Doctors,Patients, and Nudging in the Clinical Context—Four Views on Nudging and Informed Consent

In an analysis of recent work on nudging we distinguish three positions on the relationship between nudging founded in libertarian paternalism and the protection of personal autonomy through informed consent. We argue that all three positions fail to provide adequate protection of personal autonomy in the clinical context. Acknowledging that nudging may be beneficial, we suggest a fourth position according to which nudging and informed consent are valuable in different domains of interaction.     

The protection of patients’ rights in clinical trials

The Helsinki Declaration is a very important document regarding the protection of patients’ rights in clinical trials and one of the fundamental sources of operational principles for every ethics committee. Although they have been updated, the international guidelines for ethics committees continually fail to address certain issues pertaining to the protection of patients’ rights in clinical trials. These issues include, most significantly, the method of electing ethics committees (a free, secret ballot should be preferred to direct appointment), the avoidance of conflict of interest during the election of ethics committee members, and the necessary insurance coverage for the participants of clinical trials. Polish law should, on the other hand, be developed in such way as to not limit the effectiveness of ethics committees in protecting patients’ rights in clinical trials. The ideal solution would be to draft a uniform law concerning not only clinical trials, but all medical experiments. The opinions of experts who have been reviewing medical research projects for several years may prove to be especially valuable in this setting. This paper was presented at the 6th International Bioethics Conference on the subject of ‘The Responsible Conduct of Basic and Clinical Research’, held in Warsaw, Poland, 3–4 June 2005. The author is Chairman, Bioethics Committee of the Warsaw Regional Chamber of Physicians and Dentists.     

Property rights, genes, and common good

This paper applies aspects of Hugo Grotius's theologically informed theory of property to contemporary issues concerning access to the human DNA sequence and patenting practices. It argues that Christians who contribute to public debate in these areas might beneficially employ some of the concepts with which he worked--notably "common right," the "right of necessity," and "use right." In the seventeenth century, wars were fought over trading rights and access to the sea. In the twenty-first century, information and intellectual property are the issues of the day. Grotius's writings serve to correct the overemphasis in modern liberalism on individual rights, and have practical application to the debate concerning the reduction of the human genome to the status of private property.     

Homelessness in the United States: Assessing Changes in Prevalence and Public Opinion, 1993–2001

A national survey was administered in 1993-1994 (N = 360) and repeated in 2001 (N = 435) to assess the prevalence of homelessness as well as attitudes, opinions and knowledge regarding homelessness. No significant changes in prevalence were found, despite a strong US economy during most of the 7-8 year period. Respondents in 2001 had less stereotyped views of homeless people and were more supportive of services, but came to see homelessness as a less serious problem that was less often due to economic factors. This "mixed" set of findings may reflect both beliefs on the benefits of a good economy and an increased awareness of the complexity of homelessness. Across the surveys, younger, female, liberal, and less wealthy respondents demonstrated more sympathetic attitudes towards homeless people.     

Efficacy of self-administered treatments for pathological academic worry: A randomized controlled trial

Research on treatments for reducing pathological worry is limited. In particular, academic worry is a common theme in generalized anxiety disorder (GAD) samples as well as non-clinical student samples. Given the high cost of anxiety disorders to society, research is needed to examine the efficacy of self-administered treatments designed to reduce pathological worry. The primary goal of this study was to investigate the benefits of three self-administered interventions for reducing academic worry. College students (N = 113) experiencing clinically significant academic worry were randomized to either: (a) worry exposure (WE); (b) expressive writing (EW); (c) relaxation consisting of pulsed audio-photic stimulation (APS); or (d) waitlist control (WLC). Participants were instructed to practice their interventions three times per week for one month and completed home practice logs online to track treatment adherence. Academic worry, general anxiety, and perceived stress were assessed at baseline and post-treatment. Academic worry and general anxiety were also assessed at a three-month follow-up. Those assigned to the WE and APS conditions showed significant improvement relative to EW and WLC at post-treatment. All treatment conditions showed continued improvement by follow-up, with no between-group differences. Treatment and public health implications are discussed.     

Implementation Quality and Positive Experiences in After-School Programs

Data collected during an evaluation of a multi-site trial of an enhanced after-school program were used to relate quality of program implementation to student experiences after school. The enhanced after-school program incorporated a drug use and violence prevention component that was shown to be effective in previous research. Building on Durlak and Dupre’s (Am J Community Psychol 41:327–350, 2008) dimensions of implementation, we assessed the level of dosage, quality of management and climate, participant responsiveness, and staffing quality achieved at the five program sites. We evaluated how these characteristics co-varied with self-reported positive experiences after-school. The study illustrates how multiple dimensions of program implementation can be measured, and shows that some but not all dimensions of implementation are related to the quality of student after-school experiences. Measures of quality of management and climate, participant responsiveness, and staffing stability were most clearly associated with youth experiences. The importance of measuring multiple dimensions of program implementation in intervention research is discussed.     

Confidence in accuracy moderates the benefits of retrieval practice

ABSTRACT

The effect of Retrieval Practice refers to the phenomenon that taking a practice test is more effective for learning than re-study, probably due to the benefit from processes underlying successful retrievals during practice. However, it is rarely studied whether other processes (e.g., metacognitive monitoring) during retrieval practice may also play an important role. In two experiments, we examined whether the effectiveness of retrieval was affected by subjects’ confidence in their retrieval success. Subjects studied word-pairs and rated their confidence after each practice test trial (cued-recall in Exp.1, multiple choice in Exp.2), or re-study trial. In both experiments, we observed the classic retrieval practice effect. Moreover, in Exp.2, the benefits differed as a function of subjects’ confidence in their retrieval performance: the effect of retrieval practice only emerged for high-confidence trials with higher than 56% confidence. In summary, the retrieval practice only facilitates the retention of correct answers with high confidence.     

Retrieval practice benefits memory precision

ABSTRACT

Although previous research on retrieval practice (RP) has predominantly featured stimuli with discrete right-or-wrong answers, continuous measures offer potentially greater sensitivity in assessing the effects of RP on memory precision. The present study used a colour gradient (125 points ranging from magenta to yellow) as a continuous response variable. The colours of different images were learned through either RP or restudy and either one or three cycles of practice after initial study. On a delayed final test, participants’ memory was assessed for each item’s colour. Participants also created per-item intervals representing the region where they believed the correct colour most likely to have been. We found that repeated rounds of RP enhanced the correspondence between responses and the correct colour. In addition, RP led to participants creating more accurate (correct answers were more likely to be within the participant-specified intervals) and more precise (narrower) intervals relative to restudy, suggesting that RP enhances the precision of memories.     

Adapting to test structure: Letting testing teach what to learn

We propose that we encode and store information as a function of the particular ways we have used similar information in the past. More specifically, we contend that the experience of retrieval can serve as a powerful cue to the most effective ways to encode similar information in comparable future learning episodes. To explore these ideas, we did two studies in which all participants went through study–test cycles of single category lists while we manipulated the nature of the recognition tests. The recognition tests either included only same-category lures or only different-category lures. The experience of repeated testing leads participants to avoid conceptual-based strategies but only when conceptual knowledge was poorly diagnostic for recognition (i.e., in the same-category lures condition). In a second study with a similar manipulation, we showed that repeated testing with lures from the same category as study items improved performance in a final recall surprise test compared to conditions in which different-category lures were used. Such a difference is akin to the one obtained when encoding instructions focus on distinctive item features compared to cases in which the focus is on relational processing. We suggest that testing requirements lead to adaptive changes at encoding.