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.
    Full-text · Article · Jul 2015 · British Journal of Health Psychology
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    • "All rights reserved. influence of trade-off preferences may be particularly germane to analgesic decision-making given that related literature has shown that medical decisions are largely swayed by emotions and preferences when risks are uncertain, evoke fear (Zikmund-Fisher et al., 2010; Amsterlaw et al., 2006; Loewenstein et al., 2001), or when goals are in conflict (Elwyn and Miron-Shatz, 2010). For instance, parents' trade-off perceptions (i.e., relative treatment benefit/risk perception) and their preference to reduce risk have been associated with their likelihood of initiating or ensuring their child's adherence to chronic medication regimens (Wroe, 2002; Bussing et al., 2012). "
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    ABSTRACT: Despite parents' stated desire to treat pain in their children, recent studies have critiqued their underuse of prescribed analgesics to treat pain in their children after painful procedures. Parents' analgesic preferences, including their perceived importance of providing pain relief or avoiding adverse drug effects may have important implications for their analgesic decisions, yet no studies have evaluated the influence of preferences on decisions to withhold prescribed opioids for children. We prospectively explored how parents' preferences influenced decisions to withhold prescribed opioids when faced with hypothetical dilemmas and after hospital discharge. Prospective Observational Study Design: Phase 1 included hypothetical analgesic decisions and Phase 2, real analgesic decisions after hospital discharge. Large tertiary care pediatric hospital in the Midwest of the United States. Five-hundred seven parents whose children underwent a painful surgical procedure requiring an opioid prescription were included. At baseline, parents completed surveys assessing their pain relief preference (i.e., their rated importance of pain relief relative to adverse drug event avoidance), preferred treatment thresholds (i.e., pain level at which they would give an opioid), adverse drug event understanding, and hypothetical trade-off decisions (i.e., scenarios presenting variable pain and adverse drug event symptoms in a child). After discharge, parents recorded all analgesics they gave their child as well as pain scores at the time of administration. Higher preference to provide pain relief (over avoid analgesic risk) lessened the likelihood that parents would withhold the prescribed opioid when adverse drug event symptoms were present together with high pain scores in the hypothetical scenarios. Additionally, higher preferred treatment thresholds increased the likelihood of parents withholding opioids during their hypothetical decision-making as well as at home. The strong influence of these preferences weakened the effect of opioid ADE understanding on decisions to withhold opioids when ADEs (i.e., nausea/vomiting or oversedation) were present together with high pain. Findings from this study suggest that preferences strongly influence and may interfere with parents' effective and safe analgesic decision-making when conflicting symptoms (i.e., high pain and an ADE) are present. To improve effective analgesic use, there is a need to shape parents' preferences and improve their understanding of safe actions that will treat pain when ADE symptoms are present. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Full-text · Article · May 2015 · International journal of nursing studies
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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.
    Full-text · Article · Apr 2015 · Vaccine
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