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Item Adding Natural Frequency Data to a Decision Aid for Colorectal Cancer Screening: Results of a Randomized Trial(2013-10-22) Schwartz, Peter H.; Muriello, Paul F.; Perkins, Susan M.; Schmidt, Karen K.; Rawl, Susan M.Guidelines recommend that decision aids provide natural frequency data regarding baseline risk, risk reduction, and chances of false positives and negatives. Such quantitative information may confuse patients, especially those with low numeracy. We conducted a randomized trial to compare effects of 2 colorectal cancer (CRC) screening decision aids—one with and one without natural frequency data.Item Early Cost Realization and College Choice(Sage, 2021) Yoon, Haewon; Yang, Yang; Morewedge, Carey K.; Kelley School of BusinessStudent loans defer the cost of college until after graduation, allowing many students access to higher lifetime earnings and colleges and universities they otherwise could not afford. Even with student loans, however, the authors find that students psychologically realize the financial costs of a college education long before their loan repayments begin. This early cost realization frames financial decisions between most pairs of colleges as an intertemporal trade-off. Students choose between investments with (1) smaller short-term costs but smaller long-term returns (a lower-cost, lower-return [LC-LR] college) and (2) larger short-term costs but larger long-term returns (a higher-cost, higher-return [HC-HR] college). The authors find that early cost realization increases preferences for LC-LR colleges—preferences that could reduce lifetime earnings—in both simulations and experiments. Preferences for LC-LR colleges are pronounced among financially impatient students and in choice pairs of LC-LR and HC-HR colleges where the equilibrium is set at a low-discount-rate threshold. A return-on-investment strategy, future uncertainty, and debt aversion cannot explain these results. A decision aid synchronizing the psychological realization of costs and benefits reduced preferences for LC-LR colleges, illustrating that the preference is constructed and receptive to interventions.Item Impact of including quantitative information in a decision aid for colorectal cancer screening: A randomized controlled trial(Elsevier, 2019) Schwartz, Peter H.; Imperiale, Thomas F.; Perkins, Susan M.; Schmidt, Karen K.; Althouse, Sandra; Rawl, Susan M.; Medicine, School of MedicineObjective: Guidelines recommend that decision aids provide quantitative information about risks and benefits of available options. Impact of providing this information is unknown. Methods: Randomized trial comparing two decision aids about colorectal cancer (CRC) screening with colonoscopy or fecal immunochemical test (FIT). 688 primary care patients due for CRC screening viewed a decision aid that uses words only (Verbal arm) vs. one that provides quantitative information (Quantitative arm). Main outcomes included perceived CRC risk, intent to be screened, and test preference, measured before and after viewing decision aid, and screening uptake at six months. Analyses were performed with ANCOVA and logistic regression. Results: Compared to the Verbal arm, those in the Quantitative arm had a larger increase in intent to undergo FIT (p = 0.011) and were more likely to switch their preferred test from non-FIT to FIT (28% vs. 19%, p = .010). There were decreases in perceived risk in the Verbal Arm but not the Quantitative Arm (p = 0.004). There was no difference in screening uptake. Numeracy did not moderate any effects. Conclusions: Quantitative information had relatively minor impact and no clearly negative effects, such as reducing uptake. Practice implications: Quantitative information may be useful but not essential for patients viewing decision aids.Item Questioning the Quantitative Imperative: Decision Aids, Prevention, and the Ethics of Disclosure(2011-03) Schwartz, Peter H.Patients should not always receive hard data about the risks and benefits of a medical intervention. That information should always be available to patients who expressly ask for it, but it should be part of standard disclosure only sometimes, and only for some patients. And even then, we need to think about how to offer it.