Going with your gut: How William James' theory of emotions brings insights to risk perception and decision making research

Acceptability of adding a non-contrast abdominal CT scan to screen for kidney cancer and other abdominal pathology within a community-based CT screening programme for lung cancer: A qualitative study

OBJECTIVES

The Yorkshire Kidney Screening Trial (YKST) is a feasibility study of adding non-contrast abdominal CT scanning to screen for kidney cancer and other abdominal malignancies to community-based CT screening for lung cancer within the Yorkshire Lung Screening Trial (YLST). This study explored the acceptability of the combined screening approach to participants and healthcare professionals (HCPs) involved in the trial.

METHODS

We conducted semi-structured interviews with eight HCPs and 25 participants returning for the second round of scanning within YLST, 20 who had taken up the offer of the additional abdominal CT scan and five who had declined. Transcripts were analysed using thematic analysis, guided by the Theoretical Framework of Acceptability.

RESULTS

Overall, combining the offer of a non-contrast abdominal CT scan alongside the low-dose thoracic CT was considered acceptable to participants, including those who had declined the abdominal scan. The offer of the additional scan made sense and fitted well within the process, and participants could see benefits in terms of efficiency, cost and convenience both for themselves as individuals and also more widely for the NHS. Almost all participants made an instant decision at the point of initial invitation based more on trust and emotions than the information provided. Despite this, there was a clear desire for more time to decide whether to accept the scan or not. HCPs also raised concerns about the burden on the study team and wider healthcare system arising from additional workload both within the screening process and downstream following findings on the abdominal CT scan.

CONCLUSIONS

Adding a non-contrast abdominal CT scan to community-based CT screening for lung cancer is acceptable to both participants and healthcare professionals. Giving potential participants prior notice and having clear pathways for downstream management of findings will be important if it is to be offered more widely.

Changes of public risk perception in China: 2008-2018

This paper characterizes the risk acceptance of the Chinese public based on a psychometric paradigm and documents its change by conducting a nationally representative longitudinal survey spanning 10 years. We explore key factors that influence the acceptance of seven typical risks: drinking water pollution, interior decoration, electromagnetic radiation, air pollution, chemical plants, public transportation, and natural hazards, reflecting the general and referential changes in risk perception. The results show a general decrease in the acceptance of all of these risks in the examined decade, especially in economically developed areas. Different types of risk perception varied, but environmental risks had similar trends of perception. The perceived benefits from these risks and local GDP had the greatest impact on risk acceptance. The interaction between the changing perspectives of the emerging middle class and the evolving hazard risk landscape may be the reasons for the reduction in risk acceptance. The main findings offer insights for effective risk education and communication as well as sustainable risk management strategy.

The impact of information about different absolute benefits and harms on intention to participate in colorectal cancer screening: A think-aloud study and online randomised experiment

BACKGROUND

There is considerable heterogeneity in individuals' risk of disease and thus the absolute benefits and harms of population-wide screening programmes. Using colorectal cancer (CRC) screening as an exemplar, we explored how people make decisions about screening when presented with information about absolute benefits and harms, and how those preferences vary with baseline risk, between screening tests and between individuals.

METHOD

We conducted two linked studies with members of the public: a think-aloud study exploring decision making in-depth and an online randomised experiment quantifying preferences. In both, participants completed a web-based survey including information about three screening tests (colonoscopy, sigmoidoscopy, and faecal immunochemical testing) and then up to nine scenarios comparing screening to no screening for three levels of baseline risk (1%, 3% and 5% over 15 years) and the three screening tests. Participants reported, after each scenario, whether they would opt for screening (yes/no).

RESULTS

Of the 20 participants in the think-aloud study 13 did not consider absolute benefits or harms when making decisions concerning CRC screening. In the online experiment (n = 978), 60% expressed intention to attend at 1% risk of CRC, 70% at 3% and 77% at 5%, with no differences between screening tests. At an individual level, 535 (54.7%) would attend at all three risk levels and 178 (18.2%) at none. The 27% whose intention varied by baseline risk were more likely to be younger, without a family history of CRC, and without a prior history of screening.

CONCLUSIONS

Most people in our population were not influenced by the range of absolute benefits and harms associated with CRC screening presented. For an appreciable minority, however, magnitude of benefit was important.

Worry about lung cancer is related to numeracy and risk perception of diseases associated with smoking

Background

Numeracy is one's ability to use numbers in context and influence's decision making and perceptions of health risk. Worry about lung cancer¹ is an indicator of perceived risk² and is related to interest in cessation and cancer screening.

Purpose

The analysis sought to explore underlying relationships among worry about lung cancer, smoking-related disease risk perceptions, and numeracy in a web-based panel.

Methods

A Web-based survey, including a numeracy measure, was completed by 1,682 participants aged 18-65 recruited in 2014. Former and current smokers were asked about LC worry and current smokers were asked their PR of diseases associated with smoking.

Results

Females (m=25.64, 95% CI [24.67, 26.61]), respondents aged 45-65 (m=26.15, 95% CI [24.89, 27.41]), those who worry "all the time" about LC (m=27.62, 95% CI [25.66, 29.58]), and respondents perceiving a higher risk of LC compared to other smokers (m=28.84, 95% CI [27.66, 30.01]) expressed significantly higher PR means. Higher household income (OR=1.20, 95% CI [1.08, 1.34]), age (OR=0.86, 95% CI [0.77, 0.98]), and comparative LC risk (OR=2.52, 95% CI [2.01, 3.17]) were significantly associated with greater worry about LC. As PR increases by one unit, the probability of worrying increases by 4.6%. For numeracy scores, odds ratio showed that as scores increased by one unit, the probability of worrying decreased by 11.9%.

Discussion

In this study, we have shown that PR has a positive association with LC worry and that numeracy has a negative association with LC worry.

Translation to health education practice

This information can be used to target subpopulations with low PR and numeracy about their risks for lung cancer and to develop tailored messages to educate these people.