We introduce a brief instrument specifically validated for measuring positive and negative feelings about risks—the Berlin Emotional Responses to Risk Instrument (BERRI). Based on seven studies ...involving diverse adults from three countries (n = 2120), the BERRI was found to robustly estimate anticipatory affective reactions derived from subjective evaluations of positive (i.e., assured, hopeful, and relieved) and negative emotions (i.e., anxious, afraid, and worried). The brief BERRI outperformed a 14‐item assessment, uniquely tracking costs/benefits associated with cancer screening among men and women (Studies 1 and 2). Predictive validity was further documented in paradigmatic risky choice studies wherein options varied over probabilities and severities across six contexts (health, social, financial, technological, ethical, and environmental; Study 3). Studies 4–6, conducted during the Ebola epidemic and COVID‐19 pandemic, indicated BERRI responses were sensitive to subtle effects caused by emotion‐related framing manipulations presented in different cultures and languages (the United States, Spain, and Poland). Study 7 indicated BERRI responses remained stable for 2 weeks. Although the BERRI can provide an estimate of overall affect, choices were generally better explained by the unique influences of positive and negative affect. Overall, results suggest the novel, brief instrument can be an efficient tool for high‐stakes research on decision making and risk communication.
Research suggests that people are less sensitive to variations in probability in affect‐rich compared with affect‐poor risky choices. This effect is modeled by a more curved probability weighting ...function (PWF). We investigated the role of different numeric competencies and the effectiveness of several intervention strategies to decrease this affect‐laden probability distortion. In two experiments, we manipulated the affect‐richness of a risky prospect. In Experiment 1 (N = 467), we measured numeracy and symbolic‐number mapping (i.e., the ability to accurately map numbers onto their underlying magnitudes). The affect‐based manipulations showed the expected effects only in participants with more accurate symbolic‐number mapping, who also reported more differentiated emotional reactions to the various probabilities and displayed more linear PWFs. Instructions to focus on the probability information decreased probability distortion and revealed differences in the use of probability information on the basis of symbolic‐number mapping ability. In Experiment 2 (N = 417), we manipulated the format in which the probability information was presented: using visual aids versus no visual aids and a positive frame (e.g., one person wins) versus combined frame (e.g., one person wins and 99 persons do not win). The affect‐based manipulations had no effect but both the visual aids and combined frame decreased probability distortion. Whereas affect‐richness manipulations require further research, results suggest that probability weighting is at least partially driven by the inability to translate numerical information into meaningful and well‐calibrated affective intuitions. Visual aids and simple framing manipulations designed to calibrate these intuitions can help decision makers extract the gist and increase sensitivity to probabilities.
ABSTRACT
BACKGROUND
Patients must be informed about risks before any treatment can be implemented. Yet serious problems in communicating these risks occur because of framing effects.
OBJECTIVE
To ...investigate the effects of different information frames when communicating health risks to people with high and low numeracy and determine whether these effects can be countered or eliminated by using different types of visual displays (i.e., icon arrays, horizontal bars, vertical bars, or pies).
DESIGN
Experiment on probabilistic, nationally representative US (
n
= 492) and German (
n
= 495) samples, conducted in summer 2008.
OUTCOME MEASURES
Participants’ risk perceptions of the medical risk expressed in positive (i.e., chances of surviving after surgery) and negative (i.e., chances of dying after surgery) terms.
KEY RESULTS
Although low‐numeracy people are more susceptible to framing than those with high numeracy, use of visual aids is an effective method to eliminate its effects. However, not all visual aids were equally effective: pie charts and vertical and horizontal bars almost completely removed the effect of framing. Icon arrays, however, led to a smaller decrease in the framing effect.
CONCLUSIONS
Difficulties with understanding numerical information often do not reside in the mind, but in the representation of the problem.
Aims
Physical and psychiatric comorbidities are common in cancer patients and could impact their treatment and prognosis. However, the evidence base regarding the influence of comorbidities in the ...management and health service use of patients is still scant. In this research we investigated how physical comorbidities are related to the mental health and help‐seeking of cancer patients.
Methods
Data were obtained from the representative National Health Survey of Spain (2017). Participants were respondents who reported a cancer diagnosis (n = 484). These were also matched with controls without cancer history (n = 484) based on age, gender, and region. Four alternative physical comorbidities indices were created based on information regarding 28 chronic conditions. Outcomes of interest were psychological distress and having consulted a mental healthcare professional in the year before the survey.
Results
Thirty percent of cancer patients reported significant psychological distress but only 10% had consulted a professional. After adjusting for sociodemographic variables, among cancer patients each additional comorbidity was associated with 9% higher odds of reporting high psychological distress (odds ratio OR = 1.09, 95% confidence interval CI: 1.01–1.16) and 21% higher odds of having consulted a mental healthcare professional (OR = 1.21, 95% CI: 1.09–1.34). The effects of comorbidities depended on the type of index and were different in controls without cancer history.
Conclusion
Physical comorbidities in cancer patients are associated with higher risk of psychological distress and higher demand for mental health services. We encourage further research on this issue as it could improve mental health screening and management in oncologic care.
Background In the past decade, the number of lawsuits for medical malpractice has risen significantly. This could affect the way doctors make decisions for their patients.
Objective To investigate ...whether and why doctors practice defensive medicine with their patients.
Design A questionnaire study was conducted in general practice departments of eight metropolitan hospitals in Spain, between January and February 2010.
Setting and participants Eighty general practitioners (48% men; mean age 52 years) with an average of 15.3 years of experience and their 80 adult patients (42% men; mean age 56 years) participated in the study.
Main outcome measurements Participants completed a self‐administered questionnaire involving choices between a risky and a conservative treatment. One group of doctors made decisions for their patients. Another group of doctors predicted what their patients would decide for themselves. Finally, all doctors and patients made decisions for themselves and described the factors they thought influenced their decisions.
Results Doctors selected much more conservative medical treatments for their patients than for themselves. Most notably, they did so even when they accurately predicted that the patients would select riskier treatments. When asked about the reasons for their decisions, most doctors (93%) reported fear of legal consequences.
Discussion and conclusions Doctors’ decisions for their patients are strongly influenced by concerns of possible legal consequences. Patients therefore cannot blindly follow their doctor’s advice. Our study, however, suggests a plausible method that patients could use to get around this problem: They could simply ask their doctor what he or she would do in the patient’s situation.
People with low statistical numeracy have difficulties understanding numerical information. For instance, they often misunderstand the probability of experiencing side effects, which could reduce ...adherence to medical treatments. We investigated whether presenting information about probability using a method based on the direct experience of events influences the accuracy of probability estimates compared to viewing a static numerical description of the same information. Participants completed a numeracy test and were randomly assigned to one of two conditions. In the description‐based probability condition, participants were presented with 24 binomial distributions consisting of a target stimulus “X” and a distractor stimulus “·” in the form of odds (the distribution “7 × 13 ·” is an example of a 35% probability: here the target distractor stimulus was present 713 times in a 20‐stimulus distribution). In the experience‐based probability condition, participants observed the same information but the stimuli were randomly arranged and displayed sequentially. Participants in both conditions estimated the probability of the target stimulus in each trial. In the experience‐based format participants with low numeracy made more accurate probability estimates in comparison to the description‐based format. In contrast, accuracy in participants with high numeracy was similar in the two formats.
Objective:
Icon arrays have been suggested as a potentially promising format for communicating risks to patients-especially those with low numeracy skills-but experimental studies are lacking. This ...study investigates whether icon arrays increase accuracy of understanding medical risks, and whether they affect perceived seriousness of risks and helpfulness of treatments.
Design:
Two experiments were conducted on samples of older adults (
n
= 59, 62 to 77 years of age) and university students (
n
= 112, 26 to 35 years of age).
Main Outcome Measures:
Accuracy of understanding risk reduction; perceived seriousness of risks; perceived helpfulness of treatments.
Results:
Icon arrays increased accuracy of both low- and high-numeracy people, even when transparent numerical representations were used. Risks presented via icon arrays were perceived as less serious than those presented numerically. With larger icon arrays (1,000 instead of 100 icons) risks were perceived more serious, and risk reduction larger.
Conclusions:
Icon arrays are a promising way of communicating medical risks to a wide range of patient groups, including older adults with lower numeracy skills.
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