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Article ; Online: Influence of Disease-Related Stigma on Patients' Decisions to Upload Medical Reports to the German Electronic Health Record: Randomized Controlled Trial.

von Kalckreuth, Niklas / Feufel, Markus A

JMIR human factors

2024 Volume 11, Page(s) e52625

Abstract: Background: The rollout of the electronic health record (EHR) represents a central component of the digital transformation of the German health care system. Although the EHR promises more effective, safer, and faster treatment of patients from a systems ...

Abstract	Background: The rollout of the electronic health record (EHR) represents a central component of the digital transformation of the German health care system. Although the EHR promises more effective, safer, and faster treatment of patients from a systems perspective, the successful implementation of the EHR largely depends on the patient. In a recent survey, 3 out of 4 Germans stated that they intend to use the EHR, whereas other studies show that the intention to use a technology is not a reliable and sufficient predictor of actual use. Objective: Controlling for patients' intention to use the EHR, we investigated whether disease-specific risk perceptions related to the time course of the disease and disease-related stigma explain the additional variance in patients' decisions to upload medical reports to the EHR. Methods: In an online user study, 241 German participants were asked to interact with a randomly assigned medical report that varied systematically in terms of disease-related stigma (high vs low) and disease time course (acute vs chronic) and to decide whether to upload it to the EHR. Results: Disease-related stigma (odds ratio 0.154, P<.001) offset the generally positive relationship between intention to use and the upload decision (odds ratio 2.628, P<.001), whereas the disease time course showed no effect. Conclusions: Even if patients generally intend to use the EHR, risk perceptions such as those related to diseases associated with social stigma may deter people from uploading related medical reports to the EHR. To ensure the reliable use of this key technology in a digitalized health care system, transparent and easy-to-comprehend information about the safety standards of the EHR are warranted across the board, even for populations that are generally in favor of using the EHR.
MeSH term(s)	Humans ; Electronic Health Records ; Social Stigma ; Disease Progression ; European People
Language	English
Publishing date	2024-04-10
Publishing country	Canada
Document type	Randomized Controlled Trial ; Journal Article
ISSN	2292-9495
ISSN (online)	2292-9495
DOI	10.2196/52625
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Article: Virtuelle Flurgespräche und Status-Updates: Zusammenarbeit in avatar-basierten Arbeitsumgebungen.

Oehring, Felix / Feufel, Markus A / Mörike, Frauke

Zeitschrift fur Arbeitswissenschaft

2023 , Page(s) 1–14

Abstract: This article focuses on the collaboration of hybrid teams in avatar-based virtual office environments. Based on the three dimensions of virtuality, we pursue the following research questions: (1) How is everyday work and collaboration coordinated in ... ...

Title translation	Virtual hallway chats and status updates: collaboration in avatar-based work environments.
Abstract	This article focuses on the collaboration of hybrid teams in avatar-based virtual office environments. Based on the three dimensions of virtuality, we pursue the following research questions: (1) How is everyday work and collaboration coordinated in these environments? and (2) Which advantages and challenges do users perceive in relation to this form of work? Based on a multi-method study consisting of qualitative interviews with experienced users and a participatory focus group discussion with new users, we illustrate that collaboration in avatar-based work environments is marked by a diverse array of work practices-ranging from co-present to mobile work-and that promising implementation methods exist to coordinate these practices. However, our results also suggest that to exploit this potential, not only the virtual environments but also teams' work practices and digital infrastructure must be further developed.
Language	German
Publishing date	2023-03-21
Publishing country	Germany
Document type	English Abstract ; Journal Article
ZDB-ID	2642171-9
ISSN	2366-4681 ; 0340-2444
ISSN (online)	2366-4681
ISSN	0340-2444
DOI	10.1007/s41449-023-00356-8
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Article ; Online: Extending the Privacy Calculus to the mHealth Domain: Survey Study on the Intention to Use mHealth Apps in Germany.

von Kalckreuth, Niklas / Feufel, Markus A

JMIR human factors

2023 Volume 10, Page(s) e45503

Abstract: Background: With the increasing digitalization of the health sector, more and more mobile health (mHealth) apps are coming to the market to continuously collect and process sensitive health data for the benefit of patients and providers. These ... ...

Abstract	Background: With the increasing digitalization of the health sector, more and more mobile health (mHealth) apps are coming to the market to continuously collect and process sensitive health data for the benefit of patients and providers. These technologies open up new opportunities to make the health care system more efficient and save costs but also pose potential threats such as loss of data or finances. Objective: This study aims to present an empirical review and adaptation of the extended privacy calculus model to the mHealth domain and to understand what factors influence the intended usage of mHealth technologies. Methods: A survey study was conducted to empirically validate our model, using a case vignette as cover story. Data were collected from 250 German participants and analyzed using a covariance-based structural equation model. Results: The model explains R2=79.3% of the variance in intention to use. The 3 main factors (social norms, attitude to privacy, and perceived control over personal data) influenced the intention to use mHealth apps, albeit partially indirectly. The intention to use mHealth apps is driven by the perceived benefits of the technology, trust in the provider, and social norms. Privacy concerns have no bearing on the intention to use. The attitude to privacy has a large inhibiting effect on perceived benefits, as well as on trust in the provider. Perceived control over personal data clearly dispels privacy concerns and supports the relationship of trust between the user and the provider. Conclusions: Based on the privacy calculus, our domain-specific model explains the intention to use mHealth apps better than previous, more general models. The findings allow health care providers to improve their products and to increase usage by targeting specific user groups.
Language	English
Publishing date	2023-08-16
Publishing country	Canada
Document type	Journal Article
ISSN	2292-9495
ISSN (online)	2292-9495
DOI	10.2196/45503
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Article: How to Uncover Sources of Unwarranted Practice Variation: A Case Study in Emergency Medicine.

Feufel, Markus A

Qualitative health research

2018 Volume 28, Issue 9, Page(s) 1486–1498

Abstract: Forty years of statistical database analyses have demonstrated the existence of unwarranted practice variation in care delivery, that is, variations independent of medical need, evidence, or patient preference. Alas, little is known about the underlying ... ...

Abstract	Forty years of statistical database analyses have demonstrated the existence of unwarranted practice variation in care delivery, that is, variations independent of medical need, evidence, or patient preference. Alas, little is known about the underlying mechanisms and thus finding interventions to reduce unwarranted variations remains difficult, hampering quality, equity, and efficiency of care. Whereas statistical analyses describe deviations from ideal patterns, ethnographically inspired analyses aim at understanding when, how, and why variations occur in practice. Based on case studies derived from shadowing emergency physicians, I demonstrate that analyzing practice variation in practice helps to (a) advance the understanding of mechanisms and (b) evaluate/expand the existing repertoire of interventions. Results revealed unmet expectations and new sources of known variations as well as interventions complementing systemic changes with those that empower individuals to better cope with the existing system. These findings highlight the benefits of mixed-methods for understanding and tackling practice variation.
MeSH term(s)	Efficiency, Organizational ; Emergency Medicine/organization & administration ; Emergency Medicine/standards ; Guideline Adherence/organization & administration ; Guideline Adherence/standards ; Health Services Misuse ; Hospitals, Teaching/organization & administration ; Humans ; Organizational Case Studies ; Practice Guidelines as Topic/standards ; Practice Patterns, Physicians'/organization & administration ; Practice Patterns, Physicians'/standards ; Quality of Health Care/standards ; Social Norms ; Universities/organization & administration
Language	English
Publishing date	2018-05-21
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Observational Study
ZDB-ID	1275716-0
ISSN	1552-7557 ; 1049-7323
ISSN (online)	1552-7557
ISSN	1049-7323
DOI	10.1177/1049732318774322
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Article: How suitable are clinical vignettes for the evaluation of symptom checker apps? A test theoretical perspective.

Kopka, Marvin / Feufel, Markus A / Berner, Eta S / Schmieding, Malte L

Digital health

2023 Volume 9, Page(s) 20552076231194929

Abstract: Objective: To evaluate the ability of case vignettes to assess the performance of symptom checker applications and to suggest refinements to the methodology used in case vignette-based audit studies.: Methods: We re-analyzed the publicly available ... ...

Abstract	Objective: To evaluate the ability of case vignettes to assess the performance of symptom checker applications and to suggest refinements to the methodology used in case vignette-based audit studies. Methods: We re-analyzed the publicly available data of two prominent case vignette-based symptom checker audit studies by calculating common metrics of test theory. Furthermore, we developed a new metric, the Capability Comparison Score (CCS), which compares symptom checker capability while controlling for the difficulty of the set of cases each symptom checker evaluated. We then scrutinized whether applying test theory and the CCS altered the performance ranking of the investigated symptom checkers. Results: In both studies, most symptom checkers changed their rank order when adjusting the triage capability for item difficulty (ID) with the CCS. The previously reported triage accuracies commonly overestimated the capability of symptom checkers because they did not account for the fact that symptom checkers tend to selectively appraise easier cases (i.e., with high ID values). Also, many case vignettes in both studies showed insufficient (very low and even negative) values of item-total correlation (ITC), suggesting that individual items or the composition of item sets are of low quality. Conclusions: A test-theoretic perspective helps identify previously undetected threats to the validity of case vignette-based symptom checker assessments and provides guidance and specific metrics to improve the quality of case vignettes, in particular by controlling for the difficulty of the vignettes an app was (not) able to evaluate correctly. Such measures might prove more meaningful than accuracy alone for the competitive assessment of symptom checkers. Our approach helps elaborate and standardize the methodology used for appraising symptom checker capability, which, ultimately, may yield more reliable results.
Language	English
Publishing date	2023-08-21
Publishing country	United States
Document type	Journal Article
ZDB-ID	2819396-9
ISSN	2055-2076
ISSN	2055-2076
DOI	10.1177/20552076231194929
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Article ; Online: Boosting for insight and/or boosting for agency? How to maximize accurate test interpretation with natural frequencies.

Feufel, Markus A / Keller, Niklas / Kendel, Friederike / Spies, Claudia D

BMC medical education

2023 Volume 23, Issue 1, Page(s) 75

Abstract: Background: Many physicians do not know how to accurately interpret test results using Bayes' rule. As a remedy, two kinds of interventions have been shown effective: boosting insight and boosting agency with natural frequencies. To boost insight, test ... ...

Abstract	Background: Many physicians do not know how to accurately interpret test results using Bayes' rule. As a remedy, two kinds of interventions have been shown effective: boosting insight and boosting agency with natural frequencies. To boost insight, test statistics are provided in natural frequencies (rather than conditional probabilities), without instructions on how to use them. To boost agency, a training is provided on how to translate probabilities into natural frequencies and apply them in Bayes' rule. What has not been shown is whether boosting agency is sufficient or if representing test statistics in natural frequencies may additionally boost insight to maximize accurate test interpretation. Methods: We used a pre/posttest design to assess test interpretation accuracy of 577 medical students before and after a training on two Bayesian reasoning tasks, one providing conditional probabilities, the other natural frequencies. The pretest assessed baseline abilities versus the effect of natural frequencies to boost insight. After participants received a training on how to translate conditional probabilities into natural frequencies and how to apply them in Bayes' rule, test interpretation skills were assessed using the same tasks again, comparing the effects of training-induced agency with versus without additionally boosting insight (i.e., test statistics in natural frequencies versus conditional probabilities). Results: Compared to the test question formatted in conditional probabilities (34% correct answers), natural frequencies facilitated Bayesian reasoning without training (68%), that is, they increased insight. The training on how to use natural frequencies improved performance for tasks formatted in conditional probabilities (64%). Performance was maximal after training and with test statistics formatted in natural frequencies, that is, with a combination of boosting insight and agency (89%). Conclusions: Natural frequencies should be used to boost insight and agency to maximize effective use of teaching resources. Thus, mandating that test statistics are provided in natural frequencies and adopting short trainings on how to translate conditional probabilities into natural frequencies and how to apply them in Bayes' rule will help to maximize accurate test interpretation. Trial registration: The study was a registered with the German Clinical Trial Registry ( DRKS00008723 06/03/2015).
MeSH term(s)	Humans ; Bayes Theorem ; Probability ; Problem Solving ; Students, Medical ; Physicians
Language	English
Publishing date	2023-02-07
Publishing country	England
Document type	Journal Article
ZDB-ID	2044473-4
ISSN	1472-6920 ; 1472-6920
ISSN (online)	1472-6920
ISSN	1472-6920
DOI	10.1186/s12909-023-04025-6
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Article ; Online: Workarounds in the Shadow System: An Ethnographic Study of Requirements for Documentation and Cooperation in a Clinical Advisory Center.

Mörike, Frauke / Spiehl, Hannah L / Feufel, Markus A

Human factors

2022 Volume 66, Issue 3, Page(s) 636–646

Abstract: Objective: Hospital information systems (HIS) are meant to manage complex work processes across healthcare organizations. We describe limitations of HIS to address local information requirements and how they are circumvented at different organizational ... ...

Abstract	Objective: Hospital information systems (HIS) are meant to manage complex work processes across healthcare organizations. We describe limitations of HIS to address local information requirements and how they are circumvented at different organizational levels. Results can be used to better support collaboration in socio-technical systems. Background: Workarounds Methods: An ethnographic study with observations and semi-structured interviews was conducted and analyzed through categorization and iterative coding. Results: Several digital-analog workarounds are employed for documentation and a shared server functions as a shadow system to support workflows in ways the HIS cannot. For collaborative documentation, all (official and informal) information sources were used simultaneously as part of an interconnected boundary infrastructure. Conclusion: Formal and informal IT systems are interconnected across different organizational levels and provide insights into unmet information requirements, effective and problematic work practices, and how to address them to improve system functioning. An integrated perspective on boundary infrastructures, workarounds, and shadow systems may advance system analysis, providing a more comprehensive picture of IT requirements than any concept alone. Application: Workarounds and shadow systems highlight that HIS should support systemic
MeSH term(s)	Humans ; Workflow ; Documentation/methods
Language	English
Publishing date	2022-04-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	212725-8
ISSN	1547-8181 ; 0018-7208
ISSN (online)	1547-8181
ISSN	0018-7208
DOI	10.1177/00187208221087013
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Article: Talking about Familial Breast and Ovarian Cancer Risk-Evaluation of a Psychosocial Training Module for Gynecologists in Germany.

Kendel, Friederike / Speiser, Dorothee / Fechner, Karen / Olbrich, Christine / Stegen, Stephanie / Rörig, Alina / Feufel, Markus A / Haering, Stephanie

Cancers

2024 Volume 16, Issue 2

Abstract: Primary care gynecologists are increasingly integrated into the care of patients with hereditary breast and ovarian cancer (HBOC) risks. These physicians should not only have basic genetic knowledge; they should also feel able to sensitively address an ... ...

Abstract	Primary care gynecologists are increasingly integrated into the care of patients with hereditary breast and ovarian cancer (HBOC) risks. These physicians should not only have basic genetic knowledge; they should also feel able to sensitively address an increased HBOC risk and deal with emotional, stressful situations in this context. Our project aimed at developing a training module, 'iKNOWgynetics', addressing psychosocial challenges in the context of HBOC care for primary care gynecologists. We developed the psychosocial training module in three phases: first, we conducted an online survey with
Language	English
Publishing date	2024-01-11
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers16020310
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Article ; Online: Medical education should teach heuristics rather than train them away.

Feufel, Markus A / Flach, John M

Medical education

2019 Volume 53, Issue 4, Page(s) 334–344

Abstract: Context: Ample research suggests that most decisions are based on heuristics-simple rules of thumb-that violate prescriptions of logic and probability theory and should therefore be avoided. Yet findings on decision making in everyday work contexts ... ...

Abstract	Context: Ample research suggests that most decisions are based on heuristics-simple rules of thumb-that violate prescriptions of logic and probability theory and should therefore be avoided. Yet findings on decision making in everyday work contexts support the idea that heuristics are in fact the very basis of good decision making if adapted to the challenges and performance criteria of the specific work domain. Because traditional pedagogies aim at circumventing heuristics in (clinical) decision making, ways in which to improve the use of heuristics via (medical) education have rarely been explored. Objective: To describe the rationale for teaching and learning proper use of heuristics, rather than stigmatising them, and to identify principles and potential implications for the design and improvement of pedagogies for training in clinical decision making. Results: Based on theory and evidence concerning heuristic decision making in everyday work domains, we suggest that heuristics should not be avoided as irrational or a mere source of errors, in particular in domains where errors are unavoidable. Instead, we should teach and learn how to use heuristics to make fewer and 'smarter' mistakes rather than 'dumb' ones. Based on concepts borrowed from signal detection and control theory, we demonstrate that, to improve heuristic decision making, teaching should focus on differential diagnoses and learning from feedback and mistakes, in teams and in contextually rich settings where the frequencies, costs and trade-offs between different types of errors (misses versus false alarms) can be experienced. We discuss three possible teaching formats and how to best implement them based on our findings. Conclusions: The most promising way to train (future) physicians and other health professionals in clinical decision making is not to circumvent heuristics or correct deviations from logic and probability theory but to enhance the use of heuristics by improving perspicacity, that is, by tuning the (recognition) processes that underlie the domain-specific adaptive selection of heuristics and management of ensuing errors.
MeSH term(s)	Clinical Decision-Making/methods ; Education, Medical/methods ; Heuristics ; Humans ; Physicians
Language	English
Publishing date	2019-01-07
Publishing country	England
Document type	Journal Article
ZDB-ID	195274-2
ISSN	1365-2923 ; 0308-0110
ISSN (online)	1365-2923
ISSN	0308-0110
DOI	10.1111/medu.13789
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Article ; Online: The Triage Capability of Laypersons: Retrospective Exploratory Analysis.

Kopka, Marvin / Feufel, Markus A / Balzer, Felix / Schmieding, Malte L

JMIR formative research

2022 Volume 6, Issue 10, Page(s) e38977

Abstract: Background: Although medical decision-making may be thought of as a task involving health professionals, many decisions, including critical health-related decisions are made by laypersons alone. Specifically, as the first step to most care episodes, it ... ...

Abstract	Background: Although medical decision-making may be thought of as a task involving health professionals, many decisions, including critical health-related decisions are made by laypersons alone. Specifically, as the first step to most care episodes, it is the patient who determines whether and where to seek health care (triage). Overcautious self-assessments (ie, overtriaging) may lead to overutilization of health care facilities and overcrowded emergency departments, whereas imprudent decisions (ie, undertriaging) constitute a risk to the patient's health. Recently, patient-facing decision support systems, commonly known as symptom checkers, have been developed to assist laypersons in these decisions. Objective: The purpose of this study is to identify factors influencing laypersons' ability to self-triage and their risk averseness in self-triage decisions. Methods: We analyzed publicly available data on 91 laypersons appraising 45 short fictitious patient descriptions (case vignettes; N=4095 appraisals). Using signal detection theory and descriptive and inferential statistics, we explored whether the type of medical decision laypersons face, their confidence in their decision, and sociodemographic factors influence their triage accuracy and the type of errors they make. We distinguished between 2 decisions: whether emergency care was required (decision 1) and whether self-care was sufficient (decision 2). Results: The accuracy of detecting emergencies (decision 1) was higher (mean 82.2%, SD 5.9%) than that of deciding whether any type of medical care is required (decision 2, mean 75.9%, SD 5.25%; t Conclusions: Our study suggests that laypersons are overcautious in deciding whether they require medical care at all, but they miss identifying a considerable portion of emergencies. Our results further indicate that women are more risk averse than men in both types of decisions. Layperson participants made most triage errors when they were certain of their own appraisal. Thus, they might not follow or even seek advice (eg, from symptom checkers) in most instances where advice would be useful.
Language	English
Publishing date	2022-10-12
Publishing country	Canada
Document type	Journal Article
ISSN	2561-326X
ISSN (online)	2561-326X
DOI	10.2196/38977
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