Evaluating explanations about drug prescriptions: effects of varying the nature of information about side effects and its relative position in explanations

This study evaluates computer-generated written explanations about drug prescriptions that are based on an analysis of both patient and doctor informational needs. Three experiments examine the effects of varying the type of information given about the possible side effects of the medication, and the order of information within the explanation. Experiment 1 investigated the effects of these two factors on people's ratings of how good they consider the explanations to be and of their perceived likelihood of taking the medication, as well as on their memory for the information in the explanation. Experiment 2 further examined the effects of varying information about side effects by separating out the contribution of number and severity of side effects. It was found that participants in this study did not “like” explanations that described severe side effects, and also judged that they would be less likely to take the medication if given such explanations. Experiment 3 therefore investigated whether information about severe side effects could be presented in such a way as to increase judgements of how good explanations are thought to be, as well as the perceived likelihood of adherence. The results showed some benefits of providing additional explanatory information.

Habituation and dishabituation to speech and office noise

The authors examined whether background noise can be habituated to in the laboratory by using memory for prose tasks in 3 experiments. Experiment 1 showed that background speech can be habituated to after 20 min exposure and that meaning and repetition had no effect on the degree of habituation seen. Experiment 2 showed that office noise without speech can also be habituated to. Finally, Experiment 3 showed that a 5-min period of quiet, but not a change in voice, was sufficient to partially restore the disruptive effects of the background noise previously habituated to. These results are interpreted in light of current theories regarding the effects of background noise and habituation; practical implications for office planning are discussed.

What do patients want to know about their medicines, and what do doctors want to tell them?: a comparative study

A two phase study is reported. In the first phase, we asked a number of doctors to rate a list of information categories (identified by Berry, Gillie and Banbury 1995) in terms of how important they felt it was for the items to be included in an explanation to a patient about a drug prescription. In the second phase, we presented a large sample of people with a scenario about visiting their doctor and being prescribed medication, together with an explanation about the prescription which was said to be provided by the doctor. Four different explanations were compared, which were either based on what people in our earlier study wanted to know about drug prescriptions or on what the doctors thought it was important lo tell them. We also manipulated whether or not the explanations conveyed negative information (e.g. about the possible side effects of the medication). The results showed that people 'preferred' the explanations based on what the participants in the earlier study wanted to know about their medicines, rather than those based on what the doctors thought they should be told. They also 'preferred' the explanations that did not convey negative information, rather than those that did convey some negative information. In addition, the inclusion of negative information affected ratings of likely compliance with the prescribed medication.

Implicit learning: Below the subjective threshold?

In this review, we consider three possible criteria by which knowledge might be regarded as implicit or inaccessible: It might be implicit only in the sense that it is difficult to articulate freely, or it might be implicit according to either an objective threshold or a subjective threshold. We evaluate evidence for these criteria in relation to artificial grammar learning, the control of complex systems, and sequence learning, respectively. We argue that the convincing evidence is not yet in, but construing the implicit nature of implicit learning in terms of a subjective threshold is most likely to prove fruitful for future research. Furthermore, the subjective threshold criterion may demarcate qualitatively different types of knowledge. We argue that (1) implicit, rather than explicit, knowledge is often relatively inflexible in transfer to different domains, (2) implicit, rather than explicit, learning occurs when attention is focused on specific items and not underlying rules, and (3) implicit learning and the resulting knowledge are often relatively robust.

Transfer across form and modality in implicit and explicit memory

Three experiments examined transfer across form (words/pictures) and modality (visual/ auditory) in written word, auditory word, and pictorial implicit memory tests, as well as on a free recall task. Experiment 1 showed no significant transfer across form on any of the three implicit memory tests,and an asymmetric pattern of transfer across modality. In contrast, the free recall results revealed a very different picture. Experiment 2 further investigated the asymmetric modality effects obtained for the implicit memory measures by employing articulatory suppression and picture naming to control the generation of phonological codes. Finally, Experiment 3 examined the effects of overt word naming and covert picture labelling on transfer between study and test form. The results of the experiments are discussed in relation to Tulving and Schacter's (1990) Perceptual Representation Systems framework and Roediger's (1990) Transfer Appropriate Processing theory.

Generating recipient-centred explanations about drug prescription

In this paper we describe how we generated written explanations to ‘indirect users’ of a knowledge-based system in the domain of drug prescription. We call ‘indirect users’ the intended recipients of explanations, to distinguish them from the prescriber (the ‘direct’ user) who interacts with the system. The Explanation Generator was designed after several studies about indirect users' information needs and physicians' explanatory attitudes in this domain. It integrates text planning techniques with ATN-based surface generation. A double modeling component enables adapting the information content, order and style to the indirect user to whom explanation is addressed. Several examples of computer-generated texts are provided, and they are contrasted with the physicians' explanations to discuss advantages and limits of the approach adopted.

The effects of different forms of advice on the control of a simulated complex system

Three experiments examine the effect of different forms of computer-generated advice on concurrent and subsequent performance of individuals controlling a simulated intensive-care task. Experiment 1 investigates the effect of optional and compulsory advice and shows that both result in an improvement in subjects' performance while receiving the advice, and also in an improvement in subsequent unaided performance. However, although the advice compliance displayed by the optional advice group shows a strong correlation with subsequent unaided performance, compulsory advice has no extra benefit over the optional use of advice. Experiment 2 examines the effect of providing users with on-line explanations of the advice, as well as providing less specific advice. The results show that both groups perform at the same level on the task as the advice groups from Experiment 1, although subjects receiving explanations scored significantly higher on a written post-task questionnaire. Experiment 3 investigates in more detail the relationship between advice compliance and performance. The results reveal a complex relationship between natural ability on the task and the following of advice, in that people who use the advice more tend to perform either better or worse than the more moderate users. The theoretical and practical implications of these experiments are discussed.

Mediating between hearer's and speaker's views in the generation of adaptive explanations

In this article, we examine the case of a system that cooperates with a “direct” user to plan an activity that some “indirect” user, not interacting with the system, should perform. The specific application we consider is the prescription of drugs. In this case, the direct user is the prescriber and the indirect user is the person who is responsible for performing the therapy. Relevant characteristics of the two users are represented in two user models. Explanation strategies are represented in planning operators whose preconditions encode the cognitive state of the indirect user; this allows tailoring the message to the indirect user's characteristics. Expansion of optional subgoals and selection among candidate operators is made by applying decision criteria represented as metarules, that negotiate between direct and indirect users' views also taking into account the context where explanation is provided. After the message has been generated, the direct user may ask to add or remove some items, or change the message style. The system defends the indirect user's needs as far as possible by mentioning the rationale behind the generated message. If needed, the plan is repaired and the direct user model is revised accordingly, so that the system learns progressively to generate messages suited to the preferences of people with whom it interacts.

Negative correlations between control performance and verbalizable knowledge: indicators for implicit learning in process control tasks?

Negative correlations between task performance in dynamic control tasks and verbalizable knowledge, as assessed by a post-task questionnaire, have been interpreted as dissociations that indicate two antagonistic modes of learning, one being “explicit”, the other “implicit”. This paper views the control tasks as finite-state automata and offers an alternative interpretation of these negative correlations. It is argued that “good controllers” observe fewer different state transitions and, consequently, can answer fewer post-task questions about system transitions than can “bad controllers”. Two experiments demonstrate the validity of the argument by showing the predicted negative relationship between control performance and the number of explored state transitions, and the predicted positive relationship between the number of explored state transitions and questionnaire scores. However, the experiments also elucidate important boundary conditions for the critical effects. We discuss the implications of these findings, and of other problems arising from the process control paradigm, for conclusions about implicit versus explicit learning processes.

What do patients want to know? An empirical approach to explanation generation and validation

This article describes an empirical, user-centred approach to explanation design. It reports three studies that investigate what patients want to know when they have been prescribed medication. The question is asked in the context of the development of a drug prescription system called OPADE. The system is aimed primarily at improving the prescribing behaviour of physicians, but will also produce written explanations for indirect users such as patients. In the first study, a large number of people were presented with a scenario about a visit to the doctor, and were asked to list the questions that they would like to ask the doctor about the prescription. On the basis of the results of the study, a categorization of question types was developed in terms of how frequently particular questions were asked. In the second and third studies a number of different explanations were generated in accordance with this categorization, and a new sample of people were presented with another scenario and were asked to rate the explanations on a number of dimensions. The results showed significant differences between the different explanations. People preferred explanations that included items corresponding to frequently asked questions in study 1. For an explanation to be considered useful, it had to include information about side effects, what the medication does, and any lifestyle changes involved. The implications of the results of the three studies are discussed in terms of the development of OPADE's explanation facility.

Implicit and explicit processes in a second-language learning task

Two experiments examined the learning of a set of Greek pronunciation rules through explicit and implicit modes of rule presentation. Experiment 1 compared the effectiveness of implicit and explicit modes of presentation in two modalities, visual and auditory. Subjects in the explicit or rule group were presented with the rule set, and those in the implicit or natural group were shown a set of Greek words, composed of letters from the rule set, linked to their pronunciations. Subjects learned the Greek words to criterion and were then given a series of tests which aimed to tap different types of knowledge. The results showed an advantage of explicit study of the rules. In addition, an interaction was found between mode of presentation and modality. Explicit instruction was more effective in the visual than in the auditory modality, whereas there was no modality effect for implicit instruction. Experiment 2 examined a possible reason for the advantage of the rule groups by comparing different combinations of explicit and implicit presentation in the study and learning phases. The results suggested that explicit presentation of the rules is only beneficial when it is followed by practice at applying them.

New strings for old : the role of similarity processing in an incidental learning task

This paper reports three experiments that examine the role of similarity processing in McGeorge and Burton's (1990) incidental learning task. In the experiments subjects performed a distractor task involving four-digit number strings, all of which conformed to a simple hidden rule. They were then given a forced-choice memory test in which they were presented with pairs of strings and were led to believe that one string of each pair had appeared in the prior learning phase. Although this was not the case, one string of each pair did conform to the hidden rule. Experiment 1 showed that, as in the McGeorge and Burton study, subjects were significantly more likely to select test strings that conformed to the hidden rule. However, additional analyses suggested that rather than having implicitly abstracted the rule, subjects may have been selecting strings that were in some way similar to those seen during the learning phase. Experiments 2 and 3 were designed to try to separate out effects due to similarity from those due to implicit rule abstraction. It was found that the results were more consistent with a similarity-based model than implicit rule abstraction per se.