Mosquera, Roberto, Odunowo, Mofioluwasademi, and others
December 1, 2018.
http://dx.doi.org/10.2139/ssrn.3312462
Abstract
Social media permeates many aspects of our lives, including how we connect with others, where we get our news and how we spend our time. Yet, we know little about the economic effects for users. Using a large field experiment with over 1,765 individuals, we document the value of Facebook to users and its causal effect on news consumption and awareness, well-being and daily activities. Participants reveal how much they value one week of Facebook usage and are then randomly assigned to a validated Facebook restriction or normal use. Those who are off Facebook for a week reduce news consumption, are less likely to recognize politically-skewed news stories, report being less depressed and engage in healthier activities. One week of Facebook is worth $25, and this increases by 15% after experiencing a Facebook restriction (26% for women), reflecting information loss or that using Facebook may be addictive.
Ethical/Clinical Question: Knowing this research, is it ethical and clinically appropriate to recommend depressed patients to stop using Facebook?
Showing posts with label Clinical Outcomes. Show all posts
Showing posts with label Clinical Outcomes. Show all posts
Friday, February 15, 2019
Tuesday, June 26, 2018
The alliance in adult psychotherapy: A meta-analytic synthesis.
Flückiger C, Del Re AC, Wampold BE, & Horvath AO
Psychotherapy (Chicago, Ill.) [24 May 2018]
Abstract
The alliance continues to be one of the most investigated variables related to success in psychotherapy irrespective of theoretical orientation. We define and illustrate the alliance (also conceptualized as therapeutic alliance, helping alliance, or working alliance) and then present a meta-analysis of 295 independent studies that covered more than 30,000 patients (published between 1978 and 2017) for face-to-face and Internet-based psychotherapy. The relation of the alliance and treatment outcome was investigated using a three-level meta-analysis with random-effects restricted maximum-likelihood estimators. The overall alliance-outcome association for face-to-face psychotherapy was r = .278 (95% confidence intervals [.256, .299], p < .0001; equivalent of d = .579). There was heterogeneity among the effect sizes, and 2% of the 295 effect sizes indicated negative correlations. The correlation for Internet-based psychotherapy was approximately the same (viz., r = .275, k = 23). These results confirm the robustness of the positive relation between the alliance and outcome. This relation remains consistent across assessor perspectives, alliance and outcome measures, treatment approaches, patient characteristics, and countries. The article concludes with causality considerations, research limitations, diversity considerations, and therapeutic practices.
The research is here.
Psychotherapy (Chicago, Ill.) [24 May 2018]
Abstract
The alliance continues to be one of the most investigated variables related to success in psychotherapy irrespective of theoretical orientation. We define and illustrate the alliance (also conceptualized as therapeutic alliance, helping alliance, or working alliance) and then present a meta-analysis of 295 independent studies that covered more than 30,000 patients (published between 1978 and 2017) for face-to-face and Internet-based psychotherapy. The relation of the alliance and treatment outcome was investigated using a three-level meta-analysis with random-effects restricted maximum-likelihood estimators. The overall alliance-outcome association for face-to-face psychotherapy was r = .278 (95% confidence intervals [.256, .299], p < .0001; equivalent of d = .579). There was heterogeneity among the effect sizes, and 2% of the 295 effect sizes indicated negative correlations. The correlation for Internet-based psychotherapy was approximately the same (viz., r = .275, k = 23). These results confirm the robustness of the positive relation between the alliance and outcome. This relation remains consistent across assessor perspectives, alliance and outcome measures, treatment approaches, patient characteristics, and countries. The article concludes with causality considerations, research limitations, diversity considerations, and therapeutic practices.
The research is here.
Thursday, May 17, 2018
Empathy and outcome meta-analysis
Elliott, Robert and Bohart, Arthur C. and Watson, Jeanne C. and Murphy, David
(2018) Psychotherapy
Abstract
Put simply, empathy refers to understanding what another person is experiencing or trying to express. Therapist empathy has a long history as a hypothesized key change process in psychotherapy. We begin by discussing definitional issues and presenting an integrative definition. We then review measures of therapist empathy, including the conceptual problem of separating empathy from other relationship variables. We follow this with clinical examples illustrating different forms of therapist empathy and empathic response modes. The core of our review is a meta-analysis of research on the relation between therapist empathy and client outcome. Results indicated that empathy is a moderately strong predictor of therapy outcome: mean weighted r= .28 (p< .001; 95% confidence interval: .23 –.33; equivalent of d= .58) for 82 independent samples and 6,138 clients. In general, the empathy-outcome relation held for different theoretical orientations and client presenting problems; however, there was considerable heterogeneity in the effects. Client, observer, and therapist perception measures predicted client outcome better than empathic accuracy measures. We then consider the limitations of the current data. We conclude with diversity considerations and practice recommendations, including endorsing the different forms that empathy may take in therapy.
You can request a copy of the article here.
(2018) Psychotherapy
Abstract
Put simply, empathy refers to understanding what another person is experiencing or trying to express. Therapist empathy has a long history as a hypothesized key change process in psychotherapy. We begin by discussing definitional issues and presenting an integrative definition. We then review measures of therapist empathy, including the conceptual problem of separating empathy from other relationship variables. We follow this with clinical examples illustrating different forms of therapist empathy and empathic response modes. The core of our review is a meta-analysis of research on the relation between therapist empathy and client outcome. Results indicated that empathy is a moderately strong predictor of therapy outcome: mean weighted r= .28 (p< .001; 95% confidence interval: .23 –.33; equivalent of d= .58) for 82 independent samples and 6,138 clients. In general, the empathy-outcome relation held for different theoretical orientations and client presenting problems; however, there was considerable heterogeneity in the effects. Client, observer, and therapist perception measures predicted client outcome better than empathic accuracy measures. We then consider the limitations of the current data. We conclude with diversity considerations and practice recommendations, including endorsing the different forms that empathy may take in therapy.
You can request a copy of the article here.
Monday, March 20, 2017
When Evidence Says No, But Doctors Say Yes
David Epstein
ProPublica
Originally published February 22, 2017
Here is an excerpt:
When you visit a doctor, you probably assume the treatment you receive is backed by evidence from medical research. Surely, the drug you’re prescribed or the surgery you’ll undergo wouldn’t be so common if it didn’t work, right?
For all the truly wondrous developments of modern medicine — imaging technologies that enable precision surgery, routine organ transplants, care that transforms premature infants into perfectly healthy kids, and remarkable chemotherapy treatments, to name a few — it is distressingly ordinary for patients to get treatments that research has shown are ineffective or even dangerous. Sometimes doctors simply haven’t kept up with the science. Other times doctors know the state of play perfectly well but continue to deliver these treatments because it’s profitable — or even because they’re popular and patients demand them. Some procedures are implemented based on studies that did not prove whether they really worked in the first place. Others were initially supported by evidence but then were contradicted by better evidence, and yet these procedures have remained the standards of care for years, or decades.
The article is here.
ProPublica
Originally published February 22, 2017
Here is an excerpt:
When you visit a doctor, you probably assume the treatment you receive is backed by evidence from medical research. Surely, the drug you’re prescribed or the surgery you’ll undergo wouldn’t be so common if it didn’t work, right?
For all the truly wondrous developments of modern medicine — imaging technologies that enable precision surgery, routine organ transplants, care that transforms premature infants into perfectly healthy kids, and remarkable chemotherapy treatments, to name a few — it is distressingly ordinary for patients to get treatments that research has shown are ineffective or even dangerous. Sometimes doctors simply haven’t kept up with the science. Other times doctors know the state of play perfectly well but continue to deliver these treatments because it’s profitable — or even because they’re popular and patients demand them. Some procedures are implemented based on studies that did not prove whether they really worked in the first place. Others were initially supported by evidence but then were contradicted by better evidence, and yet these procedures have remained the standards of care for years, or decades.
The article is here.
Wednesday, September 28, 2016
The Ethics of Behavioral Health Information Technology
Michelle Joy, Timothy Clement, and Dominic Sisti
JAMA. Published online September 08, 2016.
doi:10.1001/jama.2016.12534
Here is an excerpt:
Individuals with mental illness and addiction experience negative stereotyping, prejudice, discrimination, distancing, and marginalization—social dynamics commonly called stigma. These dynamics are also often internalized and accepted by individuals with mental health conditions, amplifying their negative effect. Somewhat counterintuitively, stigmatizing beliefs about these patients are common among health care workers and often more common among mental health care professionals. Given these facts, the reinforcement of any stigmatizing concept within the medical record system or health information infrastructure is ethically problematic.
Stigmatizing iconography presents the potential for problematic clinical consequences. Patients with dual psychiatric and medical conditions often receive low-quality medical care and experience worse outcomes. One factor in this disparity is the phenomenon of diagnostic overshadowing. For example, diagnostic overshadowing can occur in patients with co-occurring mental illness and conditions such as cardiovascular disease or diabetes. These patients are less likely to receive appropriate medical care than patients without a mental health condition—their psychiatric conditions overshadow their other conditions, potentially biasing the clinician’s judgment about diagnosis and treatment such that the clinician may misattribute physical symptoms to mental health problems.
The article is here.
JAMA. Published online September 08, 2016.
doi:10.1001/jama.2016.12534
Here is an excerpt:
Individuals with mental illness and addiction experience negative stereotyping, prejudice, discrimination, distancing, and marginalization—social dynamics commonly called stigma. These dynamics are also often internalized and accepted by individuals with mental health conditions, amplifying their negative effect. Somewhat counterintuitively, stigmatizing beliefs about these patients are common among health care workers and often more common among mental health care professionals. Given these facts, the reinforcement of any stigmatizing concept within the medical record system or health information infrastructure is ethically problematic.
Stigmatizing iconography presents the potential for problematic clinical consequences. Patients with dual psychiatric and medical conditions often receive low-quality medical care and experience worse outcomes. One factor in this disparity is the phenomenon of diagnostic overshadowing. For example, diagnostic overshadowing can occur in patients with co-occurring mental illness and conditions such as cardiovascular disease or diabetes. These patients are less likely to receive appropriate medical care than patients without a mental health condition—their psychiatric conditions overshadow their other conditions, potentially biasing the clinician’s judgment about diagnosis and treatment such that the clinician may misattribute physical symptoms to mental health problems.
The article is here.
Wednesday, March 9, 2016
Engaging Patients Through OpenNotes: An Evaluation Using Mixed Methods
Tobias Esch, Roanne Mejilla1, M. Anselmo1, B. Podtschaske, T. Delbanco, J. Walker
BMJ Open, published online Jan. 29, 2016.
Abstract
Objectives
(A) To gain insights into the experiences of patients invited to view their doctors’ visit notes, with a focus on those who review multiple notes;
(B) to examine the relationships among fully transparent electronic medical records and quality of care, the patient-doctor relationship, patient engagement, self-care, self-management skills and clinical outcomes.
(cut)
Results
Patient experiences indicate improved understanding (of health information), better relationships (with doctors), better quality (adherence and compliance; keeping track) and improved self-care (patient-centredness, empowerment). Patients want more doctors to offer access to their notes, and some wish to contribute to their generation. Those patients with repeated experience reviewing notes express fewer concerns and more perceived benefits.
Conclusions
As the use of fully transparent medical records spreads, it is important to gain a deeper understanding of possible benefits or harms, and to characterise target populations that may require varying modes of delivery. Patient desires for expansion of this practice extend to specialty care and settings beyond the physician's office. Patients are also interested in becoming involved actively in the generation of their medical records. The OpenNotes movement may increase patient activation and engagement in important ways.
The article is here.
BMJ Open, published online Jan. 29, 2016.
Abstract
Objectives
(A) To gain insights into the experiences of patients invited to view their doctors’ visit notes, with a focus on those who review multiple notes;
(B) to examine the relationships among fully transparent electronic medical records and quality of care, the patient-doctor relationship, patient engagement, self-care, self-management skills and clinical outcomes.
(cut)
Results
Patient experiences indicate improved understanding (of health information), better relationships (with doctors), better quality (adherence and compliance; keeping track) and improved self-care (patient-centredness, empowerment). Patients want more doctors to offer access to their notes, and some wish to contribute to their generation. Those patients with repeated experience reviewing notes express fewer concerns and more perceived benefits.
Conclusions
As the use of fully transparent medical records spreads, it is important to gain a deeper understanding of possible benefits or harms, and to characterise target populations that may require varying modes of delivery. Patient desires for expansion of this practice extend to specialty care and settings beyond the physician's office. Patients are also interested in becoming involved actively in the generation of their medical records. The OpenNotes movement may increase patient activation and engagement in important ways.
The article is here.
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