The Experts below are selected from a list of 318 Experts worldwide ranked by ideXlab platform
John B Mckinlay - One of the best experts on this subject based on the ideXlab platform.
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effects of patient medication requests on physician prescribing behavior results of a Factorial Experiment
Medical Care, 2014Co-Authors: John B Mckinlay, Lisa D Marceau, Jeffrey N Katz, Felicia Trachtenberg, Michael A FischerAbstract:Background:Because of internet searches, advice from friends, and pharmaceutical advertising, especially direct-to-consumer advertising, patients are increasingly activated to request medications during a physician encounter.Objectives:To estimate the effect of patient requests for medications on ph
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variations among primary care physicians in exercise advice imaging and analgesics for musculoskeletal pain results from a Factorial Experiment
Arthritis Care and Research, 2014Co-Authors: Nancy N Maserejian, Lisa D Marceau, John B Mckinlay, Michael A Fischer, Felicia L Trachtenberg, Jing Yu, Jeffrey N KatzAbstract:Objective To examine whether medical decisions regarding evaluation and management of musculoskeletal pain conditions varied systematically by characteristics of the patient or provider. Methods We conducted a balanced Factorial Experiment among primary care physicians in the US. Physicians (n = 192) viewed 2 videos of different patients (actors) presenting with pain: undiagnosed sciatica symptoms or diagnosed knee osteoarthritis. Systematic variations in patient gender, socioeconomic status, and race and physician gender and experience (<20 versus ≥20 years in practice) permitted estimation of unconfounded effects. Analysis of variance was used to evaluate associations between patient or provider attributes and clinical decisions. Quality of decisions was defined based on the current recommendations of the American College of Rheumatology, American Pain Society, and clinical expert consensus. Results Despite current recommendations, less than one-third of physicians would provide exercise advice (30.2% for osteoarthritis and 32.8% for sciatica). Physicians with fewer years in practice were more likely to provide advice on lifestyle changes, particularly exercise (P ≤ 0.01), and to prescribe nonsteroidal antiinflammatory drugs for pain relief, both of which were appropriate and consistent with current recommendations for care. Newer physicians ordered fewer tests, particularly basic laboratory investigations or urinalysis. Test ordering decreased as organizational emphasis on business or profits increased. Patient factors and physician gender had no consistent effects on pain evaluation or treatment. Conclusion Physician education on disease management recommendations regarding exercise and analgesics and implementation of quality measures may be useful, particularly for physicians with more years in practice.
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physician styles of patient management as a potential source of disparities cluster analysis from a Factorial Experiment
Health Services Research, 2013Co-Authors: Karen E Lutfey, M Eric S Gerstenberger, John B MckinlayAbstract:Medical practice variation has a long history as a topic of interest for social science and health services researchers, with recent empirical investigations (McKinlay et al. 2006; Bernheim et al. 2008; Franks and Fiscella 2008; Lee et al. 2008; Muroff et al. 2008; Shackelton et al. 2009) and health policy strategies (Institute of Medicine 2001, 2003; Icks et al. 2007) increasingly turning to provider decision making as one potential contributor to observed health disparities. This literature generally seeks to understand well-documented patterns wherein physicians make different diagnostic and treatment decisions based on nonmedical factors, including patient characteristics (such as race, gender, age, socioeconomic status) (Arber et al. 2006), but also providers' individual attributes (gender, level of experience, specialty, place of training) (Shackelton-Piccolo et al. 2011) and the characteristics of the health care settings in which they work, such as practice culture (Kralewski et al. 2005a,b), work stress (Siegrist et al. 2010), presence of health information technology (Ketcham et al. 2009), and country (von dem Knesebeck et al. 2008). In some cases, this variation amounts to differences in quality as measured by health care processes, such as whether a patient receives a specific test (e.g., hemoglobin A1c) or meets guideline criteria (e.g., average glucose or lipid levels). However, to the extent that medical decision making reinforces health disparities that accrue as a function of broader social differences, and reinforces bias in epidemiologic bases rates used to justify medical decisions, decision making has the potential to amplify or exacerbate broader differentials in health outcomes and therefore requires further investigation. For example, much of this research focuses on variation in diagnostic rather than management decisions, with an overall effect that has been criticized as too narrow to accurately or fully understand medical decision making (Cook 2010). Furthermore, technical health care process outcomes are typically measured by single measures, either the presence of a diagnostic label or the implementation of a specific treatment defined by practice guidelines as appropriate (e.g., hospitalization, revascularization), and these processes are assumed to have predictive value for health outcomes of individuals. Variation in these process outcomes, by extension, is predicted based on demographic characteristics of physicians and patients, while less is known about how modifiable factors such as attitudinal and behavioral differences predict differential diagnosis and management. As a result, the growing literature on the role of clinical decision making in the generation or exacerbation of health disparities, while rich in these aspects, is increasingly fragmented and descriptive. There is a need for research that integrates and synthesizes broader patterns of decision making, not only in terms of understanding what providers do across a range of process outcomes but also what kind of providers engage in which styles of management, and how they think through those decisions. We build on earlier research using cluster analysis to examine how physicians' styles of management influence differential treatment decisions. We use data from a video vignette Factorial Experiment wherein a wide range of outcome data were collected, ranging from additional information physicians would seek in a medical history, to tests they would order, to (among others) referrals they would make. Rather than examining how individual patient or provider characteristics would influence specific outcomes (e.g., whether male physicians are more likely to order EKG tests for female patients), we conducted cluster analysis to identify types or styles of management behavior physicians exhibited. Because these outcomes are generated in a balanced Factorial Experiment, we are able to adjust for patient and physician characteristics, all in the context of a standardized vignette presentation for coronary heart disease (CHD). The cluster analysis therefore accounts for variation that is unexplained in ANOVA analysis where outcomes are treated separately.
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influences of organizational features of healthcare settings on clinical decision making qualitative results from a cross national Factorial Experiment
Health, 2012Co-Authors: Karen E Lutfey, Lisa D Marceau, Stephen Campbell, Martin Roland, John B MckinlayAbstract:A proliferating literature documents cross-national variation in medical practice and seeks to explain observed differences in terms of the presence of certain kinds of healthcare systems, economic, and cultural differences between countries. Less is known about how providers themselves understand these influences and perceive them as relevant to their clinical work. Using qualitative data from a cross-national Factorial Experiment in the United States and United Kingdom, we analyze 244 primary care physicians’ explanations of how organizational features of their respective healthcare settings influence the treatment decisions they made for a vignette patient, including affordability of care; within-system quality deficits; and constraints due to patient behavior. While many differences are attributed to financial constraints deriving from two very differently structured healthcare systems, in other ways they are reflections of cultural and historical expectations regarding medical care, or interactions between the two. Implications, including possible challenges to the implementation of universal care in the US, are discussed.
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diagnosis and management of depression in 3 countries results from a clinical vignette Factorial Experiment
The Primary Care Companion To The Journal of Clinical Psychiatry, 2011Co-Authors: Carol L Link, Lisa D Marceau, Theodore A Stern, Rebecca S Piccolo, Sara Arber, Ann Adams, Johannes Siegrist, Olaf Von Dem Knesebeck, John B MckinlayAbstract:Objective: International differences in disease prevalence rates are often reported and thought to reflect different lifestyles, genetics, or cultural differences in care-seeking behavior. However, they may also be produced by differences among health care systems. We sought to investigate variation in the diagnosis and management of a "patient" with exactly the same symptoms indicative of depression in 3 different health care systems (Germany, the United Kingdom, and the United States).Method: A Factorial Experiment was conducted between 2001 and 2006 in which 384 randomly selected primary care physicians viewed a video vignette of a patient presenting with symptoms suggestive of depression. Under the supervision of experienced clinicians, professional actors were trained to realistically portray patients who presented with 7 symptoms of depression: sleep disturbance, decreased interest, guilt, diminished energy, impaired concentration, poor appetite, and psychomotor agitation or retardation.Results: Most physicians listed depression as one of their diagnoses (89.6%), but German physicians were more likely to diagnose depression in women, while British and American physicians were more likely to diagnose depression in men (P = .0251). American physicians were almost twice as likely to prescribe an antidepressant as British physicians (P = .0241). German physicians were significantly more likely to refer the patient to a mental health professional than British or American physicians (P < .0001). German physicians wanted to see the patient in follow-up sooner than British or American physicians (P < .0001).Conclusions: Primary care physicians in different countries diagnose the exact same symptoms of depression differently depending on the patient's gender. There are also significant differences between countries in the management of a patient with symptoms suggestive of depression. International differences in prevalence rates for depression, and perhaps other diseases, may in part result from differences among health care systems in different countries.
Lisa D Marceau - One of the best experts on this subject based on the ideXlab platform.
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effects of patient medication requests on physician prescribing behavior results of a Factorial Experiment
Medical Care, 2014Co-Authors: John B Mckinlay, Lisa D Marceau, Jeffrey N Katz, Felicia Trachtenberg, Michael A FischerAbstract:Background:Because of internet searches, advice from friends, and pharmaceutical advertising, especially direct-to-consumer advertising, patients are increasingly activated to request medications during a physician encounter.Objectives:To estimate the effect of patient requests for medications on ph
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variations among primary care physicians in exercise advice imaging and analgesics for musculoskeletal pain results from a Factorial Experiment
Arthritis Care and Research, 2014Co-Authors: Nancy N Maserejian, Lisa D Marceau, John B Mckinlay, Michael A Fischer, Felicia L Trachtenberg, Jing Yu, Jeffrey N KatzAbstract:Objective To examine whether medical decisions regarding evaluation and management of musculoskeletal pain conditions varied systematically by characteristics of the patient or provider. Methods We conducted a balanced Factorial Experiment among primary care physicians in the US. Physicians (n = 192) viewed 2 videos of different patients (actors) presenting with pain: undiagnosed sciatica symptoms or diagnosed knee osteoarthritis. Systematic variations in patient gender, socioeconomic status, and race and physician gender and experience (<20 versus ≥20 years in practice) permitted estimation of unconfounded effects. Analysis of variance was used to evaluate associations between patient or provider attributes and clinical decisions. Quality of decisions was defined based on the current recommendations of the American College of Rheumatology, American Pain Society, and clinical expert consensus. Results Despite current recommendations, less than one-third of physicians would provide exercise advice (30.2% for osteoarthritis and 32.8% for sciatica). Physicians with fewer years in practice were more likely to provide advice on lifestyle changes, particularly exercise (P ≤ 0.01), and to prescribe nonsteroidal antiinflammatory drugs for pain relief, both of which were appropriate and consistent with current recommendations for care. Newer physicians ordered fewer tests, particularly basic laboratory investigations or urinalysis. Test ordering decreased as organizational emphasis on business or profits increased. Patient factors and physician gender had no consistent effects on pain evaluation or treatment. Conclusion Physician education on disease management recommendations regarding exercise and analgesics and implementation of quality measures may be useful, particularly for physicians with more years in practice.
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influences of organizational features of healthcare settings on clinical decision making qualitative results from a cross national Factorial Experiment
Health, 2012Co-Authors: Karen E Lutfey, Lisa D Marceau, Stephen Campbell, Martin Roland, John B MckinlayAbstract:A proliferating literature documents cross-national variation in medical practice and seeks to explain observed differences in terms of the presence of certain kinds of healthcare systems, economic, and cultural differences between countries. Less is known about how providers themselves understand these influences and perceive them as relevant to their clinical work. Using qualitative data from a cross-national Factorial Experiment in the United States and United Kingdom, we analyze 244 primary care physicians’ explanations of how organizational features of their respective healthcare settings influence the treatment decisions they made for a vignette patient, including affordability of care; within-system quality deficits; and constraints due to patient behavior. While many differences are attributed to financial constraints deriving from two very differently structured healthcare systems, in other ways they are reflections of cultural and historical expectations regarding medical care, or interactions between the two. Implications, including possible challenges to the implementation of universal care in the US, are discussed.
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diagnosis and management of depression in 3 countries results from a clinical vignette Factorial Experiment
The Primary Care Companion To The Journal of Clinical Psychiatry, 2011Co-Authors: Carol L Link, Lisa D Marceau, Theodore A Stern, Rebecca S Piccolo, Sara Arber, Ann Adams, Johannes Siegrist, Olaf Von Dem Knesebeck, John B MckinlayAbstract:Objective: International differences in disease prevalence rates are often reported and thought to reflect different lifestyles, genetics, or cultural differences in care-seeking behavior. However, they may also be produced by differences among health care systems. We sought to investigate variation in the diagnosis and management of a "patient" with exactly the same symptoms indicative of depression in 3 different health care systems (Germany, the United Kingdom, and the United States).Method: A Factorial Experiment was conducted between 2001 and 2006 in which 384 randomly selected primary care physicians viewed a video vignette of a patient presenting with symptoms suggestive of depression. Under the supervision of experienced clinicians, professional actors were trained to realistically portray patients who presented with 7 symptoms of depression: sleep disturbance, decreased interest, guilt, diminished energy, impaired concentration, poor appetite, and psychomotor agitation or retardation.Results: Most physicians listed depression as one of their diagnoses (89.6%), but German physicians were more likely to diagnose depression in women, while British and American physicians were more likely to diagnose depression in men (P = .0251). American physicians were almost twice as likely to prescribe an antidepressant as British physicians (P = .0241). German physicians were significantly more likely to refer the patient to a mental health professional than British or American physicians (P < .0001). German physicians wanted to see the patient in follow-up sooner than British or American physicians (P < .0001).Conclusions: Primary care physicians in different countries diagnose the exact same symptoms of depression differently depending on the patient's gender. There are also significant differences between countries in the management of a patient with symptoms suggestive of depression. International differences in prevalence rates for depression, and perhaps other diseases, may in part result from differences among health care systems in different countries.
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differences in the diagnosis and management of type 2 diabetes in 3 countries us uk and germany results from a Factorial Experiment
Medical Care, 2010Co-Authors: Olaf Von Dem Knesebeck, Carol L Link, Lisa D Marceau, Stephen Campbell, Martin Roland, Johannes Siegrist, Eric Gerstenberger, Werner De Cruppe, John B MckinlayAbstract:OBJECTIVES: This article examines the diagnosis and management of type-2 diabetes when exactly the same "patient" is encountered by 192 randomly selected primary care doctors in 3 different health care systems--the United States, United Kingdom, and Germany. METHODS: We conducted a Factorial Experiment, employing 2 clinically authentic filmed scenarios, to examine country differences in the treatment of diabetes, while controlling the effects of selected characteristics of patients and physicians. The patient in the first scenario presented with (undiagnosed) signs and symptoms strongly suggestive of diabetes, while the second scenario presented an already diagnosed patient with an emerging foot neuropathy. Physicians were asked how they would diagnose and manage the patients after watching the video vignettes using a questionnaire with standardized and open-ended questions. RESULTS: Regarding the first (undiagnosed) case, US doctors would ask significantly more questions than physicians from the UK and Germany (P < 0.001). German physicians would give less advice but would want to see the patient again much sooner (P < 0.001). Regarding the diagnosed case with an emerging foot neuropathy, US physicians would be most active in terms of questioning, testing, prescribing, and advice giving. Again, physicians from Germany would be less active in terms of therapeutic strategies but they would like to see the patient again sooner (P = 0.005). CONCLUSIONS: Although physicians in the 3 countries encountered exactly the same patient, differences in diagnostic and management decisions were evident. The Experimental design provides unconfounded estimates of health system differences while simultaneously controlling for the effects of selected patient attributes and physician characteristics.
Timothy B Baker - One of the best experts on this subject based on the ideXlab platform.
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effects of motivation phase intervention components on quit attempts in smokers unwilling to quit a Factorial Experiment
Drug and Alcohol Dependence, 2019Co-Authors: Jessica L Engle, Megan E Piper, Tanya R Schlam, Stevens S Smith, Robin J Mermelstein, Linda M Collins, Timothy B Baker, Douglas E Jorenby, Jessica W CookAbstract:Abstract Background Smoking reduction treatment is a promising approach to increase abstinence amongst smokers initially unwilling to quit. However, little is known about which reduction treatment elements increase quit attempts and the uptake of cessation treatment amongst such smokers. Methods This study is a secondary analysis of a 4-factor randomized Factorial Experiment conducted amongst primary care patients (N = 517) presenting for regular healthcare visits in Southern Wisconsin who were unwilling to quit smoking but willing to cut down. We evaluated the main and interactive effects of Motivation-phase intervention components on whether participants: 1) made a quit attempt (intentional abstinence ≥24 h) by 6- and 26-weeks post-study enrollment and, 2) used cessation treatment. We also evaluated the relations of quit attempts with abstinence. The four intervention components evaluated were: 1) Nicotine Patch vs. None; 2) Nicotine Gum vs. None; 3) Motivational Interviewing (MI) vs. None; and 4) Behavioral Reduction Counseling (BR) vs. None. Intervention components were administered over 6 weeks, with an option to repeat treatment; participants could request cessation treatment at any point. Results Nicotine gum significantly increased the likelihood of making a quit attempt by 6 weeks (23% vs. 15% without gum; p Conclusion Nicotine gum is a promising Motivation-phase intervention that may spur quit attempts amongst smokers initially unwilling to quit.
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toward precision smoking cessation treatment i moderator results from a Factorial Experiment
Drug and Alcohol Dependence, 2017Co-Authors: Megan E Piper, Tanya R Schlam, Jessica W Cook, Stevens S Smith, Daniel M Bolt, Robin J Mermelstein, Linda M Collins, Michael C Fiore, Timothy B BakerAbstract:Abstract Background The development of tobacco use treatments that are effective for all smokers is critical to improving clinical and public health. The Multiphase Optimization Strategy (MOST) uses highly efficient Factorial Experiments to evaluate multiple intervention components for possible inclusion in an optimized tobacco use treatment. Factorial Experiments permit analyses of the influence of patient characteristics on main and interaction effects of multiple, relatively discrete, intervention components. This study examined whether person-factor and smoking characteristics moderated the main or interactive effects of intervention components on 26-week self-reported abstinence rates. Methods This fractional Factorial Experiment evaluated six smoking cessation intervention components among primary care patients (N = 637): Prequit Nicotine Patch vs. None, Prequit Nicotine Gum vs. None, Preparation Counseling vs. None, Intensive Cessation In-Person Counseling vs. Minimal, Intensive Cessation Telephone Counseling vs. Minimal, and 16 vs. 8 Weeks of Combination Nicotine Replacement Therapy (NRT; nicotine patch + nicotine gum). Results Both psychiatric history and smoking heaviness moderated intervention component effects. In comparison with participants with no self-reported history of a psychiatric disorder, those with a positive history showed better response to 16- vs. 8-weeks of combination NRT, but a poorer response to counseling interventions. Also, in contrast to light smokers, heavier smokers showed a poorer response to counseling interventions. Conclusions Heavy smokers and those with psychiatric histories demonstrated a differential response to intervention components. This research illustrates the use of Factorial designs to examine the interactions between person characteristics and relatively discrete intervention components. Future research is needed to replicate these findings.
Linda M Collins - One of the best experts on this subject based on the ideXlab platform.
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a Factorial Experiment to optimize remotely delivered behavioral treatment for obesity results of the opt in study
Obesity, 2020Co-Authors: Bonnie Spring, Angela F Pfammatter, Sara H Marchese, Tammy Kay Stump, Christine A Pellegrini, Gene H Mcfadden, Donald Hedeker, Juned Siddique, Neil Jordan, Linda M CollinsAbstract:OBJECTIVE Intensive behavioral obesity treatments face scalability challenges, but evidence is lacking about which treatment components could be cut back without reducing weight loss. The Optimization of Remotely Delivered Intensive Lifestyle Treatment for Obesity (Opt-IN) study applied the Multiphase Optimization Strategy to develop an entirely remotely delivered, technology-supported weight-loss package to maximize the amount of weight loss attainable for ≤$500. METHODS Six-month weight loss was examined among adults (N = 562) with BMI ≥ 25 who were randomly assigned to conditions in a Factorial Experiment crossing five dichotomous treatment components set to either low/high (12 vs. 24 coaching calls) or off/on (primary care provider reports, text messaging, meal replacements, and buddy training). RESULTS About 84.3% of participants completed the final assessment. The treatment package yielding maximum weight loss for ≤$500 included 12 coaching calls, buddy training, and primary care provider progress reports; produced average weight loss of 6.1 kg, with 57.1% losing ≥5% and 51.8% losing ≥7%; and cost $427 per person. The most expensive candidate-treatment component (24 vs. 12 coaching calls) was screened out of the optimized treatment package because it did not increase weight loss. CONCLUSIONS Systematically testing each treatment component's effect on weight loss made it possible to eliminate more expensive but less impactful components, yielding an optimized, resource-efficient obesity treatment for evaluation in a randomized controlled trial.
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effects of motivation phase intervention components on quit attempts in smokers unwilling to quit a Factorial Experiment
Drug and Alcohol Dependence, 2019Co-Authors: Jessica L Engle, Megan E Piper, Tanya R Schlam, Stevens S Smith, Robin J Mermelstein, Linda M Collins, Timothy B Baker, Douglas E Jorenby, Jessica W CookAbstract:Abstract Background Smoking reduction treatment is a promising approach to increase abstinence amongst smokers initially unwilling to quit. However, little is known about which reduction treatment elements increase quit attempts and the uptake of cessation treatment amongst such smokers. Methods This study is a secondary analysis of a 4-factor randomized Factorial Experiment conducted amongst primary care patients (N = 517) presenting for regular healthcare visits in Southern Wisconsin who were unwilling to quit smoking but willing to cut down. We evaluated the main and interactive effects of Motivation-phase intervention components on whether participants: 1) made a quit attempt (intentional abstinence ≥24 h) by 6- and 26-weeks post-study enrollment and, 2) used cessation treatment. We also evaluated the relations of quit attempts with abstinence. The four intervention components evaluated were: 1) Nicotine Patch vs. None; 2) Nicotine Gum vs. None; 3) Motivational Interviewing (MI) vs. None; and 4) Behavioral Reduction Counseling (BR) vs. None. Intervention components were administered over 6 weeks, with an option to repeat treatment; participants could request cessation treatment at any point. Results Nicotine gum significantly increased the likelihood of making a quit attempt by 6 weeks (23% vs. 15% without gum; p Conclusion Nicotine gum is a promising Motivation-phase intervention that may spur quit attempts amongst smokers initially unwilling to quit.
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toward precision smoking cessation treatment i moderator results from a Factorial Experiment
Drug and Alcohol Dependence, 2017Co-Authors: Megan E Piper, Tanya R Schlam, Jessica W Cook, Stevens S Smith, Daniel M Bolt, Robin J Mermelstein, Linda M Collins, Michael C Fiore, Timothy B BakerAbstract:Abstract Background The development of tobacco use treatments that are effective for all smokers is critical to improving clinical and public health. The Multiphase Optimization Strategy (MOST) uses highly efficient Factorial Experiments to evaluate multiple intervention components for possible inclusion in an optimized tobacco use treatment. Factorial Experiments permit analyses of the influence of patient characteristics on main and interaction effects of multiple, relatively discrete, intervention components. This study examined whether person-factor and smoking characteristics moderated the main or interactive effects of intervention components on 26-week self-reported abstinence rates. Methods This fractional Factorial Experiment evaluated six smoking cessation intervention components among primary care patients (N = 637): Prequit Nicotine Patch vs. None, Prequit Nicotine Gum vs. None, Preparation Counseling vs. None, Intensive Cessation In-Person Counseling vs. Minimal, Intensive Cessation Telephone Counseling vs. Minimal, and 16 vs. 8 Weeks of Combination Nicotine Replacement Therapy (NRT; nicotine patch + nicotine gum). Results Both psychiatric history and smoking heaviness moderated intervention component effects. In comparison with participants with no self-reported history of a psychiatric disorder, those with a positive history showed better response to 16- vs. 8-weeks of combination NRT, but a poorer response to counseling interventions. Also, in contrast to light smokers, heavier smokers showed a poorer response to counseling interventions. Conclusions Heavy smokers and those with psychiatric histories demonstrated a differential response to intervention components. This research illustrates the use of Factorial designs to examine the interactions between person characteristics and relatively discrete intervention components. Future research is needed to replicate these findings.
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Factorial Experiments: Efficient Tools for Evaluation of Intervention Components
American Journal of Preventive Medicine, 2014Co-Authors: Linda M Collins, Kari C Kugler, John J Dziak, Jessica B. TrailAbstract:Background An understanding of the individual and combined effects of a set of intervention components is important for moving the science of preventive medicine interventions forward. This understanding can often be achieved in an efficient and economical way via a Factorial Experiment, in which two or more independent variables are manipulated. The Factorial Experiment is a complement to the RCT; the two designs address different research questions. Purpose To offer an introduction to Factorial Experiments aimed at investigators trained primarily in the RCT. Methods The Factorial Experiment is compared and contrasted with other Experimental designs used commonly in intervention science to highlight where each is most efficient and appropriate. Results Several points are made: Factorial Experiments make very efficient use of Experimental subjects when the data are properly analyzed; a Factorial Experiment can have excellent statistical power even if it has relatively few subjects per Experimental condition; and when conducting research to select components for inclusion in a multicomponent intervention, interactions should be studied rather than avoided. Conclusions Investigators in preventive medicine and related areas should begin considering Factorial Experiments alongside other approaches. Experimental designs should be chosen from a resource management perspective, which states that the best Experimental design is the one that provides the greatest scientific benefit without exceeding available resources.
Jessica W Cook - One of the best experts on this subject based on the ideXlab platform.
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effects of motivation phase intervention components on quit attempts in smokers unwilling to quit a Factorial Experiment
Drug and Alcohol Dependence, 2019Co-Authors: Jessica L Engle, Megan E Piper, Tanya R Schlam, Stevens S Smith, Robin J Mermelstein, Linda M Collins, Timothy B Baker, Douglas E Jorenby, Jessica W CookAbstract:Abstract Background Smoking reduction treatment is a promising approach to increase abstinence amongst smokers initially unwilling to quit. However, little is known about which reduction treatment elements increase quit attempts and the uptake of cessation treatment amongst such smokers. Methods This study is a secondary analysis of a 4-factor randomized Factorial Experiment conducted amongst primary care patients (N = 517) presenting for regular healthcare visits in Southern Wisconsin who were unwilling to quit smoking but willing to cut down. We evaluated the main and interactive effects of Motivation-phase intervention components on whether participants: 1) made a quit attempt (intentional abstinence ≥24 h) by 6- and 26-weeks post-study enrollment and, 2) used cessation treatment. We also evaluated the relations of quit attempts with abstinence. The four intervention components evaluated were: 1) Nicotine Patch vs. None; 2) Nicotine Gum vs. None; 3) Motivational Interviewing (MI) vs. None; and 4) Behavioral Reduction Counseling (BR) vs. None. Intervention components were administered over 6 weeks, with an option to repeat treatment; participants could request cessation treatment at any point. Results Nicotine gum significantly increased the likelihood of making a quit attempt by 6 weeks (23% vs. 15% without gum; p Conclusion Nicotine gum is a promising Motivation-phase intervention that may spur quit attempts amongst smokers initially unwilling to quit.
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toward precision smoking cessation treatment i moderator results from a Factorial Experiment
Drug and Alcohol Dependence, 2017Co-Authors: Megan E Piper, Tanya R Schlam, Jessica W Cook, Stevens S Smith, Daniel M Bolt, Robin J Mermelstein, Linda M Collins, Michael C Fiore, Timothy B BakerAbstract:Abstract Background The development of tobacco use treatments that are effective for all smokers is critical to improving clinical and public health. The Multiphase Optimization Strategy (MOST) uses highly efficient Factorial Experiments to evaluate multiple intervention components for possible inclusion in an optimized tobacco use treatment. Factorial Experiments permit analyses of the influence of patient characteristics on main and interaction effects of multiple, relatively discrete, intervention components. This study examined whether person-factor and smoking characteristics moderated the main or interactive effects of intervention components on 26-week self-reported abstinence rates. Methods This fractional Factorial Experiment evaluated six smoking cessation intervention components among primary care patients (N = 637): Prequit Nicotine Patch vs. None, Prequit Nicotine Gum vs. None, Preparation Counseling vs. None, Intensive Cessation In-Person Counseling vs. Minimal, Intensive Cessation Telephone Counseling vs. Minimal, and 16 vs. 8 Weeks of Combination Nicotine Replacement Therapy (NRT; nicotine patch + nicotine gum). Results Both psychiatric history and smoking heaviness moderated intervention component effects. In comparison with participants with no self-reported history of a psychiatric disorder, those with a positive history showed better response to 16- vs. 8-weeks of combination NRT, but a poorer response to counseling interventions. Also, in contrast to light smokers, heavier smokers showed a poorer response to counseling interventions. Conclusions Heavy smokers and those with psychiatric histories demonstrated a differential response to intervention components. This research illustrates the use of Factorial designs to examine the interactions between person characteristics and relatively discrete intervention components. Future research is needed to replicate these findings.
