Risky feelings: Why a 6% risk of cancer does not always feel like 6%

Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI 48109-2029, USA.
Patient Education and Counseling (Impact Factor: 2.2). 12/2010; 81 Suppl:S87-93. DOI: 10.1016/j.pec.2010.07.041
Source: PubMed


Emotion plays a strong role in the perception of risk information but is frequently underemphasized in the decision-making and communication literature. We sought to discuss and put into context several lines of research that have explored the links between emotion and risk perceptions.
In this article, we provide a focused, "state of the science" review of research revealing the ways that emotion, or affect, influences people's cancer-related decisions. We identify illustrative experimental research studies that demonstrate the role of affect in people's estimates of cancer risk, their decisions between different cancer treatments, their perceptions of the chance of cancer recurrence, and their reactions to different methods of presenting risk information.
These studies show that people have strong affective reactions to cancer risk information and that the way risk information is presented often determines the emotional gist people take away from such communications.
Cancer researchers, educators and oncologists need to be aware that emotions are often more influential in decision making about cancer treatments and prevention behaviors than factual knowledge is.
Anticipating and assessing affective reactions is an essential step in the evaluation and improvement of cancer risk communications.

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Available from: Brian Zikmund-Fisher, Jan 15, 2014
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    • "Some did accept the risk number, but judged it to be not that high, whereas others doubted its accuracy. The first problem seemed to be related to the fact that risk numbers had ambiguous meaning and that participants might have used cues from the way information was presented to judge whether it was good or bad (Zikmund-Fisher et al., 2010). The bar graph seemed to evoke a false assumption that one's risk could reach a maximum of 100% and therefore conclude that 'it could have been worse', whereas experts would say that it is bad enough. "
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    ABSTRACT: Objectives To identify the barriers from the perspective of consumers with low health literacy in using risk information as provided in cardiometabolic risk assessments.DesignA qualitative thematic approach using cognitive interviews was employed.Methods We performed interviews with 23 people with low health literacy/health numeracy, who were recruited through (1) several organisations and snowball sampling and (2) an online access panel. Participants completed the risk test of the Dutch national cardiometabolic risk assessment and viewed the personalized information about their risk. They were asked to answer probing questions about different parts of the information. The qualitative data were analysed by identifying main themes related to barriers in using the information, using a descriptive thematic approach.ResultsThe four main themes identified were as follows: (1) People did not fully accept the risk message, partly because numerical information had ambiguous meaning; (2) people lacked an adequate framework for understanding their risk; (3) the purpose and setting of the risk assessment was unclear; and (4) current information tells nothing new: A need for more specific risk information.Conclusions The main barriers were that the current presentation seemed to provoke undervaluation of the risk number and that texts throughout the test, for example about cardiometabolic diseases, did not match people's existing knowledge, failing to provide an adequate framework for understanding cardiometabolic risk. Our findings have implications for the design of disease risk information, for example that alternative forms of communication should be explored that provide more intuitive meaning of the risk in terms of good versus bad.Statement of contribution What is already known on this subject? Online disease risk assessments have become widely available internationally.People with low SES and health literacy tend to participate less in health screening.Risk information is difficult to understand, yet little research has been carried out among people with low health literacy. What does this study add? People with low health literacy do not optimally use risk information in an online cardiometabolic risk assessment.The texts provided in the cardiometabolic risk assessment do not suit to their existing knowledge.The typical risk communication (numbers, bar graph, verbal label) seems to provoke undervaluation of risk.
    British Journal of Health Psychology 07/2015; DOI:10.1111/bjhp.12149 · 2.70 Impact Factor
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    • "The themes uncovered in this meta-analysis also make clear that those interested in promoting influenza vaccination need to recognize that how people make vaccination decisions is similar to how they make other health and medical decisions. Recent studies on health and medical decision making, for instance, have found that risks create feelings, and as result, even well informed patients make medical decisions or perform health behaviors that are at odds with health experts' advice [29]. In such cases, people often default to an " affect " heuristic (i.e., cognitive shortcut) where they presume that the risks are low for risks associated with things they like and that the reverse is true for things they do not like [30]. "
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    ABSTRACT: A primary mission of the U.S. Centers for Disease Control and Prevention's (CDC) is promoting immunization against seasonal influenza. As with most education efforts, CDC's influenza-related communications are often informed by formative research. A qualitative meta-analysis of 29 unpublished, primarily qualitative CDC-sponsored studies related to flu and flu vaccination knowledge, attitudes and beliefs (KABs). The studies, undertaken between 2000 and 2013, involved focus groups, in-depth interviews, message testing and surveys. Some involved health care professionals, while others involved members of the public, including sub-populations at risk for severe illness. The themes that emerged suggested progress in terms of KABs related to influenza and influenza vaccination, but also the persistence of many barriers to vaccine acceptance. With respect to the public, recurring themes included limited understanding of influenza and immunization recommendations, indications of greater sub-group recognition of the value of flu vaccination, continued resistance to vaccination among many, and overestimation of the effectiveness of non-vaccine measures. Seven cognitive facilitators of vaccination were identified in the studies along with six cognitive barriers. For health care providers, the analysis suggests greater knowledge and more favorable beliefs, but many misperceptions persist and are similar to those held by the public. KABs often differed by type or category of health care provider. The themes identified in this qualitative analysis illustrate the difficulty in changing KABs related to influenza and influenza vaccine, particularly on the scope and scale needed to greatly improve uptake. Even with an influenza pandemic and more vaccine options available, public and some health care provider perceptions and beliefs are difficult and slow to change. This meta-analysis does, however, provide important insights from previously unpublished information that can help those who are promoting influenza vaccination to health care providers, the general public and specific populations within the general population. Copyright © 2015. Published by Elsevier Ltd.
    Vaccine 04/2015; 33(24). DOI:10.1016/j.vaccine.2015.04.064 · 3.62 Impact Factor
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    • "There are a large number of individuals who are worried about their family history and who are referred to specialist cancer genetics clinics for risk assessment, genetic counselling and in some instances genetic testing. Most information in genetics is based on probability and uncertainty [5]. Therefore, living with the risk of inheriting cancer is a complex experience that can affect cognitive, emotional and social functioning. "
    Patient Education and Counseling 04/2011; 84(2):280-1. DOI:10.1016/j.pec.2011.03.004 · 2.20 Impact Factor
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