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Susan Michie

Publications and source records attributed to Susan Michie.

At least 19 recordsLinked to original sources
PubMed2006

Informed choice in antenatal Down syndrome screening: a cluster-randomised trial of combined versus separate visit testing.

OBJECTIVE: Building upon the results of an observational study, this clinical trial aimed to test the hypothesis that conducting antenatal Down syndrome screening (DSS) at the same time as other tests result in higher rates of informed choice to accept DSS, than when it is conducted separately from other tests. METHODS: The trial used a cluster-randomised controlled design, with informed choice as the outcome measure. The post of midwife was randomised to offer DSS at the same time as other tests (combined visit) or separately from other tests (separate visit). RESULTS: Overall 43.5% of women made an informed choice about DSS. There was no difference in rates of informed choice for women accepting DSS according to the method of conducting testing (23.7% at combined visit versus 22.5% at separate visit, OR = 1.1, 95% CI: 0.70-1.7, p = 0.67). CONCLUSION: Rates of informed choice about DSS were low, but there was no evidence to support that hypothesis that conducting testing at that same time as other tests increased rates of informed choice. This may reflect the limitations of conducting the trial in one centre.

Adult↗
PubMed2005

Low uptake of prenatal screening for Down syndrome in minority ethnic groups and socially deprived groups: a reflection of women's attitudes or a failure to facilitate informed choices?

BACKGROUND: It is not known if lower uptake of prenatal screening for Down syndrome in women from minority ethnic groups and socioeconomically disadvantaged women reflects more negative attitudes towards undergoing the test or women not acting in line with their attitudes i.e. not making an informed choice. METHODS: Uptake of prenatal screening, attitudes towards undergoing the test, uptake-attitude consistency, and informed choice were assessed in a prospective study of 1499 pregnant women attending two UK hospitals. RESULTS: Uptake was higher in white and socioeconomically advantaged women than in other women. There were no differences in attitudes towards undergoing the test; all women expressed relatively positive attitudes. Uptake-attitude consistency was higher in white and socioeconomically advantaged women than others, particularly in those with positive attitudes towards undergoing the test (76% white women with positive attitudes had the test compared with 45% South Asian women [difference 31%, 95% confidence interval (95% CI) 18-43] and 78% socioeconomically advantaged women compared with 63% more disadvantaged women (difference 15%, 95% CI 7-24)). Controlling for demographic variables, South Asian and socioeconomically disadvantaged women with positive attitudes were less likely to make an informed choice than other women [odds ratio (OR) 0.22, 95% CI 0.10-0.45 and OR 0.62, 95% CI 0.41-0.93, respectively]. CONCLUSION: Lower uptake of screening for Down syndrome in women from minority ethnic groups and socioeconomically disadvantaged women does not reflect more negative attitudes towards screening but rather lower rates of informed choice, as assessed in this study. Healthcare systems appear to facilitate informed choices in the context of prenatal screening for Down syndrome screening less well for women from minority ethnic groups and those who are socioeconomically disadvantaged than for other women.

Adult↗
PubMed2005

The effects of a genetic information leaflet on public attitudes towards genetic testing.

Genetics opinion surveys often include information to ensure that respondents have sufficient understanding to give informed responses. The information is assumed to be neutral but may skew responses. We assessed the impact of a seemingly "neutral" information leaflet on attitudes towards genetic testing among 1,024 survey respondents, half of whom received the leaflet. The leaflet group reported higher levels of subjective understanding of genetic testing (68 percent vs. 53 percent), were mre interested in genetic testing (81 percent vs. 77 percent), and held more positive attitudes towards genetics than people who did not receive the leaflet. Information leaflets may have the intended effect of increasing understanding, but may also unintentionally influence reported views of genetics. In the light of the weight given to public consultation in today's governance and regulation of human genetics, increased awareness of how even seemingly neutral information can influence public attitudes is recommended.

Adult↗
PubMed2005

Communicating risk information in genetic counseling: an observational study.

This study investigates risk communication within genetic counselling. Transcripts of 115 U.K. genetic consultations were reliably coded into form of risk expression used, whether the patient responded with understanding and agreement or showed signs of misunderstanding or disagreement, or did not respond at all, and whether clinicians assessed patient comprehension. Of the 492 risk expressions used, 53% were words and 47% were numbers (32% probabilities and 15% percentages). There was no association between form of risk expression and response. Clinicians assessed comprehension on only 25% of occasions, less often following the use of words than numbers, and on only 9% of occasions when there was no response to their risk communication. Because patients did not respond to 43% of risk communications, there is a concern that patients may make decisions without understanding the risks involved.

Communication↗
PubMed2005

Is cognitive behaviour therapy effective for changing health behaviours? Commentary on Hobbis and Sutton.

Although Cognitive Behaviour Therapy (CBT) has successfully combined procedures based on behavioural and cognitive theories to reduce emotional problems, there is limited research into the efficacy of CBT in changing health behaviours. Of the studies cited by Hobbis and Sutton (this issue), only one measured health behaviours. In order to evaluate the effectiveness of behaviour change techniques, it is essential that the endpoints are behaviours, rather than health or emotional outcomes. There are both theoretical and circumstantial reasons for believing that CBT may be effective for changing health behaviours. Hobbis and Sutton have considered CBT as an addition to the Theory of Planned Behaviour-based interventions. It may be even more effective as an alternative.

Cognitive Behavioral Therapy↗
PubMed2004

Increasing screening uptake amongst those intending to be screened: the use of action plans.

This experimental study investigates an intervention designed to increase rates of antenatal screening uptake in those intending to undergo antenatal screening. Eighty-eight pregnant women intending to undergo prenatal screening were alternately allocated to standard care or asked to write a simple plan for attending or making an appointment. Twenty-five (63%) in the intervention group made an action plan. There was no difference in uptake of screening between the intervention group and the control group, nor between those making an action plan and the control group. Within the intervention group, those making an action plan had higher screening uptake (21/25, 84%) than those not making one (7/15, 47%; CI(95) difference = 8-66%, P = 0.017). Asking women who intend to undergo screening to make an action plan does not increase screening uptake. This result raises doubts about introducing simple action plans in a clinical situation as an effective means of changing behaviour.

Adult↗
PubMed2004

Evidence into practice: a theory based study of achieving national health targets in primary care.

RATIONALE, AIMS AND OBJECTIVES: This study investigates reasons why general practices achieve nationally set milestones to different extents. It compares the beliefs, self-reported behaviours and organizational context of general practitioners (GPs) who have been successful in achieving milestones set out in the UK's National Service Framework (NSF) for Coronary Heart Disease (CHD) with those who have been less successful. METHODS: Sixteen London GPs were interviewed, eight 'high implementers' (having met five or more of six CHD NSF milestones) and eight 'low implementers' (having met one or two milestones). Practices were matched for practice size across the groups as far as possible. The interview consisted of open-ended questions, based on theoretical constructs identified as key to implementation research in a previous project. Interviews were transcribed and analysed with Interpretative Phenomenological Analysis (IPA). RESULTS: There were three main areas that differentiated high and low implementers: beliefs about evidence-based practice, control over professional practice and consequences of achieving the milestones. Low implementers: (i) expressed less belief in evidence-based guidelines as the basis of their practice; (ii) were more concerned about their lack of control over the development and implementation of the guidelines (lack of ownership), and over their own practice (lack of autonomy); and (iii) perceived more negative consequences and fewer positive consequences, both for themselves and for patient care. CONCLUSIONS: This study demonstrates the application of psychological theory in trying to understand and improve professional practice. The results suggest areas that could be targeted in developing interventions to increase guideline implementation in primary care.

Coronary Disease↗
PubMed2004

To be reassured or to understand? A dilemma in communicating normal cervical screening results.

BACKGROUND: Receiving negative test results may be associated with two problems: (a). not being reassured and wanting further, unnecessary screening; and (b). not understanding residual risk and not attending future recommended screening. AIM: To test two hypotheses: (1). Emphasizing test accuracy and low residual risk when giving negative test results reduces a desire for further unnecessary screening, while also reducing a correct understanding of the meaning of the result. (2). The effect of emphasizing low risk on desire for future screening is mediated by lack of reassurance. DESIGN: Experimental, vignette-based study, with a 2 x 2 factorial design. METHOD: A sample of 184 women was asked to imagine that they had recently undergone a cervical screening test and received a normal result. They were given one of four hypothetical letters from their GP,differing in whether or not it emphasized test accuracy and low residual risk of developing cervical cancer. Participants completed a questionnaire assessing perceived risk, reassurance about test results, desire for further screening within six months and understanding of the test results. RESULTS: Emphasizing test accuracy and low residual risk increases desire for inappropriate screening while reducing the understanding of residual risk. These effects are interactive, in that presenting both together has a larger effect than the sum of the two individual effects. The effect of emphasizing low risk on desire for future screening was mediated by reassurance. CONCLUSION: Emphasizing low residual risk and test accuracy is a double-edged sword: it reduces a desire for unnecessary screening, but also reduces correct understanding of the result.

Adolescent↗
PubMed2003

Understanding why negative genetic test results sometimes fail to reassure.

A proportion of those receiving negative results following predictive genetic testing desire future bowel screening. This is despite a negative result meaning a general population risk of 1:7500 and despite bowel screening being experienced as aversive and clinically unnecessary. This study aimed to investigate perceptions of risk, illness, and tests amongst those receiving negative results following predictive genetic testing. Interviews with nine people receiving negative genetic test results for familial adenomatous polyposis (FAP) were analyzed using the qualitative method, interpretative phenomenological analysis (IPA). Those not reassured by negative genetic test results perceived a continuing risk to themselves and to their children. Two sets of perceptions emerged that might explain this: (1). perceptions of the genetic basis of the condition (FAP). Although the condition was perceived to be genetic, genetic status was seen as transient, so a result today could not predict the future. The condition was also seen as caused by factors other than genes, so information about only one risk factor could not be reassuring. (2). Perceptions of the genetic test. There was a lack of conviction in the ability of the genetic test, based on a blood sample, to predict a disease located in the bowel. These results suggest that some individuals receiving negative test results are not reassured because of their representations of the cause of their condition and the nature of the tests they undergo. It may be that eliciting and, when appropriate, changing people's representations prior to testing may enable those receiving negative results to be more reassured about their residual risk.

Adenomatous Polyposis Coli↗
PubMed2003

Patient-centredness in chronic illness: what is it and does it matter?

The evidence as to whether patient-centredness is associated with beneficial physical and psychological outcomes is inconsistent. This review of published research on health care communication in chronic illness investigates whether (i) studies of patient-centred consultations use distinctive concepts, (ii) different concepts are differentially associated with health outcomes. Studies of patients with a chronic illness consulting a health professional were included if they measured health professional-patient interaction and a physical or psychological outcome. Thirty studies were identified, falling into two, reliably distinct, categories. In the first, health professionals took the patient's perspective and in the second, they sought to "activate" the patient. The 10 studies taking the latter approach were more consistently associated with good physical health outcomes than were the 20 studies taking the former approach. The suggestion that different types of patient-centredness have different associations with physical health outcomes should be investigated further in experimental studies.

Chronic Disease↗
PubMed2003

Informed choice: understanding knowledge in the context of screening uptake.

This study evaluates a scale measuring knowledge about a screening test and investigates the association between knowledge, uptake and attitudes towards screening. One thousand four hundred ninety-nine pregnant women completed the knowledge scale of the multidimensional measure of informed choice (MMIC). Three hundred forty-five of these women and 152 professionals providing antenatal care also rated the importance of the knowledge items. Item characteristic curves show that, with one exception, the knowledge items reflect a spread of difficulty and are able to discriminate between people. All items were seen as essential or helpful by both women and health professionals, with two items seen as particularly important and one as unimportant. There were some differences between health professionals, women with low risk results and women with high risk results. Knowledge was not associated with uptake, attitude, or the extent to which uptake was consistent with women's attitudes towards undergoing the test.

Attitude to Health↗
PubMed2002

Variation in uptake of serum screening: the role of service delivery.

The present study aimed to determine the extent to which variation in the uptake of serum screening for Down syndrome reflects variation in the way the test is offered. A higher uptake of serum screening was seen at hospitals that offered the blood test as part of a routine visit than at those where screening required a separate visit. The type of screening test offered and whether a reminder was sent were not associated with uptake. Given the consensus that undergoing screening should be the result of an informed choice, further research is needed to determine which methods of offering serum screening facilitate and which impede informed choice.

Delivery of Health Care↗
PubMed2002

The multi-dimensional measure of informed choice: a validation study.

The aim of this prospective study is to assess the reliability and validity of a multi-dimensional measure of informed choice (MMIC). Participants were 225 pregnant women in two general hospitals in the UK, women receiving low-risk results following serum screening for Down syndrome. The MMIC was administered before testing and the Ottawa Decisional Conflict Scale was administered 6 weeks later. The component scales of the MMIC, knowledge and attitude, were internally consistent (alpha values of 0.68 and 0.78, respectively). Those who made a choice categorised as informed using the MMIC rated their decision 6 weeks later as being more informed, better supported and of higher quality than women whose choice was categorised as uninformed. This provides evidence of predictive validity, whilst the lack of association between the MMIC and anxiety shows construct (discriminant) validity. Thus, the MMIC has been shown to be psychometrically robust in pregnant women offered the choice to undergo prenatal screening for Down syndrome and receiving a low-risk result. Replication of this finding in other groups, facing other decisions, with other outcomes, should be assessed in future research.

Choice Behavior↗
PubMed2002

Predictive genetic testing: high risk expectations in the face of low risk information.

The aims of this cross-sectional, questionnaire study were (1) to estimate the proportion of those receiving negative ("low risk") results following predictive genetic testing who expect to undergo clinically unnecessary future screening and (2) to examine the factors associated with this expectation. Of 127 adults receiving negative results following predictive genetic testing for familial adenomatous polyposis (FAP), 54 people (42%) were expected to attend for future bowel screening. The main predictor was doubt about the accuracy of genetic test results. Expecting to attend was also associated univariately with perceiving the chance of developing FAP as higher, being more worried about this, perceiving the test result to be more uncertain and threatening, and holding a behavioral model of the cause of FAP. Attendance for health screening may be influenced by people's perception of the accuracy of genetic tests that they have undergone. Future research should investigate test presentation and influences on test perception.

Adult↗
PubMed2002

Likelihood of attending bowel screening after a negative genetic test result: the possible influence of health professionals.

This study was undertaken to determine the extent to which the reported likelihood of attending future bowel screening following negative genetic testing results for familial adenomatous polyposis (FAP) varies between the type of health professional providing care and the country of testing. The study subjects were 103 unaffected adults at risk for FAP who received negative results following predictive DNA testing. Our study indicates that the reported likelihood of attending bowel screening was higher in those given results by nongenetics physicians, rather than by genetics professionals; the reported likelihood of attending bowel screening under these circumstances was also higher in the UK than in Australia. Both of these results were affected by the perceived chances of developing FAP, and, in the case of the country of testing, by the perceived accuracy of the genetic test result and the perceived seriousness of the disease. How and what health professionals communicate with patients about genetic testing may explain the differences between type of health professional and country of testing and attitudes toward bowel screening. If this is the case, training in communication may change patients' perceptions and, in turn, their behavioral intentions and actions following a negative test result.

Adenomatous Polyposis Coli↗
PubMed2002

Predictive genetic testing: mediators and moderators of anxiety.

Mediators and moderators of anxiety following predictive genetic testing were investigated in a cross-sectional study of 208 individuals at risk for familial adenomatous polyposis (FAP). Receiving a positive test result was associated with increased anxiety. The relationship between test result and anxiety was mediated by how threatened individuals felt by their test results. The impact of a positive test result was greater for those who felt distressed about FAP in their families, perceived FAP to be more serious, and perceived the genetic test to be more accurate. The results suggest that assessing, and possibly modifying, people's appraisals of the condition and of its impact on the family and of the threat of the genetic test may help to reduce subsequent anxiety. This has implications for the practice of genetic counseling.

Adolescent↗