Paradigmatic Approach to Support Personalized Counseling With Digital Health (iKNOW).

iKNOW is the first evidence-based digital tool to support personalized counseling for women in Germany with a hereditary cancer risk. The counseling tool is designed for carriers of pathogenic gBRCA (germline breast cancer gene) variants that increase the lifetime risk of breast and ovarian cancer. Carriers of pathogenic variants are confronted with complex, individualized risk information, and physicians must be able to convey this information in a comprehensible way to enable preference-sensitive health decisions. In this paper, we elaborate on the clinical, regulatory, and practical premises of personalized counseling in Germany. By operationalizing these premises, we formulate 5 design principles that, we suggest, are specific enough to develop a digital tool (eg, iKNOW), yet wide-ranging enough to inform the development of counseling tools for personalized medicine more generally: (1) digital counseling tools should implement the current standard of care (eg, based on guidelines); (2) digital counseling tools should help to both standardize and personalize the counseling process (eg, by enabling the preference-sensitive selection of counseling contents from a common information base); (3) digital counseling tools should make complex information easy to access both cognitively (eg, by using evidenced-based risk communication formats) and technically (eg, by means of responsive design for various devices); (4) digital counseling tools should respect the counselee's data privacy rights (eg, through strict pseudonymization and opt-in consent); and (5) digital counseling tools should be systematically and iteratively evaluated with the users in mind (eg, using formative prototype testing to ensure a user-centric design and a summative multicenter, randomized controlled trial). On the basis of these paradigmatic design principles, we hope that iKNOW can serve as a blueprint for the development of more digital innovations to support personalized counseling approaches in cancer medicine.

"You Never Get a Second Chance": First Impressions of Physicians Depend on Their Body Posture and Gender.

A first impression matters, in particular when encounters are brief as in most doctor-patient interactions. In this study, we investigate how physicians' body postures impact patients' first impressions of them and extend previous research by exploring posture effects on the perception of all roles of a physician - not just single aspects such as scholarly expertise or empathy. In an online survey, 167 participants ranked photographs of 4 physicians (2 female, 2 male) in 4 postures (2 open, 2 closed). The results show that male physicians were rated more positively when assuming open rather than closed postures with respect to all professional physician roles. Female physicians in open postures were rated similarly positive for items related to medical competence, but they tended to be rated less favorably with respect to social skills (such as the ability to communicate with and relate to the patient). These findings extend what is known about the effects of physicians' body postures on the first impressions patients form to judge physicians' medical versus social competencies. We discuss practical implications and the need for more research on interaction effects of body postures and physician gender on first impressions.