Ignite Creation Date:
2024-10-26 @ 3:36 PM
Last Modification Date:
2024-10-26 @ 3:36 PM
Study NCT ID:
NCT06526663
Status:
RECRUITING
Last Update Posted:
None
First Post:
2024-07-25
Brief Title:
Randomizing Vignettes to Understand Contributors to Trust in Primary Care Doctors
Sponsor:
None
Organization:
None
Study Overview
Official Title:
Randomizing Vignettes to Understand Contributors to Trust in Primary Care Doctors
Status:
RECRUITING
Status Verified Date:
2024-10
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
No
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
In this proposed work the investigators plan to generate experimental evidence about trust and overuse of healthcare The protocol described below is for the first phase of this work to establish the feasibility of modifying feelings of trust via a vignette
Detailed Description:
The investigators will engage survey participants by recruiting from among the Workers registered with Amazon Mechanical Turk MTurk These are paid participants who chose to participate in this anonymous low-risk activity After pilot testing on a small set of Workers the investigators will field the full survey using a randomized design to test hypotheses about the investigators ability to manipulate trust experimentally
Individuals eligible as participants will be over the age of 18 years able to read and respond in English and have had one or more visits with a doctor in the past 3 years
Survey
The survey has three parts The investigators will use Qualtrics to develop the survey vignette and use the randomization feature of Qualtrics to randomize the participants when the participant clicks on the link to Qualtrics
1 Vignette Participants will be randomized to view one of sixteen vignettes The vignettes describe a clinical encounter and vary four attributes each of which has two levels
Duration of relationship with doctor No previous relationship episodic care walk-in-care on demand telemedicine versus 3 years Connection Physician is attending to computer versus Physician is attending to patient Length of visit 15 minutes versus 30 minutes Shares information Doctor does not explain the decision making versus Doctor shares what heshe knows that informed the decision
A sample vignette is presented here
Imagine having low back pain that started 4 days ago and being very uncomfortable For this visit the patient sees a doctor at the usual practice that the patient has never met before The doctor spends 30 minutes with the patient He is primarily looking at the computer screen and not at the patient At the end the doctor tells the patient that no xrays are needed and makes recommendations for treating the patients pain
The investigators will do a test of attention quiz to assure that the participant read the vignette asking
1 Why did you go for care twisted ankle back pain
2 Did the doctor make any recommendations recommended pain treatment recommended a cast
2 Trust in Clinician Survey
The investigators will use the Wake Forest Trust in Physician WFTP scale slightly modified to clarify that the investigators are inquiring about the clinician described in the vignette Whereas the WFTP scale asks about your doctor the investigators will ask about this doctor The WFTP uses a 5-pt Likert scale Items 2 3 and 8 are reverse coded upon analysis strongly agree agree neutral disagree strongly disagree
The introduction will read
Think about the visit described above What do you think about this doctor
1 This doctor will do whatever it takes to get you all the care you need
2 Sometimes this doctor cares more about what is convenient for him or her than about the patients medical needs
3 This doctors medical skills are not as good as they should be
4 This doctor is extremely thorough and careful
5 You completely trust this doctors decisions about which medical treatments are best for you
6 This doctor is totally honest in telling you about all of the different treatment options available for the patients condition
7 This doctor only thinks about what is best for you
8 Sometimes this doctor does not pay full attention to what you are trying to tell him or her
9 The patient has no worries about putting the patients life in this doctors hands
10 All in all the patient has complete trust in this doctor
3 Demographics
The investigators will ask the respondents to describe themselves as follows
Sex Male Female Non-binary Age 18-35 36-50 51-65 65 RaceEthnicity Black White Asian Native AmericanPacific Islander Hispanic Other Choose all that apply How do you describe your health Excellent Very good Good Fair Poor Do you have health insurance Yes or No What is your highest level of education completed Grade school High School college post-graduate
Analysis The investigators will use descriptive statistics to describe the characteristics of the respondents and the distribution of the WFTP score which is a quasi-continuous measure The investigators will look for outliers defined as scores greater or less than 32 standard deviations from the mean Linearity will be examined with scatterplots The assumption of normality will be assessed by analyzing the skewness and kurtosis of the variables and with use of histograms The investigators expect the WFTP to be normally distributed as it has been in other populations If it is not the investigators will consider log transformation The investigators will describe the respondents by vignette assignment to confirm that randomization was successful
Given the structure of MTurk the investigators will not have a measure of survey response The investigators will however be able to assess the pattern of missing variables across the responses and will incorporate this appropriately into the models
In the validation study by Katz she reports in a national sample the Wake Forest Physician Trust Scale WFPTS had a mean score of 408 SD 62 for the national sample of 959 participants In her study of fewer participants recruited from MTurk the mean score for the WFPTS was 359 SD 612 for young adult participants and 361 SD 611 for older adult participants
The investigators would like to be able to detect a 2 standard deviation SD difference between the lower trust vignettes and the higher trust vignettes If the study has 36 individuals in each group the investigators are able to detect with a power of 08 and an alpha of 05 a difference of 4 points on the WFTP 38 sd 6 vs 42 sd 6 The investigators will aim to have 36 respondents in each of 16 groups
The investigators will test hypotheses about the vignettes and the reported trust in the physician
Individuals eligible as participants will be over the age of 18 years able to read and respond in English and have had one or more visits with a doctor in the past 3 years
Survey
The survey has three parts The investigators will use Qualtrics to develop the survey vignette and use the randomization feature of Qualtrics to randomize the participants when the participant clicks on the link to Qualtrics
1 Vignette Participants will be randomized to view one of sixteen vignettes The vignettes describe a clinical encounter and vary four attributes each of which has two levels
Duration of relationship with doctor No previous relationship episodic care walk-in-care on demand telemedicine versus 3 years Connection Physician is attending to computer versus Physician is attending to patient Length of visit 15 minutes versus 30 minutes Shares information Doctor does not explain the decision making versus Doctor shares what heshe knows that informed the decision
A sample vignette is presented here
Imagine having low back pain that started 4 days ago and being very uncomfortable For this visit the patient sees a doctor at the usual practice that the patient has never met before The doctor spends 30 minutes with the patient He is primarily looking at the computer screen and not at the patient At the end the doctor tells the patient that no xrays are needed and makes recommendations for treating the patients pain
The investigators will do a test of attention quiz to assure that the participant read the vignette asking
1 Why did you go for care twisted ankle back pain
2 Did the doctor make any recommendations recommended pain treatment recommended a cast
2 Trust in Clinician Survey
The investigators will use the Wake Forest Trust in Physician WFTP scale slightly modified to clarify that the investigators are inquiring about the clinician described in the vignette Whereas the WFTP scale asks about your doctor the investigators will ask about this doctor The WFTP uses a 5-pt Likert scale Items 2 3 and 8 are reverse coded upon analysis strongly agree agree neutral disagree strongly disagree
The introduction will read
Think about the visit described above What do you think about this doctor
1 This doctor will do whatever it takes to get you all the care you need
2 Sometimes this doctor cares more about what is convenient for him or her than about the patients medical needs
3 This doctors medical skills are not as good as they should be
4 This doctor is extremely thorough and careful
5 You completely trust this doctors decisions about which medical treatments are best for you
6 This doctor is totally honest in telling you about all of the different treatment options available for the patients condition
7 This doctor only thinks about what is best for you
8 Sometimes this doctor does not pay full attention to what you are trying to tell him or her
9 The patient has no worries about putting the patients life in this doctors hands
10 All in all the patient has complete trust in this doctor
3 Demographics
The investigators will ask the respondents to describe themselves as follows
Sex Male Female Non-binary Age 18-35 36-50 51-65 65 RaceEthnicity Black White Asian Native AmericanPacific Islander Hispanic Other Choose all that apply How do you describe your health Excellent Very good Good Fair Poor Do you have health insurance Yes or No What is your highest level of education completed Grade school High School college post-graduate
Analysis The investigators will use descriptive statistics to describe the characteristics of the respondents and the distribution of the WFTP score which is a quasi-continuous measure The investigators will look for outliers defined as scores greater or less than 32 standard deviations from the mean Linearity will be examined with scatterplots The assumption of normality will be assessed by analyzing the skewness and kurtosis of the variables and with use of histograms The investigators expect the WFTP to be normally distributed as it has been in other populations If it is not the investigators will consider log transformation The investigators will describe the respondents by vignette assignment to confirm that randomization was successful
Given the structure of MTurk the investigators will not have a measure of survey response The investigators will however be able to assess the pattern of missing variables across the responses and will incorporate this appropriately into the models
In the validation study by Katz she reports in a national sample the Wake Forest Physician Trust Scale WFPTS had a mean score of 408 SD 62 for the national sample of 959 participants In her study of fewer participants recruited from MTurk the mean score for the WFPTS was 359 SD 612 for young adult participants and 361 SD 611 for older adult participants
The investigators would like to be able to detect a 2 standard deviation SD difference between the lower trust vignettes and the higher trust vignettes If the study has 36 individuals in each group the investigators are able to detect with a power of 08 and an alpha of 05 a difference of 4 points on the WFTP 38 sd 6 vs 42 sd 6 The investigators will aim to have 36 respondents in each of 16 groups
The investigators will test hypotheses about the vignettes and the reported trust in the physician
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None