BACKGROUND: ChatGPT (OpenAI) is a powerful tool for a wide range of tasks, from entertainment and creativity to health care queries. There are potential risks and benefits associated with this technology. In the discourse concerning the deployment of ChatGPT and similar large language models, it is sensible to recommend their use primarily for tasks a human user can execute accurately. As we transition into the subsequent phase of ChatGPT deployment, establishing realistic performance expectations and understanding users\' perceptions of risk associated with its use are crucial in determining the successful integration of this artificial intelligence (AI) technology.
OBJECTIVE: The aim of the study is to explore how perceived workload, satisfaction, performance expectancy, and risk-benefit perception influence users\' trust in ChatGPT.
METHODS: A semistructured, web-based survey was conducted with 607 adults in the United States who actively use ChatGPT. The survey questions were adapted from constructs used in various models and theories such as the technology acceptance model, the theory of planned behavior, the unified theory of acceptance and use of technology, and research on trust and security in digital environments. To test our hypotheses and structural model, we used the partial least squares structural equation modeling method, a widely used approach for multivariate analysis.
RESULTS: A total of 607 people responded to our survey. A significant portion of the participants held at least a high school diploma (n=204, 33.6%), and the majority had a bachelor\'s degree (n=262, 43.1%). The primary motivations for participants to use ChatGPT were for acquiring information (n=219, 36.1%), amusement (n=203, 33.4%), and addressing problems (n=135, 22.2%). Some participants used it for health-related inquiries (n=44, 7.2%), while a few others (n=6, 1%) used it for miscellaneous activities such as brainstorming, grammar verification, and blog content creation. Our model explained 64.6% of the variance in trust. Our analysis indicated a significant relationship between (1) workload and satisfaction, (2) trust and satisfaction, (3) performance expectations and trust, and (4) risk-benefit perception and trust.
CONCLUSIONS: The findings underscore the importance of ensuring user-friendly design and functionality in AI-based applications to reduce workload and enhance user satisfaction, thereby increasing user trust. Future research should further explore the relationship between risk-benefit perception and trust in the context of AI chatbots.

BACKGROUND: Acute gastroenteritis (AGE) in children is a leading cause of emergency department (ED) visits, resulting in substantial health care costs and stress for families and caregivers. The majority of pediatric AGE cases are caused by viral infections and can be managed at home using strategies to prevent dehydration. To increase knowledge of, and support health decision-making for, pediatric AGE, we developed a knowledge translation (KT) tool (fully automated web-based whiteboard animation video).
OBJECTIVE: The aim of this study was to assess the potential effectiveness of the web-based KT tool in terms of knowledge, health care decision-making, use of resources, and perceived benefit and value.
METHODS: A convenience sample of parents was recruited between December 18, 2020, and August 10, 2021. Parents were recruited in the ED of a pediatric tertiary care hospital and followed for up to 14 days after the ED visit. The eligibility criteria included parent or legal guardian of a child aged <16 years presenting to the ED with an acute episode of diarrhea or vomiting, ability to communicate in English, and agreeable to follow-up via email. Parents were randomized to receive the web-based KT tool (intervention) about AGE or a sham video (control) during their ED visit. The primary outcome was knowledge assessed before the intervention (baseline), immediately after the intervention, and at follow-up 4 to 14 days after ED discharge. Other outcomes included decision regret, health care use, and KT tool usability and satisfaction. The intervention group participants were invited to participate in a semistructured interview to gather additional feedback about the KT tool.
RESULTS: A total of 103 parents (intervention: n=51, 49.5%, and control: n=52, 50.5%) completed the baseline and postintervention assessments. Of these 103 parents, 78 (75.7%; intervention: n=36, 46%, and control: n=42, 54%) completed the follow-up questionnaire. Knowledge scores after the intervention (mean 8.5, SD 2.6 vs mean 6.3, SD 1.7; P<.001) and at follow-up (mean 9.1, SD 2.7 vs mean 6.8, SD 1.6; P<.001) were significantly higher in the intervention group. After the intervention, parents in the intervention group reported greater confidence in knowledge than those in the control group. No significant difference in decision regret was found at any time point. Parents rated the KT tool higher than the sham video across 5 items assessing usability and satisfaction.
CONCLUSIONS: The web-based KT tool improved parental knowledge about AGE and confidence in their knowledge, which are important precursors to behavior change. Further research is needed into understanding what information and delivery format as well as other factors influence parents\' decision-making regarding their child\'s health.
BACKGROUND: ClinicalTrials.gov NCT03234777; https://clinicaltrials.gov/ct2/show/NCT03234777.
UNASSIGNED: RR2-10.1186/s40814-018-0318-0.

Inadequate consideration has been given to patient preferences for patient-centered care (PCC) across countries or cultures in our increasingly global society. We examined what 1,698 participants from the United States, Hong Kong, Philippines, and Australia described as important when making health care decisions. Analysis of frequencies following directed content coding of open-ended questions revealed differences in patients\' preferences for doctor behaviors and decision-making considerations across countries. Being well informed by their doctor emerged as most important in decision-making, especially in Hong Kong. Participants in Australia and the United States wanted their doctor to meet their emotional needs. The safety and efficacy of treatments were the most common consideration, especially for Hong Kong. Findings suggest that doctors should focus on information exchange and identifying patient concerns about efficacy, lifestyle impact, cost, and recovery speed. Rather than assuming patients prefer shared decision-making, doctors must assess patient\'s decision control preferences.

Real-world data (RWD) collected in routine health care processes and transformed to real-world evidence have become increasingly interesting within the research and medical communities to enhance medical research and support regulatory decision-making. Despite numerous European initiatives, there is still no cross-border consensus or guideline determining which qualities RWD must meet in order to be acceptable for decision-making within regulatory or routine clinical decision support. In the absence of guidelines defining the quality standards for RWD, an overview and first recommendations for quality criteria for RWD in pharmaceutical research and health care decision-making is needed in Austria. An Austrian multistakeholder expert group led by Gesellschaft für Pharmazeutische Medizin (Austrian Society for Pharmaceutical Medicine) met regularly; reviewed and discussed guidelines, frameworks, use cases, or viewpoints; and agreed unanimously on a set of quality criteria for RWD. This consensus statement was derived from the quality criteria for RWD to be used more effectively for medical research purposes beyond the registry-based studies discussed in the European Medicines Agency guideline for registry-based studies. This paper summarizes the recommendations for the quality criteria of RWD, which represents a minimum set of requirements. In order to future-proof registry-based studies, RWD should follow high-quality standards and be subjected to the quality assurance measures needed to underpin data quality. Furthermore, specific RWD quality aspects for individual use cases (eg, medical or pharmacoeconomic research), market authorization processes, or postmarket authorization phases have yet to be elaborated.

The impression of bioethicists as \"dangerous,\" as articulated in Mouth Magazine in 1994, has continued to be a theme in the disability movement. We respond to three common responses by bioethicists to this impression-namely, this is from the past, and bioethicists are different now; this is an angry and extremist position; and the Americans with Disabilities Act and other disability rights and justice efforts have solved historical inequities. We draw on the historical record and on our collective experiences as bioethicists engaged in clinical consultation and education and as the founding, former, and current directors of a program focused on disability and rehabilitation ethics to argue that ableism and unexamined assumptions about people with disabilities have persisted in bioethics despite decades of counternarratives, research, and divergent perspectives. Ableism and such assumptions can lead to health care decisions that are prone to bias, mistreatment, and a lack of consideration of viable options for living with disability. As the field of bioethics moves toward certification examinations and as new generations join the field\'s ranks, these problems need to be rectified with solutions at the individual, interpersonal, and structural levels. It is past time to take disability seriously.

BACKGROUND: Health care coverage decisions deal with health care technology provision or reimbursement at a national level. The coverage decision report, i.e., the publicly available document giving reasons for the decision, may contain various elements: quantitative calculations like cost and clinical effectiveness analyses and formalised and non-formalised qualitative considerations. We know little about the process of combining these heterogeneous elements into robust decisions.
METHODS: This study describes a model for combining different elements in coverage decisions. We build on two qualitative cases of coverage appraisals at the Dutch National Health Care Institute, for which we analysed observations at committee meetings (n = 2, with field notes taken) and the corresponding audio files (n = 3), interviews with appraisal committee members (n = 10 in seven interviews) and with Institute employees (n = 5 in three interviews), and relevant documents (n = 4).
RESULTS: We conceptualise decisions as combinations of elements, specifically (quantitative) findings and (qualitative) arguments and values. Our model contains three steps: 1) identifying elements; 2) designing the combinations of elements, which entails articulating links, broadening the scope of designed combinations, and black-boxing links; and 3) testing these combinations and choosing one as the final decision.
CONCLUSIONS: Based on the proposed model, we suggest actively identifying a wider variety of elements and stepping up in terms of engaging patients and the public, including facilitating appeals. Future research could explore how different actors perceive the robustness of decisions and how this relates to their perceived legitimacy.

The involvement of lay people in health care decision-making processes is now the norm in many countries. However, one important aspect of participation has not received sufficient attention in the past and remains underexplored: representation.
This paper explores the question of how public participation efforts in collective health care decision-making processes can attempt to aim for legitimate representation so that those individuals or groups not present can be taken into account in the decisions affecting them. This paper argues that to make decisions that effectively address those affected, representation needs to be seen as a relevant part of any participatory setting. To support this argument, the paper outlines the concepts of participation and representation and transfers them to health care contexts.
A conceptual reflection on responsiveness and the characteristics of representative actors in representative-participatory settings is introduced, which could provide actors planning to conduct participatory health care projects with tools to reflect on the merits and possible flaws of participatory constellations.
The paper contributes to improving public participation in health care decision-making.

BACKGROUND: Involving patients and citizens in health care decision-making is considered increasingly important in Germany. Participatory structures have been implemented, especially in rehabilitative care. However, it is unknown whether and to what extent German patients and citizens want to participate in decisions that exceed their own medical treatment.
OBJECTIVE: This study aimed to survey participation preferences and associated factors of health service users in decisions regarding rehabilitative care at micro, meso and macro levels.
METHODS: A questionnaire was sent to 3872 former rehabilitants. We collected participation preferences using the Control Preference Scale or an adapted form. Possible influencing factors were examined using logistic regression models.
RESULTS: The response rate was 5.7% (n = 217). At all decision-making levels, joint decision-making was preferred. At the macro level, preferences for actively participating were the highest. Preferences were significantly interrelated between decision-making levels. At the micro level, an orthopaedic indication significantly decreased the desire for participation compared to psychosomatic indications (odds ratio = 0.44, p = .019).
CONCLUSIONS: Participants wanted to be equally involved in decision-making as experts. Higher preferences for active participation at the macro level might be due to dissatisfaction with the current health care organisation and lack of trust in politicians. Compared to the general public, our study sample was older (73.3% between 50 and 69 years) and more often chronically ill-factors associated with increased participation preferences in the literature.
CONCLUSIONS: Contrary to the identified preferences, participation opportunities in the German health care system are rare. Further research on participation preferences and structures that enable meaningful involvement are needed.

Childhood stunting remains a global public health concern. Little has been documented on the effect of women\'s decision-making autonomy on child growth in settings where decision-making at the household and community levels is largely dominated by men. To assess the relationship between maternal autonomy and child growth, we analysed data from a cross-sectional study of 422 mothers and their youngest child aged 6-24 months in the Bawku West District of Ghana. The dimensions of women\'s autonomy measured were decision-making power, freedom of mobility and financial autonomy. We then compared how each dimension was associated with the likelihood of stunting and wasting. The important predictors of child growth and dietary intake as measured by the mean length-for-age Z-score (LAZ) and minimum acceptable (MAD) diet, respectively, were determined using multivariable regression models. The overall composite index of women autonomy (CIWA) showed that 52⋅8 % of women were of high autonomy and half of them had higher autonomy regarding their own and their children\'s health. After adjusting (multiple regression analysis) for potential confounders, the mean LAZ of children born to women of high autonomy was significantly higher than LAZ of children born to women of low autonomy (β = 0⋅132; 95 % CI 0⋅19, 0⋅95; P = 0⋅004). Similarly, high women\'s autonomy was a significant independent predictor of meeting MAD (AOR = 1⋅59; CI 1⋅09, 2⋅34). Of all, the dimensions of women\'s autonomy measured in this study, health care autonomy better predicted child growth and dietary intake. Based on the findings, nutrition policies and interventions that enhance women\'s decision-making autonomy could have a positive impact on child growth outcomes.

Health care coverage decisions may employ many different considerations, which are brought together across two phases. The assessment phase examines the available scientific evidence, such as the cost-effectiveness, of the technology. The appraisal then contextualises this evidence to arrive at an (advised) coverage decision, but little is known about how this is done.In the Netherlands, the appraisal is set up to achieve a societal weighing and is the primary place where need- and solidarity-related (\'necessity\') argumentations are used. To elucidate how the Dutch appraisal committee \'constructs necessity\', we analysed observations and recordings of two appraisal committee meetings at the National Health Care Institute, the corresponding documents (five), and interviews with committee members and policy makers (13 interviewees in 12 interviews), with attention to specific necessity argumentations.The Dutch appraisal committee constructs necessity in four phases: (1) allowing explicit criteria to steer the process; (2) allowing patient (representative) contributions to challenge the process; (3) bringing new argumentations in from outside and weaving them together; and (4) formulating recommendations to societal stakeholders. We argue that in these ways, the appraisal committee achieves societal weighing rationality, as the committee actively uses argumentations from society and embeds the decision outcome in society.