussion between the neurosurgeon and patient. We have reviewed the commonly used products in the centres of the authors and their commercial equivalents. The product information is taken from the manufacturer’s instructions or the Federal Drug Administration documents regarding the product. Animal products commonly available to neurosurgeons can be broadly categorised into haemostatic agents, dural substitutes, dural sealants and bone cements. Many products contain a variety of animal (or human) derived products. In order to ensure informed consent and shared decision making, it is important to establish any relevant patient beliefs or views regarding the use of animal-derived products. Given the wide availability and use of neurosurgical adjuncts containing human or animal derived products, coupled with the heterogeneity within ethnic, religious, and social groups, each patient must be approached individually to ensure patient-specific concerns are identified and alternatives offered when appropriate.
Stop agonising over informed consent when researchers use crowdsourcing platforms to conduct survey research
Stop agonising over informed consent when researchers use crowdsourcing platforms to conduct survey research
Jonathan Lewis, Vilius Dranseika, Søren Holm
Clinical Ethics, 2023; 18(4)
Abstract
Research ethics committees and institutional review boards spend considerable time developing, scrutinising, and revising specific consent processes and materials for survey-based studies conducted on crowdsourcing and online recruitment platforms such as MTurk and Prolific. However, there is evidence to suggest that many users of ICT services do not read the information provided as part of the consent process and they habitually provide or refuse their consent without adequate reflection. In principle, these practices call into question the validity of their consent. In this paper we argue that although the ‘no read problem’ and the routinisation of consent may apply to research participants’ consent practices for studies on crowdsourcing platforms, this is not a serious problem. Furthermore, given that the informational requirements for informed consent in these contexts are minimal, we argue that these participants are, nevertheless, sufficiently informed to give valid consent. We conclude that research ethics committees and institutional review boards should only agonise over the precise details of the informed consent process and materials in those rare cases where appreciable risks to research participants need to be managed.
Consent
Consent
Book Chapter
Elizabeth Groeneveld, Carrie Rentschler
Rethinking Women’s and Gender Studies, 2023 [Routledge]
Abstract
This chapter examines liberal, affirmative, and critical consent frameworks that inform constructions of this term, after a review of the circulation of consent as a keyword in Women’s and Gender Studies (WGS). Feminist theory starts from the premise that social relationships are, by-and-large, unequal, critiquing liberal models of consent precisely for their failures to address power. Many feminists have critiqued the liberal model of consent for its failures to address structural conditions of oppression along the axes of gender, race, class, age, and ability, all of which shape the very conditions. The focus of the affirmative consent model on the negotiation of mutual pleasure and the setting of limits in sexual situations—an ideal many of us do invest in—when codified into law may serve the criminal justice system more than anyone else. In contrast to affirmative consent, critical, ethical, and trauma-informed consent practice reveals power as something that is both always present and something that can be negotiated in relationship.
Center for Informed Consent Integrity 