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Head and neck cancer is a potentially traumatizing disease with the potential to impact many of the functions which are core to human life: eating, drinking, breathing, and speaking. Patients with head and neck cancer are disproportionately impacted by socioeconomic challenges, social stigma, and difficult decisions about treatment approaches. Herein, the authors review foundational ethical principles and frameworks to guide care of these patients. The authors discuss specific challenges including shared decision-making and advance care planning. The authors further discuss palliative care with a discussion of the role of surgery as a component of palliation.

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BACKGROUND: Data dashboards are published tools that present visualizations; they are increasingly used to display data about behavioral health, social determinants of health, and chronic and infectious disease risks to inform or support public health endeavors. Dashboards can be an evidence-based approach used by communities to influence decision-making in health care for specific populations. Despite widespread use, evidence on how to best design and use dashboards in the public health realm is limited. There is also a notable dearth of studies that examine and document the complexity and heterogeneity of dashboards in community settings. OBJECTIVE: Community stakeholders engaged in the community response to the opioid overdose crisis could benefit from the use of data dashboards for decision-making. As part of the Communities That HEAL (CTH) intervention, community data dashboards were created for stakeholders to support decision-making. We assessed stakeholders' perceptions of the usability and use of the CTH dashboards for decision-making. METHODS: We conducted a mixed methods assessment between June and July 2021 on the use of CTH dashboards. We administered the System Usability Scale (SUS) and conducted semistructured group interviews with users in 33 communities across 4 states of the United States. The SUS comprises 10 five-point Likert-scale questions measuring usability, each scored from 0 to 4. The interview guides were informed by the technology adoption model (TAM) and focused on perceived usefulness, perceived ease of use, intention to use, and contextual factors. RESULTS: Overall, 62 users of the CTH dashboards completed the SUS and interviews. SUS scores (grand mean 73, SD 4.6) indicated that CTH dashboards were within the acceptable range for usability. From the qualitative interview data, we inductively created subthemes within the 4 dimensions of the TAM to contextualize stakeholders' perceptions of the dashboard's usefulness and ease of use, their intention to use, and contextual factors. These data also highlighted gaps in knowledge, design, and use, which could help focus efforts to improve the use and comprehension of dashboards by stakeholders. CONCLUSIONS: We present a set of prioritized gaps identified by our national group and list a set of lessons learned for improved data dashboard design and use for community stakeholders. Findings from our novel application of both the SUS and TAM provide insights and highlight important gaps and lessons learned to inform the design of data dashboards for use by decision-making community stakeholders. TRIAL REGISTRATION: ClinicalTrials.gov NCT04111939; https://clinicaltrials.gov/study/NCT04111939.

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BACKGROUND: Tractors and quad bikes pose a significant risk of fatal injuries among farmers, particularly affecting older farmers. This study aimed to explore the barriers and facilitators to the adoption of machine related safety behaviors among older farmers in Irish farm settings. METHOD: Four focus groups were conducted via Zoom in February 2021. Nineteen Irish farmers from four farm types participated. The discussions were audio-recorded, transcribed verbatim, and analyzed using an inductive, reflexive thematic analysis approach. The themes identified were then mapped to the COM-B (Capability-Opportunity-Motivation) model, providing a systematic theoretical basis for designing a future intervention to reduce machine-related accidents. RESULTS: The analysis identified five inductive themes that encompassed both barriers and facilitators in farm safety practices: (1) Capability to manage competing responsibilities; (2) Characteristics of the farm and its work environment; (3) Availability and affordability of resources; (4) Prevailing sociocultural opportunities; and (5) Perceived likelihood and cost-benefit analysis in safety decision-making. These themes captured the complex interplay of capability, opportunity, and motivation in farmers' decision-making processes. The study also revealed limitations in existing interventions, such as voluntary guidelines and educational methods, in effectively addressing these barriers. CONCLUSIONS: Farmers' abilities (capability), prevailing sociocultural factors, resource availability (opportunity), and their perceived consequences and benefits (motivation) affect how safely they work with machines. The study emphasizes the need for comprehensive, theory-driven approaches that consider the interplay of capability, opportunity, and motivational factors that may support or impede machine safety. Understanding the challenges faced by Irish farmers highlights potential strategies for safety intervention, and these strategies should be co-designed with farmers and attentive to the local context. PRACTICAL APPLICATIONS: The study provides a template for understanding farmers' perspectives using the COM-B model. The findings can inform the development of theoretically informed intervention strategies based on the Behavior Change Wheel framework.

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RESEARCH QUESTION: From the perspectives of healthcare professionals (HCPs) and people with chronic obstructive pulmonary disease (COPD) known to tertiary care, what influences successful referrals to a pulmonary rehabilitation program (PRP)? METHODS: This cross-sectional qualitative study was informed by a critical realist perspective. We purposively sampled people with COPD and HCPs who deliver COPD care and used semi-structured interviews and focus groups to explore determinants of a successful referral to a PRP. Interviews were recorded, transcribed verbatim and analysed using reflexive thematic analysis. RESULTS: Data were available on 38 HCPs and 15 people with COPD. We generated three core themes pertaining to successful referrals. The first theme was that HCPs should be mindful of how professional responsibilities (such as their personal value and interest in a PRP, their degree of understanding of PRPs, and the organisational culture the PRPs are embedded within) shape decision-making during a therapeutic interaction. The second theme, there's more to me than my COPD, characterised psychological perceptions that shape a person's readiness to engage in a PRP. The third theme, communication is a two-way street that requires careful navigation, characterised the interpersonal dynamic between HCP and patient, and how dedicated conversations about PRPs can encourage successful referrals. CONCLUSION: Therapeutic interactions that include dedicated conversations about PRPs can foster successful referrals among people with COPD. During these interactions, HCPs should take the time to understand and carefully unpack psychological perceptions whilst imparting value, interest and enthusiasm for PRPs. Doing so can shape patient engagement toward referral success.

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A workhorse tool of economic decision-making has long sought to get inside people's heads through careful examination of their choices. In this issue of Neuron, Carandini1 flips the script, showing how it can model how the brain makes sensory choices.

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In-season management of anterior shoulder instability in athletes is a complex problem. Athletes often wish to play through their current season, though recurrent instability rates are high, particularly in contact sports. Athletes are generally considered safe to return to play when they are relatively pain-free, and their strength and range of motion match the uninjured extremity. If an athlete is unable to progress toward recovering strength and range of motion, surgical management is an option, though this is often a season-ending decision.

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OBJECTIVE: This study investigated women living with HIV/AIDS (WLHA)'s practices and decision-making regarding disclosure of HIV status in healthcare settings in Vietnam. Introduction: Disclosure of HIV status in healthcare settings is under-studied. METHODS: We conducted in-depth interviews with 30 WLHA in Hanoi, Vietnam. Thematic analysis was conducted to investigate the patterns, considerations, and consequences of HIV disclosure. Results: Most participants chose a selective disclosure strategy based on the type of procedure and healthcare setting. They considered several factors: concerns about stigma/discrimination, risks of confidentiality breach, relevance to healthcare provision, and altruism towards protecting providers and other patients. Selective disclosure or non-disclosure often prevented participants from accessing comprehensive care. Conclusion: The study underscores the need to prepare WLHA to make informed decisions regarding disclosure and provide them with service navigations and support. It also highlights the necessity of reducing stigma and enhancing confidentiality protection to ensure safe disclosure in healthcare settings.

Telling Healthcare Providers About HIV Status: How Women with HIV/AIDS in Vietnam Decide and What They ConsiderThis study focuses on how women living with HIV/AIDS in Vietnam decide to share their HIV status with healthcare providers. We interviewed 30 women with HIV/AIDS in Vietnam and found that many choose to reveal their status only in certain situations, depending on the medical procedure and the setting. They weigh various factors before deciding to disclose, including the risk of facing stigma, the need to protect their privacy, how relevant their HIV status is to their other health issues, their wish to protect their healthcare providers and other patients, and how they have been advised by HIV specialists. Unfortunately, choosing not to disclose their status sometimes stops them from getting the full range of medical care they need. The findings stress the importance of helping these women make well-informed choices about disclosing their HIV status. We also need to provide them with additional support and navigational help through healthcare services. Moreover, reducing stigma in healthcare, enhancing providers' ability to gather necessary health information, and ensuring patient privacy are crucial to encouraging more open discussions of HIV status in medical settings.

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Theoretical computational models are widely used to describe latent cognitive processes. However, these models do not equally explain data across participants, with some individuals showing a bigger predictive gap than others. In the current study, we examined the use of theory-independent models, specifically recurrent neural networks (RNNs), to classify the source of a predictive gap in the observed data of a single individual. This approach aims to identify whether the low predictability of behavioral data is mainly due to noisy decision-making or misspecification of the theoretical model. First, we used computer simulation in the context of reinforcement learning to demonstrate that RNNs can be used to identify model misspecification in simulated agents with varying degrees of behavioral noise. Specifically, both prediction performance and the number of RNN training epochs (i.e., the point of early stopping) can be used to estimate the amount of stochasticity in the data. Second, we applied our approach to an empirical dataset where the actions of low IQ participants, compared with high IQ participants, showed lower predictability by a well-known theoretical model (i.e., Daw's hybrid model for the two-step task). Both the predictive gap and the point of early stopping of the RNN suggested that model misspecification is similar across individuals. This led us to a provisional conclusion that low IQ subjects are mostly noisier compared to their high IQ peers, rather than being more misspecified by the theoretical model. We discuss the implications and limitations of this approach, considering the growing literature in both theoretical and data-driven computational modeling in decision-making science.

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BACKGROUND: Parents of neonates with life-threatening conditions and professionals, bear the burden of making complex decisions. Parents may not be fully involved in decision-making, and there is a paucity of evidence regarding the influence of social context on parents' participation. We aimed to explore factors that extended beyond the healthcare system and impacted parents' participation in decision-making for neonates with life-threatening conditions. MATERIALS AND METHODS: This qualitative research was carried out in 2019 in four level-III Iranian NICUs, (neonatal intensive care units) where twenty-three face-to-face semi-structured interviews were conducted, transcribed, and analyzed using a conventional content analysis technique. Interviews were condensed into meaningful units during the coding phase, resulting in 206 open codes. These codes were then categorized into eleven categories based on commonalities and distinctions. This iterative process continued until 4 main subcategories were established. RESULTS: The main categories and sub-categories were "unmodified regulations according to the neonatology advances" (lack of regulations to modify ineffective treatments, lack of a legally documented do not resuscitate order, lack of a defined regional neonatal viability threshold, and lack of maternal guardianship of child medical care), "deficiencies of the health insurance system" (covering the cost of ineffective treatments and lack of insurance covering for palliative care services), "treatment-oriented culture in society" (expecting a miracle for medical science, difficult acceptance of neonatal death and difficult acceptance of home death), and "physician-oriented culture in society" (excessive respect for physicians' decision-making eligibility and social position of physicians). CONCLUSION: The findings revealed concepts surrounding parents' participation in decision-making for life-threatening conditions neonates are influenced by social, legal, cultural, and financial aspects. To bridge the gap between healthcare professionals' attitudes and cultural and religious beliefs, fatwas, and laws, a collaborative approach is necessary. To address the complex challenges of decision-making for these neonates, involving stakeholders like clinicians, legal experts, Islamic scholars, sociologists, jurists, judges, and medical ethicists is crucial for modifying laws to align with neonatology advancements.

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BACKGROUND: Deprescribing has been defined as the planned process of reducing or stopping medications that may no longer be beneficial or are causing harm, with the goal of reducing medication burden while improving patient quality of life. At present, little is known about the specific challenges of decision-making to support deprescribing for patients who are accessing palliative care. By exploring the perspectives of healthcare professionals, this qualitative study aimed to address this gap, and explore the challenges of, and potential solutions to, making decisions about deprescribing in a palliative care context. METHODS: Semi-structured interviews were conducted with healthcare professionals in-person or via video call, between August 2022 - January 2023. Perspectives on approaches to deprescribing in palliative care; when and how they might deprescribe; and the role of carers and family members within this process were discussed. Interviews were audio-recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes. QSR NVivo (Version 12) facilitated data management. Ethical approval was obtained from the NHS Health Research Authority (ref 305394). RESULTS: Twenty healthcare professionals were interviewed, including: medical consultants, nurses, specialist pharmacists, and general practitioners (GPs). Participants described the importance of deprescribing decision-making, and that it should be a considered, proactive, and planned process. Three themes were developed from the data, which centred on: (1) professional attitudes, competency and responsibility towards deprescribing; (2) changing the culture of deprescribing; and (3) involving the patient and family/caregivers in deprescribing decision-making. CONCLUSIONS: This study sought to explore the perspectives of healthcare professionals with responsibility for making deprescribing decisions with people accessing palliative care services. A range of healthcare professionals identified the importance of supporting decision-making in deprescribing, so it becomes a proactive process within a patient's care journey, rather than a reactive consequence. Future work should explore how healthcare professionals, patients and their family can be supported in the shared decision-making processes of deprescribing. TRIAL REGISTRATION: Ethical approval was obtained from the NHS Health Research Authority (ref 305394).

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BACKGROUND: Algorithmic decision-making (ADM) utilises algorithms to collect and process data and develop models to make or support decisions. Advances in artificial intelligence (AI) have led to the development of support systems that can be superior to medical professionals without AI support in certain tasks. However, whether patients can benefit from this remains unclear. The aim of this systematic review is to assess the current evidence on patient-relevant benefits and harms, such as improved survival rates and reduced treatment-related complications, when healthcare professionals use ADM systems (developed using or working with AI) compared to healthcare professionals without AI-related ADM (standard care)-regardless of the clinical issues. METHODS: Following the PRISMA statement, MEDLINE and PubMed (via PubMed), Embase (via Elsevier) and IEEE Xplore will be searched using English free text terms in title/abstract, Medical Subject Headings (MeSH) terms and Embase Subject Headings (Emtree fields). Additional studies will be identified by contacting authors of included studies and through reference lists of included studies. Grey literature searches will be conducted in Google Scholar. Risk of bias will be assessed by using Cochrane's RoB 2 for randomised trials and ROBINS-I for non-randomised trials. Transparent reporting of the included studies will be assessed using the CONSORT-AI extension statement. Two researchers will screen, assess and extract from the studies independently, with a third in case of conflicts that cannot be resolved by discussion. DISCUSSION: It is expected that there will be a substantial shortage of suitable studies that compare healthcare professionals with and without ADM systems concerning patient-relevant endpoints. This can be attributed to the prioritisation of technical quality criteria and, in some cases, clinical parameters over patient-relevant endpoints in the development of study designs. Furthermore, it is anticipated that a significant portion of the identified studies will exhibit relatively poor methodological quality and provide only limited generalisable results. SYSTEMATIC REVIEW REGISTRATION: This study is registered within PROSPERO (CRD42023412156).

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BACKGROUND: Breast cancer is the second most commonly diagnosed cancer worldwide, with a high mortality rate in developing countries, including sub-Saharan Africa. Screening is one way to ensure early detection and management of breast cancer, and it is influenced by several factors. Education and socio-economic status may also affect the utilization of breast cancer screening services as these impact decision-making. This study aimed to investigate women's empowerment and its influence on the uptake of breast cancer screening among women in Tanzania. METHODS: This study utilized the 2022 Tanzania Demographic and Health Survey data, and included 4216 women aged 20 to 49 years. Women empowerment variables used include social independence, decision-making, ownership of assets, and attitude towards violence. Statistical Package for Social Sciences version 26 was used for data cleaning and analysis. Descriptive statistics and bivariate analysis were done, including a multivariate logistic regression to assess the level of association between independent variables with breast cancer screening. RESULTS: Findings indicate that the prevalence of breast cancer screening is 5.2%. Age, education level, literacy, ownership of assets, attitude towards violence, and decision making are associated with ever going for breast cancer screening. Women aged 45 to 49 years (AOR = 6.28, 95% CI = 6.27-6.28), those with secondary or higher education (AOR 1.1, 95% CI = 1.05-1.06), literate women (AOR = 1.13, 95% CI = 1.13-1.13), those who own a house (AOR = 3.08, 95% CI = 3.08-3.09), who jointly decide on their healthcare with partners on healthcare (AOR = 1.18, 95% CI = 1.18-1.19) had significantly higher odds of going for breast cancer screening. CONCLUSION: Women's empowerment is significantly associated with the likelihood of engaging in breast cancer screening. Empowered women are more likely to undergo screening. Focus should be on empowering women through education, businesses, and community involvement. Country-specific interventions and breast cancer screening awareness campaigns should include empowerment initiatives to promote screening uptake.

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Safety culture is a critical determinant of organisational performance, particularly in high-risk industries especially in oil and gas. Understanding stakeholder preferences is essential for developing effective strategies that enhance safety culture. This study utilised the Analytic Hierarchy Process (AHP) to prioritise stakeholder preferences, identifying key elements of safety culture in Malaysia's oil and gas sector. This study employed a structured methodology to evaluate safety culture within the oil and gas industry, focusing on 18 sub-elements across three key domains: psychological, behavioural, and situational factors. A diverse sample of industry experts was recruited using purposeful and snowball sampling to ensure a comprehensive representation of stakeholder views. The AHP framework was applied to analyse the data, utilizing structured questionnaires and multicriteria decision-making techniques to prioritize the identified safety culture elements. The AHP analysis identified distinct priorities among different professional groups within the oil and gas sector. Safety and Health Practitioners emphasized practical elements such as safety rules and management commitment, while academicians prioritized knowledge and training. Management personnel highlighted the importance of safety ownership and communication, whereas policymakers focused on broader, policy-oriented aspects. The findings suggest that safety culture improvement initiatives should be tailored to address the specific needs and priorities of each professional group. A nuanced understanding of stakeholder preferences is crucial for developing comprehensive strategies that integrate observable behaviours, situational conditions, and psychological factors, ultimately fostering a robust safety culture in the oil and gas industry.

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In a world characterised by data deserts and data swamps, translating evidence into actionable policies and practices is not easy. This article addresses this challenge through the lens of evidence emerging from the Global Burden of Animal Diseases (GBADs) initiative. It emphasises the need for an intentional approach that connects research information with the specific needs of decision-makers and identifies specific impact pathways associated with different groups of decision-makers. The GBADs programme aims to support animal health decisions, and the authors outline the diverse landscape of decision-makers in this field, encompassing the public and private sectors, livestock keepers, civil society and international development agencies. Key issues such as disease prioritisation and lobbying are also discussed. The authors propose an â€Ëœevidence ecosystem'approach, one that understands data users and their interactions, for analysing the needs of decision-makers, and framing GBADs offerings according to these needs. Two case studies, a recently concluded global case study of disease prioritisation decision-making and an ongoing policy analysis and needs assessment for GBADs in Indonesia, are presented to demonstrate how evidence ecosystem analysis and audience segmentation could be used to tailor GBADs information offerings for different decision-making groups. The article concludes by recommending that GBADs'future applications prioritise information offerings, adapt them to decision-makers'needs and consider how different segments of decision-makers will utilise the information to achieve real-world impacts.

Dans un monde où l'on rencontre aussi bien des déserts de données que des marécages de données, il n'est guère facile d'utiliser avec succès des données probantes pour les traduire en politiques et en pratiques exploitables. Les auteurs abordent cette difficulté dans l'optique des données actuellement générées dans le cadre de l'initiative " Impact mondial des maladies animales " (GBADs). Ils soulignent l'importance de disposer d'une méthode volontariste capable de relier l'information issue de la recherche avec les besoins spécifiques des décideurs, en tenant compte des chemins d'impact spécifiques associés à chaque catégorie de décideurs. Le programme GBADs vise à soutenir les décisions relatives à la santé animale ; les auteurs donnent une vue d'ensemble de la diversité des décideurs intervenant dans ce domaine, qui recouvre les secteurs public et privé, les éleveurs, la société civile et les organismes internationaux de développement. Certaines questions majeures comme le classement des maladies par ordre de priorité et les activités des groupes de pression sont également abordées. Afin de pouvoir analyser les besoins de ces décideurs et d'encadrer les propositions du GBADs en conséquence, les auteurs proposent une approche qualifiée d'" écosystème d'éléments probants ", qui permet de comprendre les utilisateurs de données et leurs interactions. À travers deux études de cas, l'une récemment achevée sur l'établissement des priorités sanitaires dans les prises de décision à l'échelle mondiale et l'autre actuellement en cours sur l'analyse des politiques et l'évaluation des besoins dans le cadre du GBADs en Indonésie, les auteurs démontrent comment l'analyse de l'écosystème d'éléments probants et la segmentation des destinataires permettent de moduler les informations proposées par le GBADs en fonction des différents groupes de décideurs auxquels elle sont destinées. Les auteurs concluent en recommandant que les applications futures du GBADs établissent des priorités parmi les informations proposées, en les adaptant aux besoins des décideurs et en considérant le nombre de segments différents de décideurs qui vont utiliser l'information en vue de résultats tangibles.

En un mundo caracterizado por los desiertos y los pantanos de datos, no es una misión fácil traducir los datos en políticas y prácticas viables. Este artículo aborda este reto desde la óptica de los datos procedentes de la iniciativa sobre el impacto global de las enfermedades animales (GBADs). Asimismo, subraya la necesidad de un planteamiento intencionado que conecte la información de las investigaciones con las necesidades específicas de los responsables de la toma de decisiones e identifique vías de impacto concretas asociadas a los distintos grupos de decisores. El programa del GBADs busca respaldar las decisiones en materia de sanidad animal y, a este respecto, los autores del artículo describen la diversidad de responsables de la toma de decisiones en dicho ámbito, entre los que figuran los sectores público y privado, los ganaderos, la sociedad civil y los organismos internacionales de desarrollo. También se abordan cuestiones clave como la priorización de enfermedades y los grupos de presión. Los autores proponen un enfoque basado en un "ecosistema de datos" que tenga en cuenta a los usuarios de los datos y sus interacciones a fin de analizar las necesidades de los responsables de la toma de decisiones y enmarcar los servicios del GBADs en función de dichas necesidades. Se presentan dos estudios de casos, uno mundial sobre la toma de decisiones en materia de priorización de enfermedades, que concluyó recientemente, y otro en curso sobre análisis de políticas y evaluación de necesidades del GBADs en Indonesia, con miras a demostrar cómo el análisis del ecosistema de datos y la segmentación de la audiencia podrían utilizarse para adaptar los servicios de información del GBADs a los distintos grupos de responsables de la toma de decisiones. El artículo concluye recomendando que las futuras aplicaciones del GBADs prioricen los servicios de información, los adapten a las necesidades de los responsables de la toma de decisiones y tengan en cuenta cómo utilizarán la información los distintos grupos de responsables para lograr repercusiones en el mundo real.

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Background Social media platforms, especially Facebook and WhatsApp, can spread public health information effectively. We aimed to estimate the influence of health-related messages circulated through these social media platforms on health-related decision-making and its associated factors. Methods We did a cross-sectional analytical study among adults (aged >18 years) who visited the outpatient department of a tertiary care hospital in suburban West Bengal, during July-September 2021. A structured questionnaire was used regarding receiving health-related messages on social media and the subsequent effect on health-related decision-making in the past year. Results A total of 673 individuals participated in the study. Their mean (SD) age was 34.4 (10.2) years and 56.8% (382) were men, 50.8% (342) were graduates, 63.6% (428) were from rural areas and 82.9% (558) were active users of more than one social media platform. A total of 474 (70.4%; 95% CI 67.0-73.9) study participants reported health-related decision-making based on social media messages, whereas 44.7% (301) reported checking the authenticity of forwarded messages or posts or updates with healthcare professionals before making a decision. On adjusted analysis, participants who had secondary education (adjusted prevalence ratio [aPR] 1.40; 95% CI 1.01-1.94), used both the media (aPR 1.31; 95% CI 1.09-1.58) and checked the authenticity of the messages with a healthcare professional (aPR 1.52, 95% CI 1.38-1.68) were significantly more influenced by the messages, posts or updates received on social media platforms. Conclusion WhatsApp forwards or updates and Facebook posts or updates influence health-related decision-making among the Indian adult population.

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Recipient financial need is a crucial factor in donation decisions. This study proposes a novel model for determining financial donations, incorporating consumption levels of both donor and recipient within a societal context. Solving our model's utility maximization problem reveals how consumption, donation, and savings are interlinked. Empirical evidence reinforces these findings, aligning with prior research and showing that larger consumption gaps between donors and recipients lead to increased donations. Our findings point towards an inherent altruistic motivation in donation, where elevating the recipient's well-being ultimately enhances the donor's own utility. This reinforces the notion that consideration of the recipient's financial hardship, as reflected by their consumption patterns, is crucial when making donation decisions. Shifting beyond traditional models, this study introduces a groundbreaking approach to financial donations. Our novel model factors in consumption levels of both the donor and recipient, along with the broader societal context, using utility maximization to unravel the intertwined decisions of consumption, donation, and savings. Real-world data validates our model, confirming known donation factors and revealing a key finding: larger disparities in consumption lead to increased giving, suggesting an altruistic drive where helping others boosts personal satisfaction.

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INTRODUCTION: Women living in rural areas are more likely to be diagnosed with advanced-stage breast cancer than their urban counterparts. The advanced stage at diagnosis is potentially attributable to lower rates of mammogram screening. We aimed to elucidate factors affecting women in decision-making about mammogram screening in a rural area in Wisconsin served by a critical access hospital. METHODS: We conducted an observational cross-sectional mixed-methods study, collecting data from various sources using 3 methods. Virtual interviews with hospital staff, virtual focus groups with community members, and a survey of women 40 years and older occurred from September 2021 through February 2022. Qualitative data were organized into themes of facilitators and barriers to mammogram screening. Survey responses were reported descriptively. FINDINGS: Eleven hospital staff interviewed and 21 community members who joined 1 of 3 virtual focus groups voiced similar perceptions of facilitators and barriers to mammogram screening. Clinician recommendation was among facilitators, while insurance concerns were the primary barrier. Among survey respondents (N = 282), mean age was 58.7, 98% self-identified as White, and 91% saw a health care provider in the past year. Top reasons for having their first mammogram were doctor recommendation (70%), family history (19%), and personal decision (18%). Top reasons they did not have a mammogram screening at least every year were putting it off (23%), lack of problems (17%), and pandemic-related reasons (15%). CONCLUSIONS: Improving patient education and supporting clinicians to deliver screening recommendations may increase appropriate screening. Future studies should focus on reaching women not engaged with the health system.

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