{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T04:37:13Z","timestamp":1785818233878,"version":"3.56.0"},"reference-count":43,"publisher":"American Medical Association (AMA)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Familial hypercholesterolemia is a common genetic disorder associated with premature cardiovascular disease. Genetic cascade screening is recommended but remains underused due to privacy laws that prevent clinicians from directly contacting at-risk relatives.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine whether implementing a web-based communication platform in a patient-mediated genetic cascade screening program for familial hypercholesterolemia increases uptake compared with usual care.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This open-label, multicenter, implementation randomized clinical trial (CATCH) was conducted between November 1, 2020, and October 31, 2023, at 7 cardiovascular prevention or lipid clinics across Switzerland, representing French-, German-, and Italian-speaking regions. Adults aged 16 years or older with genetically confirmed familial hypercholesterolemia and at least 1 eligible first-degree relative living in Switzerland participated. A total of 87 index patients with 359 eligible first-degree relatives were randomized by family cluster (1:1) to the intervention or usual care arm.<\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n A secure web-based platform allowing participants to send preprepared electronic messages (email or text) to their relatives, linking them directly to participating centers for genetic testing.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was cascade screening uptake, defined as the proportion of eligible first-degree relatives undergoing genetic testing within 6 months. The secondary outcome was new cases identified.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 221 adults screened across multiple families, 87 (39.4%) had genetically confirmed familia hypercholesterolemia (median [IQR] age, 49.2 [16.4-83.7] years; 46 [52.9%] female; median [IQR] highest low-density lipoprotein cholesterol, 289.58 [139.00-498.07] mg\/dL); 43 were randomized to the usual care arm, and 44 were randomized to the intervention arm. Among the 359 eligible relatives (median family size, 4), 99 (27.6%) underwent genetic testing. Uptake was higher in the intervention arm (30.4%; 95% CI, 22.0%-40.4%) than in usual care arm (16.7%; 95% CI, 10.1%-26.3%), yielding an odds ratio of 2.18 (95% CI, 1.06-4.51;\n P<\/jats:italic>\n \u2009=\u2009.03). New case identification was also greater (17.0% vs 8.1%; odds ratio, 2.32; 95% CI, 1.07-5.05;\n P<\/jats:italic>\n \u2009=\u2009.03). Newly identified patients were often untreated or had modifiable risk factors.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this randomized clinical trial of patient-mediated genetic cascade screening supported by a web-based platform, participation in genetic testing and detection of familial hypercholesterolemia was increased compared with usual care. These results suggest that the use of digital communication tools enhanced the reach and effectiveness of genetic screening programs within privacy-regulated health systems.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT04419090<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2026.6100","type":"journal-article","created":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T15:30:26Z","timestamp":1776094226000},"page":"e266100","source":"Crossref","is-referenced-by-count":2,"title":["Genetic Cascade Screening for Familial Hypercholesterolemia"],"prefix":"10.1001","volume":"9","author":[{"given":"David","family":"Nanchen","sequence":"first","affiliation":[{"name":"Center for Primary Care and Public Health (Unisant\u00e9), University of Lausanne, Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aziz","family":"Chaouch","sequence":"additional","affiliation":[{"name":"Center for Primary Care and Public Health (Unisant\u00e9), University of Lausanne, Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renzo","family":"Scuderi","sequence":"additional","affiliation":[{"name":"Center for Primary Care and Public Health (Unisant\u00e9), University of Lausanne, Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Faivre","sequence":"additional","affiliation":[{"name":"Center for Primary Care and Public Health (Unisant\u00e9), University of Lausanne, Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"von K\u00e4nel","sequence":"additional","affiliation":[{"name":"Central Institute of the Hospitals, H\u00f4pital du Valais, Sion, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Ehret","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Geneva University Hospitals, University of Geneva, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalie","family":"Brun","sequence":"additional","affiliation":[{"name":"Children Clinic, Geneva University Hospitals, University of Geneva, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabella","family":"Sudano","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Heart Center, Zurich University Hospital, University of Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans","family":"Rickli","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kantonsspital St Gallen, St Gallen, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gr\u00e9goire","family":"Girod","sequence":"additional","affiliation":[{"name":"Department of Cardiology, H\u00f4pital du Valais, Sion, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Audrey Butty","family":"Dettwiler","sequence":"additional","affiliation":[{"name":"Center for Primary Care and Public Health (Unisant\u00e9), University of Lausanne, Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina","family":"Krasieva","sequence":"additional","affiliation":[{"name":"Center for Primary Care and Public Health (Unisant\u00e9), University of Lausanne, Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara","family":"Podmore","sequence":"additional","affiliation":[{"name":"Center for Primary Care and Public Health (Unisant\u00e9), University of Lausanne, Lausanne, Switzerland"},{"name":"Institute of Family Medicine, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Rodondi","sequence":"additional","affiliation":[{"name":"Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland"},{"name":"Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisavet","family":"Moutzouri","sequence":"additional","affiliation":[{"name":"Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Ballhausen","sequence":"additional","affiliation":[{"name":"Pediatric Metabolic Unit, Woman-Mother-Child Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosaria","family":"Del Giorno","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Unit, Dipartimento Medicina Interna, ORBV, Ente Ospedaliero Cantonale, Universit\u00e0 della Svizzera Italiana, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnold","family":"von Eckardstein","sequence":"additional","affiliation":[{"name":"Institute of Clinical Chemistry, Zurich University Hospital, University of Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fcrg H.","family":"Beer","sequence":"additional","affiliation":[{"name":"Department of Molecular Cardiology, Zurich University Hospital, University of Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Augusto","family":"Gallino","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Unit, Dipartimento Medicina Interna, ORBV, Ente Ospedaliero Cantonale, Universit\u00e0 della Svizzera Italiana, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,4,13]]},"reference":[{"issue":"22","key":"zoi260213r1","doi-asserted-by":"publisher","first-page":"2578","DOI":"10.1016\/j.jacc.2016.03.520","article-title":"Diagnostic yield and clinical utility of sequencing familial hypercholesterolemia genes in patients with severe hypercholesterolemia.","volume":"67","author":"Khera","year":"2016","journal-title":"J Am Coll Cardiol"},{"issue":"10","key":"zoi260213r2","doi-asserted-by":"publisher","first-page":"698","DOI":"10.1161\/CIRCULATIONAHA.116.023007","article-title":"Prognosis of patients with familial hypercholesterolemia after acute coronary syndromes.","volume":"134","author":"Nanchen","year":"2016","journal-title":"circulation"},{"issue":"12","key":"zoi260213r3","doi-asserted-by":"publisher","first-page":"1406","DOI":"10.1001\/jamacardio.2021.3508","article-title":"Association between cumulative low-density lipoprotein cholesterol exposure during young adulthood and middle age and risk of cardiovascular events.","volume":"6","author":"Zhang","year":"2021","journal-title":"JAMA Cardiol"},{"issue":"6","key":"zoi260213r4","doi-asserted-by":"publisher","first-page":"662","DOI":"10.1016\/j.jacc.2018.05.044","article-title":"Clinical genetic testing for familial hypercholesterolemia: JACC Scientific Expert Panel.","volume":"72","author":"Sturm","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"zoi260213r5","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz455","article-title":"ESC\/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk: the Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS).","volume":"2019","author":"Mach","year":"2019","journal-title":"Eur Heart J"},{"issue":"10312","key":"zoi260213r7","doi-asserted-by":"publisher","first-page":"1713","DOI":"10.1016\/S0140-6736(21)01122-3","article-title":"Global perspective of familial hypercholesterolaemia: a cross-sectional study from the EAS Familial Hypercholesterolaemia Studies Collaboration (FHSC).","volume":"398","author":"Vallejo-Vaz","year":"2021","journal-title":"Lancet"},{"issue":"4","key":"zoi260213r8","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1001\/jama.2017.8543","article-title":"Cascade screening for familial hypercholesterolemia and the use of genetic testing.","volume":"318","author":"Knowles","year":"2017","journal-title":"JAMA"},{"issue":"4","key":"zoi260213r9","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1007\/s40273-023-01347-7","article-title":"Cost-effectiveness of screening strategies for familial hypercholesterolaemia: an updated systematic review.","volume":"42","author":"Marquina","year":"2024","journal-title":"Pharmacoeconomics"},{"key":"zoi260213r10","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.atherosclerosis.2021.09.014","article-title":"Effectiveness of cascade testing strategies in relatives for familial hypercholesterolemia: a systematic review and meta-analysis.","volume":"338","author":"Leonardi-Bee","year":"2021","journal-title":"Atherosclerosis"},{"issue":"7","key":"zoi260213r11","doi-asserted-by":"publisher","first-page":"800","DOI":"10.1093\/tbm\/ibac018","article-title":"Motivating cascade testing for familial hypercholesterolemia: applying the extended parallel process model for clinician communication.","volume":"12","author":"Campbell-Salome","year":"2022","journal-title":"Transl Behav Med"},{"issue":"2","key":"zoi260213r12","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1016\/j.jacl.2020.02.001","article-title":"Patient acceptance of genetic testing for familial hypercholesterolemia in the CASCADE FH Registry.","volume":"14","author":"Gidding","year":"2020","journal-title":"J Clin Lipidol"},{"issue":"11","key":"zoi260213r13","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCGEN.119.002723","article-title":"New case detection by cascade testing in familial hypercholesterolemia: a systematic review of the literature.","volume":"12","author":"Lee","year":"2019","journal-title":"Circ Genom Precis Med"},{"issue":"1","key":"zoi260213r14","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1007\/s12529-014-9402-x","article-title":"Patients\u2019 perceptions and experiences of familial hypercholesterolemia, cascade genetic screening and treatment.","volume":"22","author":"Hardcastle","year":"2015","journal-title":"Int J Behav Med"},{"issue":"9","key":"zoi260213r15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacadv.2024.101198","article-title":"IMPACT-FH study for implementing innovative family communication and cascade testing strategies for familial hypercholesterolemia.","volume":"3","author":"Jones","year":"2024","journal-title":"JACC Adv"},{"issue":"12","key":"zoi260213r16","doi-asserted-by":"publisher","first-page":"1631","DOI":"10.1038\/s41431-020-00725-5","article-title":"Barriers and facilitators for cascade testing in genetic conditions: a systematic review.","volume":"28","author":"Srinivasan","year":"2020","journal-title":"Eur J Hum Genet"},{"issue":"8","key":"zoi260213r17","doi-asserted-by":"publisher","first-page":"1235","DOI":"10.1038\/s41591-020-0982-5","article-title":"Population genetic screening efficiently identifies carriers of autosomal dominant diseases.","volume":"26","author":"Grzymski","year":"2020","journal-title":"Nat Med"},{"issue":"2","key":"zoi260213r18","doi-asserted-by":"publisher","first-page":"23","DOI":"10.3390\/jpm10020023","article-title":"A global review on the utility of genetic testing for familial hypercholesterolemia.","volume":"10","author":"Hendricks-Sturrup","year":"2020","journal-title":"J Pers Med"},{"issue":"4","key":"zoi260213r19","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1001\/jama.2019.18640","article-title":"DNA-based population screening: potential suitability and important knowledge gaps.","volume":"323","author":"Murray","year":"2020","journal-title":"JAMA"},{"key":"zoi260213r21","doi-asserted-by":"publisher","first-page":"E184","DOI":"10.1016\/j.atherosclerosis.2021.06.562","article-title":"Implementation of cascade genetic screening for familial hypercholesterolemia: design of the Swiss Catch Randomized Controlled Trial.","volume":"331","author":"Nanchen","year":"2021","journal-title":"Atherosclerosis"},{"issue":"12","key":"zoi260213r22","doi-asserted-by":"publisher","first-page":"845","DOI":"10.1038\/s41569-023-00892-0","article-title":"International Atherosclerosis Society guidance for implementing best practice in the care of familial hypercholesterolaemia.","volume":"20","author":"Watts","year":"2023","journal-title":"Nat Rev Cardiol"},{"issue":"1","key":"zoi260213r23","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1093\/eurheartj\/ehz455","article-title":"2019 ESC\/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk.","volume":"41","author":"Mach","year":"2020","journal-title":"Eur Heart J"},{"key":"zoi260213r24","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2024-081123","article-title":"CONSORT 2025 statement: updated guideline for reporting randomised trials.","volume":"389","author":"Hopewell","year":"2025","journal-title":"BMJ"},{"key":"zoi260213r25","doi-asserted-by":"publisher","DOI":"10.4414\/cvm.2022.02193","article-title":"Genetic cascade screening for familial hypercholesterolemia in Switzerland.","volume":"25","author":"Nanchen","year":"2022","journal-title":"Cardiovasc Med"},{"issue":"2","key":"zoi260213r26","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1016\/j.gim.2021.09.012","article-title":"The Clinical Genome Resource (ClinGen) Familial Hypercholesterolemia Variant Curation Expert Panel consensus guidelines for LDLR variant classification.","volume":"24","author":"Chora","year":"2022","journal-title":"Genet Med"},{"issue":"5","key":"zoi260213r27","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1038\/gim.2015.30","article-title":"Standards and guidelines for the interpretation of sequence variants: a joint consensus recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology.","volume":"17","author":"Richards","year":"2015","journal-title":"Genet Med"},{"issue":"3","key":"zoi260213r28","doi-asserted-by":"publisher","first-page":"937","DOI":"10.2307\/2533554","article-title":"Sample size calculations for studies with correlated observations.","volume":"53","author":"Liu","year":"1997","journal-title":"Biometrics"},{"issue":"1","key":"zoi260213r29","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1002\/hbm.1058","article-title":"Nonparametric permutation tests for functional neuroimaging: a primer with examples.","volume":"15","author":"Nichols","year":"2002","journal-title":"Hum Brain Mapp"},{"issue":"1","key":"zoi260213r30","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1093\/biomet\/73.1.13","article-title":"Longitudinal data-analysis using generalized linear-models.","volume":"73","author":"Liang","year":"1986","journal-title":"Biometrika"},{"issue":"10","key":"zoi260213r32","doi-asserted-by":"publisher","first-page":"1079","DOI":"10.1001\/jamacardio.2022.2641","article-title":"Trends of elevated low-density lipoprotein cholesterol, awareness, and screening among young adults in the US, 2003-2020.","volume":"7","author":"Zhang","year":"2022","journal-title":"JAMA Cardiol"},{"issue":"2","key":"zoi260213r33","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1001\/jamacardio.2021.4983","article-title":"Management of severe and moderate hypercholesterolemia in young women and men.","volume":"7","author":"Newton","year":"2022","journal-title":"JAMA Cardiol"},{"issue":"1","key":"zoi260213r34","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1161\/CIRCRESAHA.117.312319","article-title":"Lessening the burden of familial hypercholesterolemia using health information technology.","volume":"122","author":"Safarova","year":"2018","journal-title":"Circ Res"},{"issue":"5","key":"zoi260213r35","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1377\/hlthaff.2017.1630","article-title":"Delivery of cascade screening for hereditary conditions: a scoping review of the literature.","volume":"37","author":"Roberts","year":"2018","journal-title":"Health Aff (Millwood)"},{"issue":"5","key":"zoi260213r36","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.1038\/s41436-018-0311-2","article-title":"Recall by genotype and cascade screening for familial hypercholesterolemia in a population-based biobank from Estonia.","volume":"21","author":"Alver","year":"2019","journal-title":"Genet Med"},{"issue":"Pt 1","key":"zoi260213r37","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1258\/acb.2008.008094","article-title":"Family tracing to identify patients with familial hypercholesterolaemia: the second audit of the Department of Health Familial Hypercholesterolaemia Cascade Testing Project.","volume":"46","author":"Hadfield","year":"2009","journal-title":"Ann Clin Biochem"},{"issue":"3","key":"zoi260213r38","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1258\/096914106778440617","article-title":"Cascade screening for familial hypercholesterolaemia: implications of a pilot study for national screening programmes.","volume":"13","author":"Marks","year":"2006","journal-title":"J Med Screen"},{"issue":"3","key":"zoi260213r39","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1002\/ajmg.a.30102","article-title":"Psychological impact of genetic testing for familial hypercholesterolemia within a previously aware population: a randomized controlled trial.","volume":"128A","author":"Marteau","year":"2004","journal-title":"Am J Med Genet A"},{"issue":"3","key":"zoi260213r40","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1038\/ejhg.2015.122","article-title":"Outcomes of a randomised controlled trial of a complex genetic counselling intervention to improve family communication.","volume":"24","author":"Hodgson","year":"2016","journal-title":"Eur J Hum Genet"},{"issue":"12","key":"zoi260213r41","doi-asserted-by":"publisher","first-page":"1315","DOI":"10.1001\/jamacardio.2025.4047","article-title":"Genetic diagnosis of familial hypercholesterolemia in residual newborn dried blood spots.","volume":"10","author":"Peterson","year":"2025","journal-title":"JAMA Cardiol"},{"key":"zoi260213r42","doi-asserted-by":"publisher","DOI":"10.1016\/j.pecinn.2023.100134","article-title":"Facilitating family communication of familial hypercholesterolemia genetic risk: assessing engagement with innovative chatbot technology from the IMPACT-FH study.","volume":"2","author":"Walters","year":"2023","journal-title":"PEC Innov"},{"issue":"1","key":"zoi260213r43","doi-asserted-by":"publisher","DOI":"10.2196\/32568","article-title":"Web-based tool (FH Family Share) to increase uptake of cascade testing for familial hypercholesterolemia: development and evaluation.","volume":"9","author":"Bangash","year":"2022","journal-title":"JMIR Hum Factors"},{"key":"zoi260213r6","unstructured":"National Collaborating Centre for Primary Care. Identification and Management of Familial Hypercholesterolaemia (FH). NICE Clinical Guidelines, No. 71. Appendix A, Guidelines Scope. Royal College of General Practitioners; 2008. Accessed March 10, 2026. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK53818\/"},{"key":"zoi260213r20","unstructured":"ClinicalTrials.gov. Cascade Genetic Testing of Familial Hypercholesterolemia (CATCH). NCT04419090. Accessed February 24, 2026. https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04419090"},{"key":"zoi260213r31","unstructured":"R Core Team. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing; 2022. Accessed March 25, 2026. https:\/\/www.R-project.org"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2847677\/nanchen_2026_oi_260213_1775496090.90345.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T15:30:28Z","timestamp":1776094228000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2847677"}},"subtitle":["A Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2026,4,13]]},"references-count":43,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2026.6100","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,13]]}}}