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Sirota M, Navarrete G, Juanchich M. When intuitive Bayesians need to be good readers: The problem-wording effect on Bayesian reasoning. Cognition 2024; 245:105722. [PMID: 38309041 DOI: 10.1016/j.cognition.2024.105722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/30/2023] [Accepted: 01/12/2024] [Indexed: 02/05/2024]
Abstract
Are humans intuitive Bayesians? It depends. People seem to be Bayesians when updating probabilities from experience but not when acquiring probabilities from descriptions (i.e., Bayesian textbook problems). Decades of research on textbook problems have focused on how the format of the statistical information (e.g., the natural frequency effect) affects such reasoning. However, it pays much less attention to the wording of these problems. Mathematical problem-solving literature indicates that wording is critical for performance. Wording effects (the wording varied across the problems and manipulations) can also have far-reaching consequences. These may have confounded between-format comparisons and moderated within-format variability in prior research. Therefore, across seven experiments (N = 4909), we investigated the impact of the wording of medical screening problems and statistical formats on Bayesian reasoning in a general adult population. Participants generated more Bayesian answers with natural frequencies than with single-event probabilities, but only with the improved wording. The improved wording of the natural frequencies consistently led to more Bayesian answers than the natural frequencies with standard wording. The improved wording effect occurred mainly due to a more efficient description of the statistical information-cueing required mathematical operations, an unambiguous association of numbers with their reference class and verbal simplification. The wording effect extends the current theoretical explanations of Bayesian reasoning and bears methodological and practical implications. Ultimately, even intuitive Bayesians must be good readers when solving Bayesian textbook problems.
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Affiliation(s)
- Miroslav Sirota
- Department of Psychology, University of Essex, United Kingdom.
| | - Gorka Navarrete
- Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago de Chile, Chile
| | - Marie Juanchich
- Department of Psychology, University of Essex, United Kingdom
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2
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Ancker JS, Benda NC, Sharma MM, Johnson SB, Weiner S, Zikmund-Fisher BJ. Taxonomies for synthesizing the evidence on communicating numbers in health: Goals, format, and structure. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2022; 42:2656-2670. [PMID: 35007354 PMCID: PMC10241486 DOI: 10.1111/risa.13875] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Many people, especially those with low numeracy, are known to have difficulty interpreting and applying quantitative information to health decisions. These difficulties have resulted in a rich body of research about better ways to communicate numbers. Synthesizing this body of research into evidence-based guidance, however, is complicated by inconsistencies in research terminology and researcher goals. In this article, we introduce three taxonomies intended to systematize terminology in the literature, derived from an ongoing systematic literature review. The first taxonomy provides a systematic nomenclature for the outcome measures assessed in the studies, including perceptions, decisions, and actions. The second taxonomy is a nomenclature for the data formats assessed, including numbers (and different formats for numbers) and graphics. The third taxonomy describes the quantitative concepts being conveyed, from the simplest (a single value at a single point in time) to more complex ones (including a risk-benefit trade-off and a trend over time). Finally, we demonstrate how these three taxonomies can be used to resolve ambiguities and apparent contradictions in the literature.
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Affiliation(s)
- Jessica S Ancker
- Vanderbilt University Medical Center, Department of Biomedical Informatics, Nashville, TN
| | - Natalie C Benda
- Weill Cornell Medicine, Department of Population Health Sciences, New York, NY
| | - Mohit M Sharma
- Weill Cornell Medicine, Department of Population Health Sciences, New York, NY
| | - Stephen B Johnson
- New York University Langone Health, Department of Population Health, New York, NY
| | - Stephanie Weiner
- Weill Cornell Medicine, Department of Population Health Sciences, New York, NY
| | - Brian J Zikmund-Fisher
- University of Michigan School of Public Health, Department of Health Behavior and Health Education, Ann Arbor, MI
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Suk K, Hwang S, Jeong Y. The 1-in-X effect in perceptions of risk likelihood differences. ORGANIZATIONAL BEHAVIOR AND HUMAN DECISION PROCESSES 2022. [DOI: 10.1016/j.obhdp.2022.104131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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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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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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Sirota M, Juanchich M. Ratio Format Shapes Health Decisions: The Practical Significance of the "1-in-X" Effect. Med Decis Making 2019; 39:32-40. [PMID: 30799689 DOI: 10.1177/0272989x18814256] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Prior research found that "1-in-X" ratios led to higher and less accurate subjective probability than "N-in-X*N" ratios or other formats, even though they featured the same mathematical information. It is unclear, however, whether the effect transfers into health decisions, and the practical significance of the effect is undetermined. Based on previous findings and risk communication theories, we hypothesized that the 1-in-X effect would occur and transfer into relevant decisions. We also tested whether age, gender, and education differences would moderate the 1-in-X effect on decision making. We conducted 3 well-powered experiments ( n = 1912) using a sample from the general adult UK population to test our hypotheses, estimated the effect, and excluded a possible methodological explanation for such a transfer. In hypothetical scenarios, participants decided whether to travel to Kenya given the chance of contracting malaria (experiment 1) and whether to take recommended steroids given the side effects (experiments 2 and 3). Across the experiments, we replicated a small to medium 1-in-X effect on the perceived probability (Hedge's g = -0.36; 95% confidence interval [CI], -0.47 to -0.24; z = -6.18; P < 0.001) and found a small effect on subsequent decisions (odds ratio = 1.32; 95% CI, 1.10-1.59; z = 2.99; P = 0.003). The perceived probability fully mediated the effect of the ratio format on decision. Age, gender, and education did not moderate the 1-in-X effect on decision. We argue that a high prevalence of 1-in-X ratios in medical communication makes these small changes clinically relevant. Therefore, to communicate information accurately, 1-in-X ratios should not be used or at least used cautiously in medical communication.
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Affiliation(s)
- Miroslav Sirota
- Department of Psychology, University of Essex, Colchester, Essex, UK
| | - Marie Juanchich
- Department of Psychology, University of Essex, Colchester, Essex, UK
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Tentori K, Pighin S, Divan C, Crupi V. Mind the gap: Physicians' assessment of patients' importance weights in localized prostate cancer. PLoS One 2018; 13:e0200780. [PMID: 30048485 PMCID: PMC6062014 DOI: 10.1371/journal.pone.0200780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 07/03/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The management of localized prostate cancer is challenging because of the many therapeutic options available, none of which is generally acknowledged as superior to the others in every respect. The selection of the most appropriate treatment should therefore reflect patients' preferences. OBJECTIVE The purpose of the following study was to pilot a new approach for investigating whether urologists who had previously provided patients with therapeutic advice actually knew their patients' importance weights concerning the relevant aspects of the treatments at issue. METHOD Participants were patients recently diagnosed with localized prostate cancer (n = 20), urologists (n = 10), and non-medical professionals (architects, n = 10). These last served as a control group for the urologists and were matched to them for age and gender. Patients' importance weights were elicited by two standard methods (Direct Rating and Value Hierarchy). Each urologist was asked to estimate (with Direct Rating) his/her patient's importance weights. The same task was performed by a corresponding architect, who never met the patient and knew only the patient's age. Univariate and bivariate statistical analyses were performed to investigate the association between importance weights as elicited from patients and as estimated by urologists and architects, as well as to assess whether such agreement was attribute-dependent. RESULTS Participants found both elicitation methods easy to use. The correlation between patients' actual importance weights and urologists' estimates was poor and comparable to that obtained between patients and architects. This result did not depend on the attribute considered, with the sole exception of the attribute "Effectiveness in curing the cancer", which was evaluated as the most important attribute by the majority of participants. CONCLUSION These findings demonstrate the feasibility of the employed methodology and highlight the need to support preference-sensitive decisions in clinical practice by facilitating the elicitation of patients' importance weights, as well as their communication to physicians.
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Affiliation(s)
- Katya Tentori
- Center for Mind/Brain Sciences, University of Trento, Trento, Italy
| | - Stefania Pighin
- Center for Mind/Brain Sciences, University of Trento, Trento, Italy
| | - Claudio Divan
- Urology Division of the Santa Chiara Hospital, Trento, Italy
| | - Vincenzo Crupi
- Department of Philosophy and Educational Sciences, University of Torino, Torino, Italy
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Sirota M, Juanchich M, Petrova D, Garcia-Retamero R, Walasek L, Bhatia S. Health Professionals Prefer to Communicate Risk-Related Numerical Information Using “1-in-X” Ratios. Med Decis Making 2017; 38:366-376. [DOI: 10.1177/0272989x17734203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Miroslav Sirota
- Department of Psychology, University of Essex, Colchester, Essex, UK
| | - Marie Juanchich
- Department of Psychology, University of Essex, Colchester, Essex, UK
| | - Dafina Petrova
- Department of Experimental Psychology, Mind, Brain, and Behavior Research Center, University of Granada, Granada, Spain
| | - Rocio Garcia-Retamero
- Department of Experimental Psychology, Mind, Brain, and Behavior Research Center, University of Granada, Granada, Spain
| | - Lukasz Walasek
- Department of Psychology, University of Warwick, Coventry, West Midlands, UK
| | - Sudeep Bhatia
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
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Petrova D, Garcia-Retamero R. Can we improve risk communication about non-invasive prenatal testing? BJOG 2017; 125:272-276. [PMID: 28815989 DOI: 10.1111/1471-0528.14855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2017] [Indexed: 11/30/2022]
Affiliation(s)
- D Petrova
- Mind, Brain, and Behaviour Research Centre, Department of Experimental Psychology, University of Granada, Granada, Spain
| | - R Garcia-Retamero
- Mind, Brain, and Behaviour Research Centre, Department of Experimental Psychology, University of Granada, Granada, Spain.,Max Planck Institute for Human Development, Berlin, Germany
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Jaruthamsophon K, Sriplung H, Charalsawadi C, Limprasert P. Maternal Age-Specific Rates for Trisomy 21 and Common Autosomal Trisomies in Fetuses from a Single Diagnostic Center in Thailand. PLoS One 2016; 11:e0165859. [PMID: 27812158 PMCID: PMC5094691 DOI: 10.1371/journal.pone.0165859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 10/19/2016] [Indexed: 11/18/2022] Open
Abstract
To provide maternal age-specific rates for trisomy 21 (T21) and common autosomal trisomies (including trisomies 21, 18 and 13) in fetuses. We retrospectively reviewed prenatal cytogenetic results obtained between 1990 and 2009 in Songklanagarind Hospital, a university teaching hospital, in southern Thailand. Maternal age-specific rates of T21 and common autosomal trisomies were established using different regression models, from which only the fittest models were used for the study. A total of 17,819 records were included in the statistical analysis. The fittest models for predicting rates of T21 and common autosomal trisomies were regression models with 2 parameters (Age and Age2). The rate of T21 ranged between 2.67 per 1,000 fetuses at the age of 34 and 71.06 per 1,000 at the age of 48. The rate of common autosomal trisomies ranged between 4.54 per 1,000 and 99.65 per 1,000 at the same ages. This report provides the first maternal age-specific rates for T21 and common autosomal trisomies fetuses in a Southeast Asian population and the largest case number of fetuses have ever been reported in Asians.
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Affiliation(s)
- Kanoot Jaruthamsophon
- Human Genetics Unit, Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Hutcha Sriplung
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Chariyawan Charalsawadi
- Human Genetics Unit, Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Pornprot Limprasert
- Human Genetics Unit, Department of Pathology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
- * E-mail:
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Navarrete G, Correia R, Sirota M, Juanchich M, Huepe D. Doctor, what does my positive test mean? From Bayesian textbook tasks to personalized risk communication. Front Psychol 2015; 6:1327. [PMID: 26441711 PMCID: PMC4585185 DOI: 10.3389/fpsyg.2015.01327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/18/2015] [Indexed: 11/13/2022] Open
Abstract
Most of the research on Bayesian reasoning aims to answer theoretical questions about the extent to which people are able to update their beliefs according to Bayes' Theorem, about the evolutionary nature of Bayesian inference, or about the role of cognitive abilities in Bayesian inference. Few studies aim to answer practical, mainly health-related questions, such as, "What does it mean to have a positive test in a context of cancer screening?" or "What is the best way to communicate a medical test result so a patient will understand it?". This type of research aims to translate empirical findings into effective ways of providing risk information. In addition, the applied research often adopts the paradigms and methods of the theoretically-motivated research. But sometimes it works the other way around, and the theoretical research borrows the importance of the practical question in the medical context. The study of Bayesian reasoning is relevant to risk communication in that, to be as useful as possible, applied research should employ specifically tailored methods and contexts specific to the recipients of the risk information. In this paper, we concentrate on the communication of the result of medical tests and outline the epidemiological and test parameters that affect the predictive power of a test-whether it is correct or not. Building on this, we draw up recommendations for better practice to convey the results of medical tests that could inform health policy makers (What are the drawbacks of mass screenings?), be used by health practitioners and, in turn, help patients to make better and more informed decisions.
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Affiliation(s)
- Gorka Navarrete
- Psychology Department, Laboratory of Cognitive and Social Neuroscience, UDP-INECO Foundation Core on Neuroscience, Universidad Diego Portales Santiago, Chile
| | - Rut Correia
- Faculty of Education, Universidad Diego Portales Santiago, Chile
| | - Miroslav Sirota
- Department of Psychology, Kingston University Kingston upon Thames, UK
| | - Marie Juanchich
- Department of Management, Kingston University Kingston upon Thames, UK
| | - David Huepe
- Psychology Department, Laboratory of Cognitive and Social Neuroscience, UDP-INECO Foundation Core on Neuroscience, Universidad Diego Portales Santiago, Chile
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