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Peters E, Markowitz DM, Nadratowski A, Shoots-Reinhard B. Numeric social-media posts engage people with climate science. PNAS NEXUS 2024; 3:pgae250. [PMID: 39045015 PMCID: PMC11263877 DOI: 10.1093/pnasnexus/pgae250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 06/11/2024] [Indexed: 07/25/2024]
Abstract
Innumeracy (lack of math skills) among nonscientists often leads climate scientists and others to avoid communicating numbers due to concerns that the public will not understand them and may disengage. However, people often report preferring to receive numbers; providing them also can improve decisions. Here, we demonstrated that the presence vs. absence of at least one Arabic integer in climate-related social-media posts increased sharing up to 31.7% but, counter to hypothesis, decreased liking of messages 5.2% in two preregistered observational studies (climate scientists on Twitter, N > 8 million Tweets; climate subreddit, N > 17,000 posts and comments). We speculated that the decreased liking was due, not to reduced engagement, but to more negative feelings towards climate-related content described with numeric precision. A preregistered within-participant experiment (N = 212) then varied whether climate consequences were described using Arabic integers (e.g. "90%") or another format (e.g. verbal terms, "almost all"). The presence of Arabic integers about consequences led to more sharing, wanting to find out more, and greater trust and perceptions of an expert messenger; perceived trust and expertise appeared to mediate effects on sharing and wanting to find out more. Arabic integers about consequences again led to more negative feelings about the Tweets as if numbers clarified the dismaying magnitude of climate threats. Our results indicate that harnessing the power of numbers could increase public trust and concern regarding this defining issue of our time. Communicators, however, should also consider counteracting associated negative feelings-that could halt action-by providing feasible solutions to increase people's self-efficacy.
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Affiliation(s)
- Ellen Peters
- Center for Science Communication Research, School of Journalism and Communication, University of Oregon, Eugene, OR 97403, USA
- Psychology Department, University of Oregon, Eugene, OR 97403, USA
| | - David M Markowitz
- Center for Science Communication Research, School of Journalism and Communication, University of Oregon, Eugene, OR 97403, USA
- Department of Communication, Michigan State University, East Lansing, MI, USA
| | - Ariel Nadratowski
- Center for Science Communication Research, School of Journalism and Communication, University of Oregon, Eugene, OR 97403, USA
| | - Brittany Shoots-Reinhard
- Center for Science Communication Research, School of Journalism and Communication, University of Oregon, Eugene, OR 97403, USA
- Department of Psychology, The Ohio State University, Columbus, OH 43210, USA
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2
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Szulc J, Fletcher K. Numerical versus graphical aids for decision-making in a multi-cue signal identification task. APPLIED ERGONOMICS 2024; 118:104260. [PMID: 38417229 DOI: 10.1016/j.apergo.2024.104260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 02/07/2024] [Accepted: 02/20/2024] [Indexed: 03/01/2024]
Abstract
Decision aids are commonly used in tactical decision-making environments to help humans integrate base-rate and multi-cue information. However, it is important that users appropriately trust and rely on aids. Decision aids can be presented in many ways, but the literature lacks clarity over the conditions surrounding their effectiveness. This research aims to determine whether a numerical or graphical aid more effectively supports human performance, and explores the relationships between aid presentation, trust, and workload. Participants (N = 30) completed a signal-identification task that required integration of readings from a set of three dynamic gauges. Participants experienced three conditions: unaided, using a numerical aid, and using a graphical aid. The aids combined gauge and base-rate information in a statistically-optimal fashion. Participants also indicated how much they trusted the system and how hard they worked during the task. Analyses explored the impact of aid condition on sensitivity, response bias, response time, trust, and workload. Both the numerical and graphical aids produced significant increases in sensitivity and trust, and significant decreases in workload in comparison to the unaided condition. The difference in response time between the graphical and unaided conditions approached significance, with participants responding faster using the graphical aid without decrements in sensitivity. Significant interactions between aid and signal type indicated that both aided conditions promoted faster responding to non-hostile signals, with larger mean differences in the graphical aid condition. Practically, graphical aids in which suggestions are more salient to users may promote faster responding in tactical environments, with negligible cost of accuracy.
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Charlton C, Rodrigues AM. How do young women approaching screening age interpret the NHS cervical screening leaflet? A mixed methods study of identifying interpretation difficulties, barriers, facilitators, and leaflet interpretation, engagement and future screening behaviour. Health Psychol Behav Med 2024; 12:2361005. [PMID: 38831975 PMCID: PMC11146246 DOI: 10.1080/21642850.2024.2361005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/21/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Cervical cancer is a common cancer among young women aged 25-29 in England, and the NHS cervical screening leaflet is the first point of contact for those being invited for their first screening. This study aimed to explore how young women (18-24) understand and engage with the leaflet, as well as the barriers and facilitators associated with its interpretation, engagement, and screening intentions. METHODS The study used a mixed-methods approach, including a survey (n = 120) to identify interpretation difficulties and how they were affected by different characteristics, and a follow-up interview (n = 10) to assess the utility of the leaflet, identify issues with its practicality, and determine the factors that influence screening intentions. RESULTS The survey results showed that interpretation difficulties were common, particularly regarding HPV assessment, screening results, additional tests/treatment, and screening risks. Lower interpretation accuracy was associated with lower numeracy scores and non-white ethnicity. Despite these difficulties, participants had high confidence and motivation to engage with the leaflet. The interviews revealed knowledge gaps, issues with the leaflet's practicality, and a preference for digital information. Factors that were identified as barriers and facilitators of leaflet interpretation, engagement, and screening intentions included knowledge, social influence, beliefs about consequences, environmental context and resources, social role and identity, emotions and intentions. CONCLUSION The current leaflet does not provide enough information for young women to make an informed decision about screening attendance. Implementing a digital invitation featuring simplified gist representation, targeted behaviour change techniques (BCTs), videos, and interactive tools can enhance education and promote screening behaviour. Future research should consider using digital tools and strategies to address existing barriers related to interpretation and engagement.
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Affiliation(s)
- Caroline Charlton
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
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Kerr J, van der Bles AM, Dryhurst S, Schneider CR, Chopurian V, Freeman ALJ, van der Linden S. The effects of communicating uncertainty around statistics, on public trust. ROYAL SOCIETY OPEN SCIENCE 2023; 10:230604. [PMID: 38026007 PMCID: PMC10663791 DOI: 10.1098/rsos.230604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023]
Abstract
Uncertainty around statistics is inevitable. However, communicators of uncertain statistics, particularly in high-stakes and potentially political circumstances, may be concerned that presenting uncertainties could undermine the perceived trustworthiness of the information or its source. In a large survey experiment (Study 1; N = 10 519), we report that communicating uncertainty around present COVID-19 statistics in the form of a numeric range (versus no uncertainty) may lead to slightly lower perceived trustworthiness of the number presented but has no impact on perceived trustworthiness of the source of the information. We also show that this minimal impact of numeric uncertainty on trustworthiness is also present when communicating future, projected COVID-19 statistics (Study 2; N = 2,309). Conversely, we find statements about the mere existence of uncertainty, without quantification, can reduce both perceived trustworthiness of the numbers and of their source. Our findings add to others suggesting that communicators can be transparent about statistical uncertainty without undermining their credibility as a source but should endeavour to provide a quantification, such as a numeric range, where possible.
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Affiliation(s)
- John Kerr
- Winton Centre for Risk & Evidence Communication, University of Cambridge, Cambridge CB2 1TN, UK
- Department of Public Health, University of Otago, Wellington, New Zealand
| | | | - Sarah Dryhurst
- Winton Centre for Risk & Evidence Communication, University of Cambridge, Cambridge CB2 1TN, UK
- Department of Psychology, University of Cambridge, Cambridge CB2 1TN, UK
| | - Claudia R. Schneider
- Winton Centre for Risk & Evidence Communication, University of Cambridge, Cambridge CB2 1TN, UK
- Department of Psychology, University of Cambridge, Cambridge CB2 1TN, UK
| | - Vivien Chopurian
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin 10099, Germany
| | - Alexandra L. J. Freeman
- Winton Centre for Risk & Evidence Communication, University of Cambridge, Cambridge CB2 1TN, UK
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Housten AJ, Kozower BD, Engelhardt KE, Robinson C, Puri V, Samson P, Cooksey K, Politi MC. Developing an Educational and Decision Support Tool for Stage I Lung Cancer Using Decision Science. Ann Thorac Surg 2023; 115:299-308. [PMID: 35926640 DOI: 10.1016/j.athoracsur.2022.07.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/26/2022] [Accepted: 07/19/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Guidelines recommend shared decision-making about treatment options for high-risk, operable stage I lung cancer. Patient decision aids can facilitate shared decision-making; however, their development, implementation, and evaluation in routine clinical practice presents numerous challenges and opportunities. METHODS The purpose of this review is to reflect on the process of tool development; identify the challenges associated with meeting the needs of patients, clinicians from multiple disciplines, and institutional workflow during implementation; and propose recommendations for future clinicians who wish to develop, refine, or implement similar tools into routine care. RESULTS In this review, we: (1) discuss guidelines for decision aid development; (2) describe how we applied those to create an education and decision support tool for patients with clinical stage I lung cancer deciding between radiation therapy and surgical resection; and (3) highlight challenges in implementing and evaluating the tool. CONCLUSIONS We provide recommendations for those seeking to develop, refine, or implement similar tools into routine care.
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Affiliation(s)
- Ashley J Housten
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis, St Louis, Missouri
| | - Benjamin D Kozower
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St Louis, St Louis, Missouri
| | - Kathryn E Engelhardt
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St Louis, St Louis, Missouri
| | - Clifford Robinson
- Department of Radiation Oncology, Washington University in St Louis, St Louis, Missouri
| | - Varun Puri
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St Louis, St Louis, Missouri
| | - Pamela Samson
- Department of Radiation Oncology, Washington University in St Louis, St Louis, Missouri
| | - Krista Cooksey
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis, St Louis, Missouri
| | - Mary C Politi
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis, St Louis, Missouri.
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Teigen KH. Dimensions of uncertainty communication: What is conveyed by verbal terms and numeric ranges. CURRENT PSYCHOLOGY 2022; 42:1-16. [PMID: 36406843 PMCID: PMC9660216 DOI: 10.1007/s12144-022-03985-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2022] [Indexed: 11/15/2022]
Abstract
The paper reviews two strands of research on communication of uncertainty that usually have been investigated separately: (1) Probabilities attached to specific outcomes, and (2) Range judgments. Probabilities are sometimes expressed by verbal phrases ("rain is likely") and at other times in a numeric format ("70% chance of rain"), whereas range judgments describe the potential amounts expected ("1-4 mm of rain"). Examination of previous research shows that both descriptions convey, in addition to the strength of expectations, pragmatic information about the communicative situation. For instance, so-called verbal probability expressions (VPE), as likely, unlikely, a chance, or not certain give some, albeit vague, probabilistic information, but carry in addition an implicit message about the sources of uncertainty, the outcome's valence and severity, along with information about the speakers' attitudes and their communicative intentions. VPEs are directional by drawing attention either to an outcome's occurrence ("it is possible") or to its non-occurrence ("it is doubtful"). In this sense they may be more informative than numbers. Uncertainties about outcomes in a distribution (continuous quantities) are alternatively expressed as interval estimates. The width of such intervals can function as a cue to credibility and expertise. Incomplete, one-sided intervals, where only one boundary is stated, imply directionality. "More than 100 people" suggests a crowd, while "less than 200" implies a shortfall. As with VPEs, directionally positive intervals are more frequent, and perhaps more neutral than negative ones. To convey expectancies and uncertainty in a balanced way, communicators may have to alternate between complementary frames.
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Rao BR, Merchant FM, Abernethy ER, Bethencourt C, Matlock D, Dickert NW. Digging Deeper: Understanding Trajectories and Experiences of Shared Decision-Making for Primary Prevention ICD Implantation. J Card Fail 2022; 28:1437-1444. [PMID: 35550427 PMCID: PMC9580508 DOI: 10.1016/j.cardfail.2022.04.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/14/2022] [Accepted: 04/15/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Shared decision-making using a decision aid is required for patients undergoing implantation of primary prevention implantable cardioverter-defibrillators (ICD). It is unknown how much this process has impacted patients' experiences or choices. Effective shared decision-making requires an understanding of how patients make ICD decisions. A qualitative key informant study was chosen to capture the breadth of patients' experiences making ICD decisions in the context of required shared decision-making. METHODS AND RESULTS We conducted in-depth interviews with 20 patients referred to electrophysiology clinics for the consideration of primary prevention ICD implantation. Purposeful sampling from a prior survey study evaluating mandated shared decision-making was based on patient characteristics and responses to the initial survey questions. Qualitative descriptive analysis of the interviews was performed using a multilevel coding strategy. Patients' paths to an ICD decision often involved multiple visits with multiple clinicians. However, the decision aid was almost exclusively provided to the patient during electrophysiology clinic visits. Some patients used the numeric data in the decision aid to make an ICD decision based on the risk-benefit profile; others made decisions based on other data or based on trust in clinicians' recommendations. Patients highlighted information related to living with the device as particularly important in helping them to make their ICD decisions. Some patients struggled with the emotional aspects of making an ICD decision. CONCLUSIONS Patients' ICD decision-making paths poses a challenge to episodic shared decision-making and may make tools such as decision aids perfunctory if used solely during the electrophysiology visit. Understanding patients' ICD decision-making paths, especially in the context of encounters with primary cardiologists, can inform the implementation strategies of shared decision-making help to enhance its impact. Components of decision aids focusing on the experience of living with an ICD rather than probabilistic data may also be more impactful, although the nature of their impact will differ.
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Affiliation(s)
- Birju R Rao
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
| | - Faisal M Merchant
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Eli R Abernethy
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Christine Bethencourt
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Dan Matlock
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Neal W Dickert
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia; Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia; and the
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Teigen KH, Juanchich M, Løhre E. Combining verbal forecasts: The role of directionality and the reinforcement effect. JOURNAL OF BEHAVIORAL DECISION MAKING 2022. [DOI: 10.1002/bdm.2298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | - Erik Løhre
- BI Norwegian Business School Oslo Norway
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Bitterly TB, VanEpps EM, Schweitzer ME. The predictive power of exponential numeracy. JOURNAL OF EXPERIMENTAL SOCIAL PSYCHOLOGY 2022. [DOI: 10.1016/j.jesp.2022.104347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Misuraca R, Teuscher U, Scaffidi Abbate C, Ceresia F, Roccella M, Parisi L, Vetri L, Miceli S. Can We Do Better Next Time? Italians' Response to the COVID-19 Emergency through a Heuristics and Biases Lens. Behav Sci (Basel) 2022; 12:39. [PMID: 35200290 PMCID: PMC8869375 DOI: 10.3390/bs12020039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/24/2022] [Accepted: 02/01/2022] [Indexed: 02/05/2023] Open
Abstract
During the outbreak of COVID-19 in Italy, people often failed to adopt behaviors that could have stopped, or at least slowed down, the spread of this deadly disease. We offer cognitive explanations for these decisions, based on some of the most common heuristics and biases that are known to influence human judgment and decision-making, especially under conditions of high uncertainty. Our analysis concludes with the following recommendations: policymakers can and should take advantage of this established science, in order to communicate more effectively and increase the likelihood that people choose responsible actions in a public health crisis.
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Affiliation(s)
- Raffaella Misuraca
- Department of Political Science and International Relations (DEMS), University of Palermo, 90134 Palermo, Italy;
| | - Ursina Teuscher
- Department of Psychology, Portland State University, Portland, OR 97207, USA;
| | - Costanza Scaffidi Abbate
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy; (C.S.A.); (M.R.); (L.P.); (S.M.)
| | - Francesco Ceresia
- Department of Political Science and International Relations (DEMS), University of Palermo, 90134 Palermo, Italy;
| | - Michele Roccella
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy; (C.S.A.); (M.R.); (L.P.); (S.M.)
| | - Lucia Parisi
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy; (C.S.A.); (M.R.); (L.P.); (S.M.)
| | - Luigi Vetri
- OASI, Research Institute-IRCCS, 94018 Troina, Italy;
| | - Silvana Miceli
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy; (C.S.A.); (M.R.); (L.P.); (S.M.)
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Imprecision and Preferences in Interpretation of Verbal Probabilities in Health: a Systematic Review. J Gen Intern Med 2021; 36:3820-3829. [PMID: 34357577 PMCID: PMC8642516 DOI: 10.1007/s11606-021-07050-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/14/2021] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Many health providers and communicators who are concerned that patients will not understand numbers instead use verbal probabilities (e.g., terms such as "rare" or "common") to convey the gist of a health message. OBJECTIVE To assess patient interpretation of and preferences for verbal probability information in health contexts. METHODS We conducted a systematic review of literature published through September 2020. Original studies conducted in English with samples representative of lay populations were included if they assessed health-related information and elicited either (a) numerical estimates of verbal probability terms or (b) preferences for verbal vs. quantitative risk information. RESULTS We identified 33 original studies that referenced 145 verbal probability terms, 45 of which were included in at least two studies and 19 in three or more. Numerical interpretations of each verbal term were extremely variable. For example, average interpretations of the term "rare" ranged from 7 to 21%, and for "common," the range was 34 to 71%. In a subset of 9 studies, lay estimates of verbal probability terms were far higher than the standard interpretations established by the European Commission for drug labels. In 10 of 12 samples where preferences were elicited, most participants preferred numerical information, alone or in combination with verbal labels. CONCLUSION Numerical interpretation of verbal probabilities is extremely variable and does not correspond well to the numerical probabilities established by expert panels. Most patients appear to prefer quantitative risk information, alone or in combination with verbal labels. Health professionals should be aware that avoiding numeric information to describe risks may not match patient preferences, and that patients interpret verbal risk terms in a highly variable way.
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Zhong L, Donovan EE, Vangelisti AL. Examining the Effectiveness of Genetic Counselors' Communication of Variant of Uncertain Significance Results of Breast Cancer Genes. HEALTH COMMUNICATION 2021; 36:606-615. [PMID: 32122169 DOI: 10.1080/10410236.2020.1733224] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Receiving a variant of uncertain significance (VUS) result is quite common for individuals who undergo genetic testing. Because VUS results are often unexpected and necessarily complex, they are challenging for genetic counselors to deliver. The current research sought to examine how three specific message features (risk estimate formats, establishment of a future plan, and linguistic agency), and message receivers' intolerance of uncertainty, influenced the effectiveness of genetic counselors' communication of a VUS result. A series of MANCOVAs and multiple regressions suggested that these message features affected message receivers' perception of a genetic counselor's credibility and receivers' uncertainty appraisal and information-seeking intentions. Specifically, establishing a future plan and assigning agency to a VUS result enhanced perceived counselor credibility. When results were presented in a numeric format, assigning agency to counselors resulted in heightened danger appraisal and greater information-seeking intentions. Individuals' intolerance of uncertainty moderated the association between risk formats and uncertainty appraisal. These results have both theoretical and practical implications for communication of uncertainty in the context of genetic counseling.
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Affiliation(s)
- Lingzi Zhong
- Department of Communication Studies, Moody College of Communication, University of Texas at Austin
| | - Erin E Donovan
- Department of Communication Studies, Moody College of Communication, University of Texas at Austin
| | - Anita L Vangelisti
- Department of Communication Studies, Moody College of Communication, University of Texas at Austin
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Bonner C, Trevena LJ, Gaissmaier W, Han PKJ, Okan Y, Ozanne E, Peters E, Timmermans D, Zikmund-Fisher BJ. Current Best Practice for Presenting Probabilities in Patient Decision Aids: Fundamental Principles. Med Decis Making 2021; 41:821-833. [PMID: 33660551 DOI: 10.1177/0272989x21996328] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Shared decision making requires evidence to be conveyed to the patient in a way they can easily understand and compare. Patient decision aids facilitate this process. This article reviews the current evidence for how to present numerical probabilities within patient decision aids. METHODS Following the 2013 review method, we assembled a group of 9 international experts on risk communication across Australia, Germany, the Netherlands, the United Kingdom, and the United States. We expanded the topics covered in the first review to reflect emerging areas of research. Groups of 2 to 3 authors reviewed the relevant literature based on their expertise and wrote each section before review by the full authorship team. RESULTS Of 10 topics identified, we present 5 fundamental issues in this article. Although some topics resulted in clear guidance (presenting the chance an event will occur, addressing numerical skills), other topics (context/evaluative labels, conveying uncertainty, risk over time) continue to have evolving knowledge bases. We recommend presenting numbers over a set time period with a clear denominator, using consistent formats between outcomes and interventions to enable unbiased comparisons, and interpreting the numbers for the reader to meet the needs of varying numeracy. DISCUSSION Understanding how different numerical formats can bias risk perception will help decision aid developers communicate risks in a balanced, comprehensible manner and avoid accidental "nudging" toward a particular option. Decisions between probability formats need to consider the available evidence and user skills. The review may be useful for other areas of science communication in which unbiased presentation of probabilities is important.
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Affiliation(s)
- Carissa Bonner
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, NSW, Australia.,ASK-GP NHMRC Centre of Research Excellence, The University of Sydney, Australia
| | - Lyndal J Trevena
- Faculty of Medicine and Health, School of Public Health, The University of Sydney, Sydney, NSW, Australia.,ASK-GP NHMRC Centre of Research Excellence, The University of Sydney, Australia
| | | | - Paul K J Han
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, ME, USA.,School of Medicine, Tufts University, USA
| | - Yasmina Okan
- Centre for Decision Research, University of Leeds, Leeds, UK
| | | | - Ellen Peters
- Center for Science Communication Research, University of Oregon, Eugene, OR, USA
| | - Daniëlle Timmermans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, North Holland, The Netherlands
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Petrocelli JV. Bullshitting and persuasion: The persuasiveness of a disregard for the truth. BRITISH JOURNAL OF SOCIAL PSYCHOLOGY 2021; 60:1464-1483. [PMID: 33591596 DOI: 10.1111/bjso.12453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 01/22/2021] [Indexed: 11/27/2022]
Abstract
Although generally viewed as a common and undesirable social behaviour, very little is known about the nature of bullshitting (i.e., communicating with little to no regard for evidence or truth; Raritan Q Rev 6, 1986, 81); its consequences; and its potential communicative utility. Specifically, it is hypothesized that bullshitting may be may be relatively influential under specified conditions. Experiment 1 participants were exposed to a traditional persuasion paradigm, receiving either strong or weak arguments in either an evidence-based or bullshit frame. Experiment 2 also incorporated a manipulation of a peripheral route cue (i.e., source attractiveness). Findings demonstrate that bullshitting can be an effective means of influence when arguments are weak, yet undermine persuasive attempts when arguments are strong. Results also suggest that bullshit frames may cue peripheral route processing of persuasive information relative to evidence-based frames that appear to cue central route processing. Results are discussed in light of social perception and attitude change.
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15
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Eysenbach G. Adherence of Internet-Based Cancer Risk Assessment Tools to Best Practices in Risk Communication: Content Analysis. J Med Internet Res 2021; 23:e23318. [PMID: 33492238 PMCID: PMC7870349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/19/2020] [Accepted: 12/19/2020] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Internet-based risk assessment tools offer a potential avenue for people to learn about their cancer risk and adopt risk-reducing behaviors. However, little is known about whether internet-based risk assessment tools adhere to scientific evidence for what constitutes good risk communication strategies. Furthermore, their quality may vary from a user experience perspective. OBJECTIVE This study aims to understand the extent to which current best practices in risk communication have been applied to internet-based cancer risk assessment tools. METHODS We conducted a search on August 6, 2019, to identify websites that provided personalized assessments of cancer risk or the likelihood of developing cancer. Each website (N=39) was coded according to standardized criteria and focused on 3 categories: general website characteristics, accessibility and credibility, and risk communication formats and strategies. RESULTS Some best practices in risk communication were more frequently adhered to by websites. First, we found that undefined medical terminology was widespread, impeding comprehension for those with limited health literacy. For example, 90% (35/39) of websites included technical language that the general public may find difficult to understand, yet only 23% (9/39) indicated that medical professionals were their intended audience. Second, websites lacked sufficient information for users to determine the credibility of the risk assessment, making it difficult to judge the scientific validity of their risk. For instance, only 59% (23/39) of websites referenced the scientific model used to calculate the user's cancer risk. Third, practices known to foster unbiased risk comprehension, such as adding qualitative labels to quantitative numbers, were used by only 15% (6/39) of websites. CONCLUSIONS Limitations in risk communication strategies used by internet-based cancer risk assessment tools were common. By observing best practices, these tools could limit confusion and cultivate understanding to help people make informed decisions and motivate people to engage in risk-reducing behaviors.
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Zhong L, Woo J, Steinhardt MA, Vangelisti AL. "Our Job is that Whole Gray Zone in Between There": Investigating Genetic Counselors' Strategies for Managing and Communicating Uncertainty. HEALTH COMMUNICATION 2020; 35:1583-1592. [PMID: 31423843 DOI: 10.1080/10410236.2019.1654171] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Ample research suggests that uncertainty is a major concern for individuals undergoing genetic testing and for genetic mutation carriers, and that their management of uncertainty is largely influenced by healthcare providers, including genetic counselors (GCs). Indeed, uncertainty is inherent in genetic testing results. To help patients grapple with uncertainty, GCs need to effectively manage the uncertainty inherent in genetic testing and communicate it appropriately to patients. The present study aimed to identify GCs' strategies for managing uncertainty and communicating uncertainty to patients. Eighteen GCs participated in five focus group interviews, and the data were analyzed using a grounded theory approach. Findings indicated that GCs used three main strategies to manage uncertainty: becoming lifelong learners, normalizing uncertainty, and seeking social support. To communicate uncertainty to patients, GCs also used three different strategies: engaging in open and honest communication, adapting to patients' needs, and focusing on known information. The implications of these findings for uncertainty theories and for conceptual frameworks of GCs' clinical communication are discussed.
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Affiliation(s)
- Lingzi Zhong
- Department of Communication Studies, Moody College of Communication, University of Texas at Austin
| | - Jihun Woo
- Department of Kinesiology and Health Education, College of Education, University of Texas at Austin
| | - Mary A Steinhardt
- Department of Kinesiology and Health Education, College of Education, University of Texas at Austin
| | - Anita L Vangelisti
- Department of Communication Studies, Moody College of Communication, University of Texas at Austin
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17
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Waters EA, Foust JL, Scherer LD, McQueen A, Taber JM. To what extent do Internet-based cancer risk assessment tools adhere to best practices in risk communication: A content analysis (Preprint). J Med Internet Res 2020. [DOI: 10.2196/23318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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18
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Jenkins SC, Harris AJL. Maintaining credibility when communicating uncertainty: the role of directionality. THINKING & REASONING 2020. [DOI: 10.1080/13546783.2020.1723694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Sarah C. Jenkins
- Department of Experimental Psychology, University College London, London, UK
| | - Adam J. L. Harris
- Department of Experimental Psychology, University College London, London, UK
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19
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Kunneman M, Stiggelbout AM, Pieterse AH. Do clinicians convey what they intend? Lay interpretation of verbal risk labels used in decision encounters. PATIENT EDUCATION AND COUNSELING 2020; 103:418-422. [PMID: 31492531 DOI: 10.1016/j.pec.2019.08.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/20/2019] [Accepted: 08/24/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To assess the numerical probabilities that individuals associate with frequently-used verbal labels relating to treatment outcomes and their association with medical context, age, gender, educational level, health literacy, and numeracy. METHODS Verbal labels (N = 11) were extracted from N = 90 audiotaped decision encounters in oncology. Three hundred Dutch adults, as proxies for newly-diagnosed cancer patients, assigned numerical probabilities to the labels in the context of cancer recurrence or nausea, and completed questions on their socio-demographic characteristics, health literacy and numeracy. RESULTS We found considerable variation in how individuals interpreted the verbal labels. Participants' probability estimates of verbal labels was lower in the context of (the more serious) cancer recurrence compared to (less serious) nausea. Lower numerate participants differentiated less between labels. There was no association between participants' estimates and age, gender, educational level or health literacy. CONCLUSION There is considerable variation in how individuals interpret verbal labels frequently-used in decision encounters. Individuals seem to take base rates and severity of outcomes into account. Verbal labels may be less helpful to lower numerate individuals. PRACTICE IMPLICATIONS To minimize misinterpretation and to improve patient-clinician decision making about health and care, we recommend to avoid the use of verbal labels only.
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Affiliation(s)
- Marleen Kunneman
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Anne M Stiggelbout
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Arwen H Pieterse
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands.
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20
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Juanchich M, Sirota M. Most family physicians report communicating the risks of adverse drug reactions in words (vs. numbers). APPLIED COGNITIVE PSYCHOLOGY 2020. [DOI: 10.1002/acp.3623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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21
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Henneman L, van Asperen CJ, Oosterwijk JC, Menko FH, Claassen L, Timmermans DRM. Do Preferred Risk Formats Lead to Better Understanding? A Multicenter Controlled Trial on Communicating Familial Breast Cancer Risks Using Different Risk Formats. Patient Prefer Adherence 2020; 14:333-342. [PMID: 32109999 PMCID: PMC7036980 DOI: 10.2147/ppa.s232941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/07/2020] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Counselees' preferences are considered important for the choice of risk communication format and for improving patient-centered care. We here report on counselees' preferences for how risks are presented in familial breast cancer counseling and the impact of this preferred format on their understanding of risk. PATIENTS AND METHODS As part of a practice-based randomized controlled trial, 326 unaffected women with a family history of breast cancer received their lifetime risk in one of five presentation formats after standard genetic counseling in three Dutch familial cancer clinics: 1) in percentages, 2) in frequencies ("X out of 100"), 3) in frequencies plus graphical format (10×10 human icons), 4) in frequencies and 10-year age-related risk and 5) in frequencies and 10-year age-related risk plus graphical format. Format preferences and risk understanding (accuracy) were assessed at 2-week follow-up by a questionnaire, completed by 279/326 women. RESULTS The most preferred risk communication formats were numbers combined with verbal descriptions (37%) and numbers only (26%). Of the numerical formats, most (55%) women preferred percentages. The majority (73%) preferred to be informed about both lifetime and 10-year age-related risk. Women who had received a graphical display were more likely to choose a graphical display as their preferred format. There was no significant effect between the intervention groups with regard to risk accuracy. Overall, women given risk estimates in their preferred format had a slightly better understanding of risk. CONCLUSION The results suggest that the accuracy of breast cancer risk estimation is slightly better for women who had received this information in their preferred format, but the risk format used had no effect on women's risk accuracy. To meet the most frequent preference, counselors should consider providing a time frame of reference (eg, risk in the next 10 years) in a numerical format, in addition to lifetime risk.
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Affiliation(s)
- Lidewij Henneman
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
- Correspondence: Lidewij Henneman Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit, PO Box 7057, 1007 MB, Amsterdam, the NetherlandsTel +31 20-4449815 Email
| | - Christi J van Asperen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan C Oosterwijk
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Fred H Menko
- Family Cancer Clinic, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Liesbeth Claassen
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
| | - Daniëlle RM Timmermans
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
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22
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Okan Y, Smith SG, Bruine de Bruin W. How is cervical cancer screening information communicated in UK websites? Cross-sectional analysis of content and quantitative presentation formats. BMJ Open 2019; 9:e029551. [PMID: 31662361 PMCID: PMC6830680 DOI: 10.1136/bmjopen-2019-029551] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 09/03/2019] [Accepted: 09/13/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To investigate whether UK websites about cervical cancer screening targeted to the public include (1) information about benefits and risks of screening, possible screening results and cervical cancer statistics, (2) quantitative presentation formats recommended in the risk communication literature and (3) appeals for participation and/or informed decision-making. DESIGN Cross-sectional analysis of websites using a comprehensive checklist of information items on screening benefits, risks, possible results and cervical cancer statistics. OUTCOME MEASURES We recorded the number of websites that contained each of the information items, and the presentation format used for probabilistic information (no quantification provided, verbal quantifiers only, different types of numerical formats and/or graphs). We also recorded the number of websites containing appeals for participation and/or informed decision-making. SETTING Websites were identified through the most common Google search terms used in the UK to find information on cervical screening, according to GoogleTrends and a commercial internet-monitoring programme. Two additional websites were identified by the authors as relevant. RESULTS After applying exclusion criteria, 14 websites were evaluated, including websites of public and private health service providers, charities, a medical society and a pharmacy. The websites mentioned different benefits, risks of screening and possible results. However, specific content varied between websites. Probabilistic information was often presented using non-recommended formats, including relative risk reductions to express screening benefits, and verbal quantifiers without numbers to express risks. Appeals for participation were present in most websites, with almost half also mentioning informed decision-making. CONCLUSIONS UK websites about cervical cancer screening were generally balanced. However, benefits and risks were presented using different formats, potentially hindering comparisons. Additionally, recommendations from the literature to facilitate understanding of quantitative information and facilitate informed decisions were often not followed. Designing websites that adhere to existing recommendations may support informed screening uptake.
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Affiliation(s)
- Yasmina Okan
- Centre for Decision Research, Leeds University Business School, University of Leeds, Leeds, UK
| | - Samuel G Smith
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Wändi Bruine de Bruin
- Centre for Decision Research, Leeds University Business School, University of Leeds, Leeds, UK
- Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, Pennsylvania, USA
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23
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Okan Y, Petrova D, Smith SG, Lesic V, Bruine de Bruin W. How Do Women Interpret the NHS Information Leaflet about Cervical Cancer Screening? Med Decis Making 2019; 39:738-754. [PMID: 31556840 PMCID: PMC6843617 DOI: 10.1177/0272989x19873647] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/17/2019] [Indexed: 11/16/2022]
Abstract
Background. Organized screening programs often rely on written materials to inform the public. In the United Kingdom, women invited for cervical cancer screening receive a leaflet from the National Health Service (NHS) to support screening decisions. However, information about screening may be too complex for people to understand, potentially hindering informed decision making. Objectives. We aimed to identify women's difficulties in interpreting the leaflet used in England and negative and positive responses to the leaflet. Methods. We used a sequential mixed-methods design involving 2 steps: cognitive think-aloud interviews (n = 20), followed by an England-wide survey (n = 602). Data were collected between June 2017 and December 2018, and participants included women aged 25 to 64 y with varying sociodemographics. Results. Interview results revealed misunderstandings concerning screening results, benefits, and additional tests and treatment, although participants tended to react positively to numerical information. Participants were often unfamiliar with the potential harms associated with screening (i.e., screening risks), key aspects of human papillomavirus, and complex terms (e.g., dyskaryosis). Survey results indicated that interpretation difficulties were common (M correct items = 12.5 of 23). Lower understanding was associated with lower educational level (β's >0.15, P's <0.001), lower numeracy scores (β = 0.36, P < 0.001), and nonwhite ethnicity (β = 0.10, P = 0.007). The leaflet was evaluated positively overall. Conclusions. Despite previous user testing of the leaflet, key information may be too complex for some recipients. As a consequence, they may struggle to make informed decisions about screening participation based on the information provided. We discuss implications for the improvement of communications about screening and decision support.
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Affiliation(s)
- Yasmina Okan
- Centre for Decision Research, Leeds University Business School, University of Leeds, Leeds, UK
| | - Dafina Petrova
- />Cancer Registry of Granada, Andalusian School of Public Health, Granada, Spain
- />Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), University of Granada, Spain
- />CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - Vedran Lesic
- Centre for Decision Research, Leeds University Business School, University of Leeds, Leeds, UK
| | - Wändi Bruine de Bruin
- />Centre for Decision Research, Leeds University Business School, University of Leeds, Leeds, UK
- />Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, USA
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24
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Peters E, Tompkins MK, Knoll MAZ, Ardoin SP, Shoots-Reinhard B, Meara AS. Despite high objective numeracy, lower numeric confidence relates to worse financial and medical outcomes. Proc Natl Acad Sci U S A 2019; 116:19386-19391. [PMID: 31501338 PMCID: PMC6765274 DOI: 10.1073/pnas.1903126116] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
People often laugh about being "no good at math." Unrecognized, however, is that about one-third of American adults are likely too innumerate to operate effectively in financial and health environments. Two numeric competencies conceivably matter-objective numeracy (ability to "run the numbers" correctly; like literacy but with numbers) and numeric self-efficacy (confidence that provides engagement and persistence in numeric tasks). We reasoned, however, that attaining objective numeracy's benefits should depend on numeric confidence. Specifically, among the more objectively numerate, having more numeric confidence (vs. less) should lead to better outcomes because they persist in numeric tasks and have the skills to support numeric success. Among the less objectively numerate, however, having more (vs. less) numeric confidence should hurt outcomes, as they also persist, but make unrecognized mistakes. Two studies were designed to test the generalizability of this hypothesized interaction. We report secondary analysis of financial outcomes in a diverse US dataset and primary analysis of disease activity among systemic lupus erythematosus patients. In both domains, best outcomes appeared to require numeric calculation skills and the persistence of numeric confidence. "Mismatched" individuals (high ability/low confidence or low ability/high confidence) experienced the worst outcomes. For example, among the most numerate patients, only 7% of the more numerically confident had predicted disease activity indicative of needing further treatment compared with 31% of high-numeracy/low-confidence patients and 44% of low-numeracy/high-confidence patients. Our work underscores that having 1 of these competencies (objective numeracy or numeric self-efficacy) does not guarantee superior outcomes.
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Affiliation(s)
- Ellen Peters
- School of Journalism and Communication, University of Oregon, Eugene, OR 97403;
- Department of Psychology, The Ohio State University, Columbus, OH 43210
| | | | - Melissa A Z Knoll
- Office of Research, Consumer Financial Protection Bureau, Washington, DC 20552
| | - Stacy P Ardoin
- Division of Rheumatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210
- Division of Rheumatology, Nationwide Children's Hospital, Columbus, OH 43205
| | | | - Alexa Simon Meara
- Division of Rheumatology, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210
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25
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van Maurik IS, Visser LN, Pel-Littel RE, van Buchem MM, Zwan MD, Kunneman M, Pelkmans W, Bouwman FH, Minkman M, Schoonenboom N, Scheltens P, Smets EM, van der Flier WM. Development and Usability of ADappt: Web-Based Tool to Support Clinicians, Patients, and Caregivers in the Diagnosis of Mild Cognitive Impairment and Alzheimer Disease. JMIR Form Res 2019; 3:e13417. [PMID: 31287061 PMCID: PMC6643768 DOI: 10.2196/13417] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/30/2019] [Accepted: 04/30/2019] [Indexed: 12/31/2022] Open
Abstract
Background As a result of advances in diagnostic testing in the field of Alzheimer disease (AD), patients are diagnosed in earlier stages of the disease, for example, in the stage of mild cognitive impairment (MCI). This poses novel challenges for a clinician during the diagnostic workup with regard to diagnostic testing itself, namely, which tests are to be performed, but also on how to engage patients in this decision and how to communicate test results. As a result, tools to support decision making and improve risk communication could be valuable for clinicians and patients. Objective The aim of this study was to present the design, development, and testing of a Web-based tool for clinicians in a memory clinic setting and to ascertain whether this tool can (1) facilitate the interpretation of biomarker results in individual patients with MCI regarding their risk of progression to dementia, (2) support clinicians in communicating biomarker test results and risks to MCI patients and their caregivers, and (3) support clinicians in a process of shared decision making regarding the diagnostic workup of AD. Methods A multiphase mixed-methods approach was used. Phase 1 consisted of a qualitative needs assessment among professionals, patients, and caregivers; phase 2, consisted of an iterative process of development and the design of the tool (ADappt); and phase 3 consisted of a quantitative and qualitative assessment of usability and acceptability of ADappt. Across these phases, co-creation was realized via a user-centered qualitative approach with clinicians, patients, and caregivers. Results In phase 1, clinicians indicated the need for risk calculation tools and visual aids to communicate test results to patients. Patients and caregivers expressed their needs for more specific information on their risk for developing AD and related consequences. In phase 2, we developed the content and graphical design of ADappt encompassing 3 modules: a risk calculation tool, a risk communication tool including a summary sheet for patients and caregivers, and a conversation starter to support shared decision making regarding the diagnostic workup. In phase 3, ADappt was considered to be clear and user-friendly. Conclusions Clinicians in a memory clinic setting can use ADappt, a Web-based tool, developed using multiphase design and co-creation, for support that includes an individually tailored interpretation of biomarker test results, communication of test results and risks to patients and their caregivers, and shared decision making on diagnostic testing.
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Affiliation(s)
- Ingrid S van Maurik
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands.,Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Leonie Nc Visser
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands.,Department of Medical Psychology, Amsterdam Public Health Research Insitute, University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | | | - Marieke M van Buchem
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Marissa D Zwan
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Marleen Kunneman
- Department of Medical Psychology, Amsterdam Public Health Research Insitute, University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands.,Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Wiesje Pelkmans
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Femke H Bouwman
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Mirella Minkman
- Vilans Center of Expertise for Long Term Care, Utrecht, Netherlands.,Tilburg University, TIAS School for Business and Society, Tilburg, Netherlands
| | | | - Philip Scheltens
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Ellen Ma Smets
- Department of Medical Psychology, Amsterdam Public Health Research Insitute, University of Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
| | - Wiesje M van der Flier
- Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands.,Department of Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, Netherlands
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26
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Juanchich M, Sirota M. Do people really prefer verbal probabilities? PSYCHOLOGICAL RESEARCH 2019; 84:2325-2338. [PMID: 31250102 DOI: 10.1007/s00426-019-01207-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 06/03/2019] [Indexed: 11/24/2022]
Abstract
When people communicate uncertainty, do they prefer to use words (e.g., "a chance", "possible") or numbers (e.g., "20%", "a 1 in 2 chance")? To answer this question, past research drew from a range of methodologies, yet failed to provide a clear-cut answer. Building on a review of existing methodologies, theoretical accounts and empirical findings, we tested the hypothesis that the preference for a particular format is driven by the variant of uncertainty that people experience. We expected that epistemic uncertainty would be more often communicated in words, whereas distributional uncertainty would be more often communicated in numbers; for the dispositional uncertainty, we expected that an individual's disposition would be more often communicated in words, whereas dispositions from the world would be more often communicated numerically. In three experiments (one oral, two written), participants communicated their uncertainty regarding two outcomes per variants of uncertainty: epistemic, dispositional and distributional. Overall, participants communicated their uncertainty more often in words, but this preference depended on the variants of uncertainty. Participants conveyed their epistemic and dispositional uncertainties more often in words and their distributional uncertainty in numbers (Experiments 1 and 2) but this effect was greatly reduced when the precision of uncertainty was held constant (Experiment 3), pointing out the key role of uncertainty vagueness. We have reviewed the implications of our findings for the existing accounts of format preferences.
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Affiliation(s)
- Marie Juanchich
- Department of Psychology, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, UK.
| | - Miroslav Sirota
- Department of Psychology, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, UK
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27
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Wöhlke S, Schaper M, Schicktanz S. How Uncertainty Influences Lay People's Attitudes and Risk Perceptions Concerning Predictive Genetic Testing and Risk Communication. Front Genet 2019; 10:380. [PMID: 31080458 PMCID: PMC6497735 DOI: 10.3389/fgene.2019.00380] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 04/09/2019] [Indexed: 12/11/2022] Open
Abstract
The interpretation of genetic information in clinical settings raises moral issues about adequate risk communication and individual responsibility about one's health behavior. However, it is not well-known what role numeric probabilities and/or the conception of disease and genetics play in the lay understanding of predictive genetic diagnostics. This is an important question because lay understanding of genetic risk information might have particular implications for self-responsibility of the patients. Aim: Analysis of lay attitudes and risk perceptions of German lay people on genetic testing with a special focus on how they deal with the numerical information. Methods: We conducted and analyzed seven focus group discussions (FG) with lay people (n = 43). Results: Our participants showed a positive attitude toward predictive genetic testing. We identified four main topics: (1) Anumeric risk instead of statistical information; (2) Treatment options as a factor for risk evaluation; (3) Epistemic and aleatory uncertainty as moral criticism; (4) Ambivalence as a sign of uncertainty. Conclusion: For lay people, risk information, including the statistical numeric part, is perceived as highly normatively charged, often as an emotionally significant threat. It seems necessary to provide lay people with a deeper understanding of risk information and of the limitations of genetic knowledge with respect to one's own health responsibility.
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Affiliation(s)
- Sabine Wöhlke
- Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Göttingen, Germany
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28
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Piperini MC, Berger J, Devaux L, Ginet M, Samson K. Étude sur les séances collectives d’éducation nutritionnelle pour des patients diabétiques type II. Rev Epidemiol Sante Publique 2019; 67:98-105. [DOI: 10.1016/j.respe.2019.01.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 12/05/2018] [Accepted: 01/01/2019] [Indexed: 11/26/2022] Open
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Carey M, Herrmann A, Hall A, Mansfield E, Fakes K. Exploring health literacy and preferences for risk communication among medical oncology patients. PLoS One 2018; 13:e0203988. [PMID: 30226878 PMCID: PMC6143261 DOI: 10.1371/journal.pone.0203988] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 09/02/2018] [Indexed: 11/27/2022] Open
Abstract
Objective To explore adult medical oncology outpatients’ understanding of and preferences for the format of health risk information. Methods Two surveys, one assessing sociodemographic characteristics and a second survey examining perceptions of risk information. Results Of the 361 (74%) consenting patients, 210 completed at least one question on risk communication. 17% to 65% of patients understood numeric risk information, depending on the format of the information. More than 50% of people interpreted a “very good” chance of remission as greater than 80%, greater than 90% or 100%. The most preferred format of information was in both words and numbers (38% to 43%) followed by words alone (28% to 30%). Conclusion Numeric risk information is understood by 17% to 65% of respondents, depending on the format. Interpretation of verbal risk information is highly variable, posing a risk of misunderstanding. Provision of information in both words and numbers may assist in aiding comprehension.
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Affiliation(s)
- Mariko Carey
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- * E-mail:
| | - Anne Herrmann
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Alix Hall
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Elise Mansfield
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Kristy Fakes
- Health Behaviour Research Collaborative, School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
- Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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30
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Sawant R, Sansgiry S. Communicating risk of medication side-effects: role of communication format on risk perception. Pharm Pract (Granada) 2018; 16:1174. [PMID: 30023029 PMCID: PMC6041216 DOI: 10.18549/pharmpract.2018.02.1174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 06/06/2018] [Indexed: 11/16/2022] Open
Abstract
Background: Medication side-effects often arouse fear in the minds of consumers and therefore need to be communicated in a manner such that the intended message is clearly understood, without causing undue fear. Objectives: Considering the message format and contextual factors that influence perceptions of risk, this study aimed at assessing the interaction effects of message format and contextual factors (rate of occurrence and severity) on risk perception of medication side-effects. Methods: Using Rhormann’s risk communication process model, a 2 (message format: words-only vs. words + numeric) X 2 (rate of occurrence: high vs low) X 2 (severity: mild vs severe) experimental factorial study was designed. Participants were presented with four of eight possible combinations of the three factors and were asked to indicate the risk perception with the associated side-effects. Repeated measures analysis was conducted while adjusting for control variables. Results: A total of 196 completed surveys were collected. Communication format did not have significant main effect on risk perception (P=0.4237) but demonstrated a significant interaction with rate of occurrence (P=0.0001). As compared to words-only format, least square means for words + numeric format were lower among low-rate side-effects but were higher among high-rate side-effects. Rate of occurrence (P<0.0001) and severity (P<0.0001) had significant main effects on risk perception as well as interaction effect with each other (P<0.0001). Conclusions: The results indicated that effect of communication format on risk perception of side-effect is dependent on the underlying rate of occurrence of side-effect. Healthcare providers should therefore carefully construct risk communication messages for effective communication with patients.
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Affiliation(s)
- Ruta Sawant
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston. Houston, Tx (United States).
| | - Sujit Sansgiry
- Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston. Houston, Tx (United States).
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Knoblauch TAK, Stauffacher M, Trutnevyte E. Communicating Low-Probability High-Consequence Risk, Uncertainty and Expert Confidence: Induced Seismicity of Deep Geothermal Energy and Shale Gas. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2018; 38:694-709. [PMID: 28795767 DOI: 10.1111/risa.12872] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 03/29/2017] [Accepted: 06/22/2017] [Indexed: 06/07/2023]
Abstract
Subsurface energy activities entail the risk of induced seismicity including low-probability high-consequence (LPHC) events. For designing respective risk communication, the scientific literature lacks empirical evidence of how the public reacts to different written risk communication formats about such LPHC events and to related uncertainty or expert confidence. This study presents findings from an online experiment (N = 590) that empirically tested the public's responses to risk communication about induced seismicity and to different technology frames, namely deep geothermal energy (DGE) and shale gas (between-subject design). Three incrementally different formats of written risk communication were tested: (i) qualitative, (ii) qualitative and quantitative, and (iii) qualitative and quantitative with risk comparison. Respondents found the latter two the easiest to understand, the most exact, and liked them the most. Adding uncertainty and expert confidence statements made the risk communication less clear, less easy to understand and increased concern. Above all, the technology for which risks are communicated and its acceptance mattered strongly: respondents in the shale gas condition found the identical risk communication less trustworthy and more concerning than in the DGE conditions. They also liked the risk communication overall less. For practitioners in DGE or shale gas projects, the study shows that the public would appreciate efforts in describing LPHC risks with numbers and optionally risk comparisons. However, there seems to be a trade-off between aiming for transparency by disclosing uncertainty and limited expert confidence, and thereby decreasing clarity and increasing concern in the view of the public.
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Affiliation(s)
- Theresa A K Knoblauch
- D-USYS Transdisciplinarity Lab, Department of Environmental Systems Science (D-USYS), ETH Zürich, Switzerland
| | - Michael Stauffacher
- D-USYS Transdisciplinarity Lab, Department of Environmental Systems Science (D-USYS), ETH Zürich, Switzerland
| | - Evelina Trutnevyte
- D-USYS Transdisciplinarity Lab, Department of Environmental Systems Science (D-USYS), ETH Zürich, Switzerland
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Jenkins SC, Harris AJ, Lark R. Understanding ‘Unlikely (20% Likelihood)’ or ‘20% Likelihood (Unlikely)’ Outcomes: The Robustness of the Extremity Effect. JOURNAL OF BEHAVIORAL DECISION MAKING 2018. [DOI: 10.1002/bdm.2072] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sarah C. Jenkins
- Department of Experimental Psychology; University College London; London UK
| | - Adam J.L. Harris
- Department of Experimental Psychology; University College London; London UK
| | - R.M. Lark
- Environmental Science Centre; British Geological Survey (BGS); Nottingham UK
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Windschitl PD, Smith AR, Scherer AM, Suls J. Risk it? Direct and collateral impacts of peers' verbal expressions about hazard likelihoods. THINKING & REASONING 2017. [DOI: 10.1080/13546783.2017.1307785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Paul D. Windschitl
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Andrew R. Smith
- Department of Psychology, Appalachian State University, Boone, North Carolina, USA
| | - Aaron M. Scherer
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Jerry Suls
- Behavioral Research Program, National Cancer Institute, Bathesda, Maryland, USA
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Family Communication, Risk Perception and Cancer Knowledge of Young Adults from BRCA1/2 Families: a Systematic Review. J Genet Couns 2017; 26:1179-1196. [DOI: 10.1007/s10897-017-0125-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 06/05/2017] [Indexed: 12/19/2022]
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Haider MR, Qureshi ZP, Horner R, Friedman DB, Bennett C. What Have Patients Been Hearing From Providers Since the 2012 USPSTF Recommendation Against Routine Prostate Cancer Screening? Clin Genitourin Cancer 2017. [PMID: 28625690 DOI: 10.1016/j.clgc.2017.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND In this study we aimed to determine the relationship between prostate-specific antigen (PSA)-related information obtained from the provider and PSA test uptake. With recent focus on patient-provider communication (PC) and the guidelines recommending against PSA tests for prostate cancer (PCa), PC regarding the PSA test might affect PSA screening rates. MATERIALS AND METHODS We used the fourth edition of the Health Information National Trends Survey, a nationally-representative US survey on the use of cancer-related information. The survey was conducted in 3 cycles: October 2011 to January 2012 (cycle 1); October 2012 to January 2013 (cycle 2); September 2013 to October 2013 (cycle 3). Logistic regression was used to study the effect of PC on respondents' uptake of the PSA test. RESULTS Most of the respondents were 51 to 65 years old, white, with college or higher education, were married, and had health insurance. PC regarding the PSA test greatly increased the chances of screening for PCa using the PSA test in all 3 cycles (odds ratio [OR], 2.51 [95% confidence interval (CI), 2.03-3.10] in cycle 1; OR, 3.50 [95% CI, 2.51-4.88] in cycle 2; OR, 2.69 [95% CI, 2.02-3.58] in cycle 3). CONCLUSION Our study showed that PC increased the likelihood of patients undergoing PSA screening. In light of the 2012 US Preventive Services Task Force guidelines recommending against screening for PCa, PC seemed to have an opposite effect. Although updated PC that educates patients on the risks and benefits of PSA screening is needed, patients classically overemphasize benefits and underemphasize risks-which might increase rather than decrease PSA screening rates.
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Affiliation(s)
- Mohammad Rifat Haider
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC; Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Zaina P Qureshi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC; Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, SC; William Jennings Bryan Dorn VA Medical Center, Columbia, SC.
| | - Ronnie Horner
- Department of Health Services Policy and Management, and Institute for the Advancement of Healthcare, University of South Carolina, Columbia, SC
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC
| | - Charles Bennett
- Department of Clinical Pharmacy and Outcomes Sciences, and Medication Safety, South Carolina College of Pharmacy, University of South Carolina, Columbia, SC
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Cameron LD, Biesecker BB, Peters E, Taber JM, Klein WMP. Self-Regulation Principles Underlying Risk Perception and Decision Making within the Context of Genomic Testing. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2017; 11. [PMID: 29225669 DOI: 10.1111/spc3.12315] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Advances in theory and research on self-regulation and decision-making processes have yielded important insights into how cognitive, emotional, and social processes shape risk perceptions and risk-related decisions. We examine how self-regulation theory can be applied to inform our understanding of decision-making processes within the context of genomic testing, a clinical arena in which individuals face complex risk information and potentially life-altering decisions. After presenting key principles of self-regulation, we present a genomic testing case example to illustrate how principles related to risk representations, approach and avoidance motivations, emotion regulation, defensive responses, temporal construals, and capacities such as numeric abilities can shape decisions and psychological responses during the genomic testing process. We conclude with implications for using self-regulation theory to advance science within genomic testing and opportunities for how this research can inform further developments in self-regulation theory.
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Janz NK, Li Y, Zikmund-Fisher BJ, Jagsi R, Kurian AW, An LC, McLeod MC, Lee KL, Katz SJ, Hawley ST. The impact of doctor-patient communication on patients' perceptions of their risk of breast cancer recurrence. Breast Cancer Res Treat 2017; 161:525-535. [PMID: 27943007 PMCID: PMC5513530 DOI: 10.1007/s10549-016-4076-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 12/02/2016] [Indexed: 01/07/2023]
Abstract
PURPOSE Doctor-patient communication is the primary way for women diagnosed with breast cancer to learn about their risk of distant recurrence. Yet little is known about how doctors approach these discussions. METHODS A weighted random sample of newly diagnosed early-stage breast cancer patients identified through SEER registries of Los Angeles and Georgia (2013-2015) was sent surveys about ~2 months after surgery (Phase 2, N = 3930, RR 68%). We assessed patient perceptions of doctor communication of risk of recurrence (i.e., amount, approach, inquiry about worry). Clinically determined 10-year risk of distant recurrence was established for low and intermediate invasive cancer patients. Women's perceived risk of distant recurrence (0-100%) was categorized into subgroups: overestimation, reasonably accurate, and zero risk. Understanding of risk and patient factors (e.g. health literacy, numeracy, and anxiety/worry) on physician communication outcomes was evaluated in multivariable regression models (analytic sample for substudy = 1295). RESULTS About 33% of women reported that doctors discussed risk of recurrence as "quite a bit" or "a lot," while 14% said "not at all." Over half of women reported that doctors used words and numbers to describe risk, while 24% used only words. Overestimators (OR .50, CI 0.31-0.81) or those who perceived zero risk (OR .46, CI 0.29-0.72) more often said that their doctor did not discuss risk. Patients with low numeracy reported less discussion. Over 60% reported that their doctor almost never inquired about worry. CONCLUSIONS Effective doctor-patient communication is critical to patient understanding of risk of recurrence. Efforts to enhance physicians' ability to engage in individualized communication around risk are needed.
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Affiliation(s)
- Nancy K Janz
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 2830 SPH1, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA.
| | - Yun Li
- Department of Biostatistics, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
| | - Brian J Zikmund-Fisher
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 2830 SPH1, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
- Division of General Medicine, Department of Internal Medicine, University of Michigan, 2800 Plymouth Rd, Building 16, Ann Arbor, MI, 48109, USA
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
| | - Reshma Jagsi
- Department of Radiation Oncology, University of Michigan, 1500 E Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Allison W Kurian
- Departments of Medicine and Health Research and Policy, Stanford University, 900 Blake Wilbur, Stanford, CA, 94305, USA
| | - Lawrence C An
- Center for Health Communications Research, Department of Internal Medicine, University of Michigan, 2800 Plymouth Rd, Building 16, Ann Arbor, MI, 48109, USA
| | - M Chandler McLeod
- Department of Biostatistics, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA
| | - Kamaria L Lee
- Division of General Medicine, Department of Internal Medicine, University of Michigan, 2800 Plymouth Rd, Building 16, Ann Arbor, MI, 48109, USA
| | - Steven J Katz
- Division of General Medicine, Department of Internal Medicine, University of Michigan, 2800 Plymouth Rd, Building 16, Ann Arbor, MI, 48109, USA
- Department of Health Management and Policy, University of Michigan, 2800 Plymouth Rd, Building 16, Ann Arbor, MI, 48109, USA
| | - Sarah T Hawley
- Division of General Medicine, Department of Internal Medicine, University of Michigan, 2800 Plymouth Rd, Building 16, Ann Arbor, MI, 48109, USA
- Department of Health Management and Policy, University of Michigan, 2800 Plymouth Rd, Building 16, Ann Arbor, MI, 48109, USA
- Veterans Administration Center for Clinical Management Research, Ann Arbor VA Health Care System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
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Hibbard JH, Peters E, Dixon A, Tusler M. Consumer Competencies and the Use of Comparative Quality Information. Med Care Res Rev 2016; 64:379-94. [PMID: 17684108 DOI: 10.1177/1077558707301630] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
While consumers are increasingly expected to use complex health care information to make informed decisions, it is unclear how many have the skills to do so. In this investigation we examine health literacy, numeracy, and patient activation, assessing the contribution of each to the comprehension of comparative health care performance reports and their use in making an informed choice. A convenience sample of 303 employed-age adults participated in the study. The findings indicate that numeracy skill is the strongest predictor of comprehension, followed by health literacy. Higher activation helps those low in literacy and numeracy compensate for their lower skills and achieve higher levels of comprehension. In addition, making good choices, when trade-offs are necessary, is related to activation separate from comprehension. This is important as many real-life choices involve trade-offs. Results indicate that choice is not just about literacy or comprehension, it also has to do with activation.
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Carnero MC, Gómez A. A multicriteria decision making approach applied to improving maintenance policies in healthcare organizations. BMC Med Inform Decis Mak 2016; 16:47. [PMID: 27108234 PMCID: PMC4841972 DOI: 10.1186/s12911-016-0282-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 04/08/2016] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Healthcare organizations have far greater maintenance needs for their medical equipment than other organization, as many are used directly with patients. However, the literature on asset management in healthcare organizations is very limited. The aim of this research is to provide more rational application of maintenance policies, leading to an increase in quality of care. METHODS This article describes a multicriteria decision-making approach which integrates Markov chains with the multicriteria Measuring Attractiveness by a Categorical Based Evaluation Technique (MACBETH), to facilitate the best choice of combination of maintenance policies by using the judgements of a multi-disciplinary decision group. The proposed approach takes into account the level of acceptance that a given alternative would have among professionals. It also takes into account criteria related to cost, quality of care and impact of care cover. RESULTS This multicriteria approach is applied to four dialysis subsystems: patients infected with hepatitis C, infected with hepatitis B, acute and chronic; in all cases, the maintenance strategy obtained consists of applying corrective and preventive maintenance plus two reserve machines. CONCLUSIONS The added value in decision-making practices from this research comes from: (i) integrating the use of Markov chains to obtain the alternatives to be assessed by a multicriteria methodology; (ii) proposing the use of MACBETH to make rational decisions on asset management in healthcare organizations; (iii) applying the multicriteria approach to select a set or combination of maintenance policies in four dialysis subsystems of a health care organization. In the multicriteria decision making approach proposed, economic criteria have been used, related to the quality of care which is desired for patients (availability), and the acceptance that each alternative would have considering the maintenance and healthcare resources which exist in the organization, with the inclusion of a decision-making group. This approach is better suited to actual health care organization practice and depending on the subsystem analysed, improvements are introduced that are not included in normal maintenance policies; in this way, not only have different maintenance policies been suggested, but also alternatives that, in each case and according to viability, provide a more complete decision tool for the maintenance manager.
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Affiliation(s)
- María Carmen Carnero
- Business Administration Department, University of Castilla-La Mancha, Avda. Camilo José Cela s/n, 13071, Ciudad Real, Spain. .,Centre for Management Studies (CEG-IST), University of Lisbon, Instituto Superior Tecnico, Lisbon, Portugal.
| | - Andrés Gómez
- Business Administration Department, University of Castilla-La Mancha, Avda. Camilo José Cela s/n, 13071, Ciudad Real, Spain.,SESCAM, University General Hospital of Ciudad Real, C/Obispo Rafael Torija s/n, 13005, Ciudad Real, Spain
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Williams PA, O'Donoghue AC, Sullivan HW, Willoughby JF, Squire C, Parvanta S, Betts KR. Communicating efficacy information based on composite scores in direct-to-consumer prescription drug advertising. PATIENT EDUCATION AND COUNSELING 2016; 99:583-590. [PMID: 26589655 PMCID: PMC8827128 DOI: 10.1016/j.pec.2015.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 09/02/2015] [Accepted: 10/28/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Drug efficacy can be measured by composite scores, which consist of two or more symptoms or other clinical components of a disease. We evaluated how individuals interpret composite scores in direct-to-consumer (DTC) prescription drug advertising. METHODS We conducted an experimental study of seasonal allergy sufferers (n=1967) who viewed a fictitious print DTC ad that varied by the type of information featured (general indication, list of symptoms, or definition of composite scores) and the presence or absence of an educational intervention about composite scores. We measured composite score recognition and comprehension, and perceived drug efficacy and risk. RESULTS Ads that featured either (1) the composite score definition alone or (2) the list of symptoms or general indication information along with the educational intervention improved composite score comprehension. Ads that included the composite score definition or the educational intervention led to lower confidence in the drug's benefits. The composite score definition improved composite score recognition and lowered drug risk perceptions. CONCLUSION Adding composite score information to DTC print ads may improve individuals' comprehension of composite scores and affect their perceptions of the drug. PRACTICE IMPLICATIONS Providing composite score information may lead to more informed patient-provider prescription drug decisions.
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Affiliation(s)
| | - Amie C O'Donoghue
- Office of Prescription Drug Promotion, Center for Drug Evaluation and Research, Food and Drug Administration (FDA), Silver Spring, MD, USA
| | - Helen W Sullivan
- Office of Prescription Drug Promotion, Center for Drug Evaluation and Research, Food and Drug Administration (FDA), Silver Spring, MD, USA
| | - Jessica Fitts Willoughby
- RTI International, Research Triangle Park, NC, USA; Edward R. Murrow College of Communication, Washington State University, Pullman, WA, USA.
| | | | | | - Kevin R Betts
- Office of Prescription Drug Promotion, Center for Drug Evaluation and Research, Food and Drug Administration (FDA), Silver Spring, MD, USA
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Communicating Cardiovascular Disease Risk to People with Psoriasis: What Techniques do Practitioners Use? Int J Behav Med 2015; 23:168-78. [DOI: 10.1007/s12529-015-9517-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Smith SG, Curtis LM, O'Conor R, Federman AD, Wolf MS. ABCs or 123s? The independent contributions of literacy and numeracy skills on health task performance among older adults. PATIENT EDUCATION AND COUNSELING 2015; 98:991-7. [PMID: 25936579 PMCID: PMC4468001 DOI: 10.1016/j.pec.2015.04.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 02/13/2015] [Accepted: 04/12/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the relationship between literacy and numeracy and their association with health task performance. METHODS Older adults (n=304) completed commonly used measures of literacy and numeracy. Single factor literacy and numeracy scores were calculated and used to predict performance on an established set of health self-management tasks, including: (i) responding to spoken information; (ii) comprehension of print and (iii) multimedia information; and (iv) organizing and dosing medication. Total and sub-scale scores were calculated. RESULTS Literacy and numeracy measures were highly correlated (rs=0.68; ps<0.001). In multivariable models adjusted for age, gender, race, education, and comorbidity, lower literacy (β=0.44, p<0.001) and numeracy (β=0.44, p<0.001) were independently associated with worse overall task performance and all sub-scales (literacy range, β=0.23-0.45, ps<0.001; numeracy range, β=0.31-0.41, ps<0.001). Multivariable analyses with both constructs entered explained more variance in overall health task performance compared with separate literacy and numeracy models (8.2% and 10% respectively, ps<0.001). CONCLUSION Literacy and numeracy were highly correlated, but independent predictors of health task performance. These skill sets are complementary and both are important for health self-management. PRACTICE IMPLICATIONS Self-management interventions may be more effective if they consider both literacy and numeracy skills rather than focusing on one specific ability.
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Affiliation(s)
- Samuel G Smith
- Health Literacy and Learning Program, Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, USA; Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
| | - Laura M Curtis
- Health Literacy and Learning Program, Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, USA
| | - Rachel O'Conor
- Health Literacy and Learning Program, Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, USA
| | - Alex D Federman
- Division of General Internal Medicine, Mount Sinai School of Medicine, New York, USA
| | - Michael S Wolf
- Health Literacy and Learning Program, Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, USA; Department of Learning Sciences, Northwestern University, Chicago, USA
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Wood SA, Liu PJ, Hanoch Y, Estevez-Cores S. Importance of Numeracy as a Risk Factor for Elder Financial Exploitation in a Community Sample. J Gerontol B Psychol Sci Soc Sci 2015. [PMID: 26224756 DOI: 10.1093/geronb/gbv041] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To examine the role of numeracy, or comfort with numbers, as a potential risk factor for financial elder exploitation in a community sample. METHOD Individually administered surveys were given to 201 independent, community-dwelling adults aged 60 and older. Risk for financial elder exploitation was assessed using the Older Adult Financial Exploitation Measure (OAFEM). Other variables of interest included numeracy, executive functioning, and other risk factors identified from the literature. Assessments were completed individually at the Wood Lab at Scripps College in Claremont, CA and neighboring community centers. RESULTS After controlling for other variables, including education, lower numeracy was related to higher scores on the OAFEM consistent with higher risk for financial exploitation. Self-reported physical and mental health, male gender, and younger age were also related to increased risk. CONCLUSIONS Results indicated that numeracy is a significant risk factor for elder financial exploitation after controlling for other commonly reported variables. These findings are consistent with the broader literature relating numeracy to wealth and debt levels and extend them to the area of elder financial exploitation.
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Affiliation(s)
- Stacey A Wood
- Department of Psychology, Scripps College, Claremont, California.
| | - Pi-Ju Liu
- Department of Psychology, University of San Francisco, California
| | - Yaniv Hanoch
- School of Psychology, Cognition Institute, University of Plymouth
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Misuraca R, Teuscher U, Carmeci FA. Who are maximizers? Future oriented and highly numerate individuals. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2015; 51:307-11. [PMID: 25960435 DOI: 10.1002/ijop.12169] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 04/04/2015] [Indexed: 11/06/2022]
Abstract
Two studies investigated cognitive mechanisms that may be associated with people's tendency to maximize. Maximizers are individuals who are spending a great amount of effort in order to find the very best option in a decision situation, rather than stopping the decision process when they encounter a satisfying option. These studies show that maximizers are more future oriented than other people, which may motivate them to invest the extra energy into optimal choices. Maximizers also have higher numerical skills, possibly facilitating the cognitive processes involved with decision trade-offs.
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Affiliation(s)
- Raffaella Misuraca
- Dipartimento di Scienze Psicologiche, Pedagogiche e della Formazione, Università degli Studi di Palermo, Italy.,Department of Psychology, Washington State University, Vancouver, WA, USA
| | - Ursina Teuscher
- Department of Psychology, Portland State University, Portland, OR, USA
| | - Floriana Antonella Carmeci
- Dipartimento di Scienze Psicologiche, Pedagogiche e della Formazione, Università degli Studi di Palermo, Italy
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Simple messages help set the record straight about scientific agreement on human-caused climate change: the results of two experiments. PLoS One 2015; 10:e0120985. [PMID: 25812121 PMCID: PMC4374663 DOI: 10.1371/journal.pone.0120985] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 01/22/2015] [Indexed: 11/26/2022] Open
Abstract
Human-caused climate change is happening; nearly all climate scientists are convinced of this basic fact according to surveys of experts and reviews of the peer-reviewed literature. Yet, among the American public, there is widespread misunderstanding of this scientific consensus. In this paper, we report results from two experiments, conducted with national samples of American adults, that tested messages designed to convey the high level of agreement in the climate science community about human-caused climate change. The first experiment tested hypotheses about providing numeric versus non-numeric assertions concerning the level of scientific agreement. We found that numeric statements resulted in higher estimates of the scientific agreement. The second experiment tested the effect of eliciting respondents’ estimates of scientific agreement prior to presenting them with a statement about the level of scientific agreement. Participants who estimated the level of agreement prior to being shown the corrective statement gave higher estimates of the scientific consensus than respondents who were not asked to estimate in advance, indicating that incorporating an “estimation and reveal” technique into public communication about scientific consensus may be effective. The interaction of messages with political ideology was also tested, and demonstrated that messages were approximately equally effective among liberals and conservatives. Implications for theory and practice are discussed.
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Severtson DJ. Testing Map Features Designed to Convey the Uncertainty of Cancer Risk: Insights Gained From Assessing Judgments of Information Adequacy and Communication Goals. SCIENCE COMMUNICATION 2015; 37:59-88. [PMID: 26412960 PMCID: PMC4580979 DOI: 10.1177/1075547014565908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Barriers to communicating the uncertainty of environmental health risks include preferences for certain information and low numeracy. Map features designed to communicate the magnitude and uncertainty of estimated cancer risk from air pollution were tested among 826 participants to assess how map features influenced judgments of adequacy and the intended communication goals. An uncertain versus certain visual feature was judged as less adequate but met both communication goals and addressed numeracy barriers. Expressing relative risk using words communicated uncertainty and addressed numeracy barriers but was judged as highly inadequate. Risk communication and visual cognition concepts were applied to explain findings.
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Fontana M, Asaria P, Moraldo M, Finegold J, Hassanally K, Manisty CH, Francis DP. Patient-accessible tool for shared decision making in cardiovascular primary prevention: balancing longevity benefits against medication disutility. Circulation 2014; 129:2539-2546. [PMID: 24744274 DOI: 10.1161/circulationaha.113.007595] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Primary prevention guidelines focus on risk, often assuming negligible aversion to medication, yet most patients discontinue primary prevention statins within 3 years. We quantify real-world distribution of medication disutility and separately calculate the average utilities for a range of risk strata. METHOD AND RESULTS We randomly sampled 360 members of the general public in London. Medication aversion was quantified as the gain in lifespan required by each individual to offset the inconvenience (disutility) of taking an idealized daily preventative tablet. In parallel, we constructed tables of expected gain in lifespan (utility) from initiating statin therapy for each age group, sex, and cardiovascular risk profile in the population. This allowed comparison of the widths of the distributions of medication disutility and of group-average expectation of longevity gain. Observed medication disutility ranged from 1 day to >10 years of life being required by subjects (median, 6 months; interquartile range, 1-36 months) to make daily preventative therapy worthwhile. Average expected longevity benefit from statins at ages ≥50 years ranges from 3.6 months (low-risk women) to 24.3 months (high-risk men). CONCLUSION We can no longer assume that medication disutility is almost zero. Over one-quarter of subjects had disutility exceeding the group-average longevity gain from statins expected even for the highest-risk (ie, highest-gain) group. Future primary prevention studies might explore medication disutility in larger populations. Patients may differ more in disutility than in prospectively definable utility (which provides only group-average estimates). Consultations could be enriched by assessing disutility and exploring its reasons.
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Affiliation(s)
- Marianna Fontana
- International Centre for Circulatory Health, National Heart and lung Institute, Imperial College London, UK
| | - Perviz Asaria
- International Centre for Circulatory Health, National Heart and lung Institute, Imperial College London, UK
| | - Michela Moraldo
- International Centre for Circulatory Health, National Heart and lung Institute, Imperial College London, UK
| | - Judith Finegold
- International Centre for Circulatory Health, National Heart and lung Institute, Imperial College London, UK
| | - Khalil Hassanally
- International Centre for Circulatory Health, National Heart and lung Institute, Imperial College London, UK
| | - Charlotte H Manisty
- International Centre for Circulatory Health, National Heart and lung Institute, Imperial College London, UK
| | - Darrel P Francis
- International Centre for Circulatory Health, National Heart and lung Institute, Imperial College London, UK
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Harrison M, Rigby D, Vass C, Flynn T, Louviere J, Payne K. Risk as an Attribute in Discrete Choice Experiments: A Systematic Review of the Literature. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2014; 7:151-70. [DOI: 10.1007/s40271-014-0048-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gaissmaier W, Anderson BL, Schulkin J. How do physicians provide statistical information about antidepressants to hypothetical patients? Med Decis Making 2013; 34:206-15. [PMID: 23986033 DOI: 10.1177/0272989x13501720] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Little is known about how physicians provide statistical information to patients, which is important for informed consent. METHODS In a survey, obstetricians and gynecologists (N = 142) received statistical information about the benefit and side effects of an antidepressant. They received information in various formats, including event rates (antidepressant v. placebo), absolute risks, and relative risks. Participants had to imagine 2 hypothetical patients, 1 for whom they believed the drug to be safe and effective and 1 for whom they did not, and select the information they would give those patients. We assessed whether the information they selected for each patient was complete, transparent, interpretable, or persuasive (i.e., to nudge patients toward a particular option) and compared physicians who gave both patients the same information with those who gave both patients different information. RESULTS A similar proportion of physicians (roughly 25% each) selected information that was 1) complete and transparent, 2) complete but not transparent, 3) not interpretable for the patient because necessary comparative information was missing, or 4) suited for nudging. Physicians who gave both patients the same information (61% of physicians) more often selected at least complete information, even if it was often not transparent. Physicians who gave both patients different information (39% of physicians), in contrast, more often selected information that was suited for nudging in line with the belief they were asked to imagine. A limitation is that scenarios were hypothetical. CONCLUSIONS Most physicians did not provide complete and transparent information. Clinicians who presented consistent information to different patients tended to present complete information, whereas those who varied what information they chose to present appeared more prone to nudging.
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Affiliation(s)
- Wolfgang Gaissmaier
- Harding Center for Risk Literacy, Max Planck Institute for Human Development, Berlin, Germany (WG)
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Låg T, Bauger L, Lindberg M, Friborg O. The Role of Numeracy and Intelligence in Health-Risk Estimation and Medical Data Interpretation. JOURNAL OF BEHAVIORAL DECISION MAKING 2013. [DOI: 10.1002/bdm.1788] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Torstein Låg
- Faculty of Health Sciences, Department of Psychology; University of Tromsø; Tromsø Norway
- University Library of Tromsø; Tromsø Norway
| | - Lars Bauger
- Faculty of Health Sciences, Department of Psychology; University of Tromsø; Tromsø Norway
- University College of Telemark; Porsgrunn Norway
| | - Martin Lindberg
- Faculty of Health Sciences, Department of Psychology; University of Tromsø; Tromsø Norway
| | - Oddgeir Friborg
- Faculty of Health Sciences, Department of Psychology; University of Tromsø; Tromsø Norway
- Department of Psychiatric Research; University Hospital of North Norway; Tromsø Norway
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