Making risk visible: The role of images in the assessment of (cancer) genetic risk

Existential Threat or Dissociative Response? Examining Defensive Avoidance of Point-of-Care Testing Devices Through a Terror Management Theory Framework

Using a terror management theory framework, this study investigated if providing mortality reminders or self-esteem threats would lead participants to exhibit avoidant responses toward a point-of-care testing device for cardiovascular disease risk and if the nature of the device served to diminish the existential threat of cardiovascular disease. One hundred and twelve participants aged 40-55 years completed an experimental questionnaire. Findings indicated that participants were not existentially threatened by established terror management methodologies, potentially because of cross-cultural variability toward such methodologies. Highly positive appraisals of the device also suggest that similar technologies may beneficially affect the uptake of screening behaviors.

Investigating the impact of gender and existential anxiety on the willingness to participate in point-of-care testing for cardiovascular disease

Two studies (N = 136) investigated whether or not gender or mortality reminders would impact middle-aged and older adults' appraisal of a novel point-of-care testing device for cardiovascular disease risk. Middle-aged females were significantly more likely to positively appraise and commit to using the device compared to middle-aged males, but there were no such gender differences among older adults. Both studies also failed to support hypotheses that existential concerns would lead to avoidance of the device. When taken together, the findings suggest that similar devices may beneficially affect screening behaviours and underscore a need to target middle-aged males for cardiovascular screening interventions.

Agency and choice in genetic counseling: Acknowledging patients' concerns

This paper investigates to what degree patients can be said to effectively manifest agency during the process of genetic counseling for cancer risk. Rather than talk about agency on an abstract level, the discussion is grounded in examples from actual genetic counseling sessions. Past research in this area recognises three dimensions along which clients' agency can be assessed: the availability of choice; potential prescriptiveness or framing biases in the presentation of options; and whether particular decisions are embedded within broader moral frameworks (in particular, perceived obligation to kin). In this paper it is argued that in addition to these three dimensions, an investigation of agency needs to explore the degree to which the concerns brought to counseling sessions by patients match up with the choices and management strategies offered by genetic counsellors. An analysis of four excerpts from actual counseling sessions is presented to illustrate the case.

Self-regulation and the behavioural response to DNA risk information: a theoretical analysis and framework for future research

The few studies conducted to date suggest that DNA risk information may be less likely to achieve behaviour change than other types of health risk information. We draw upon self-regulation theory to explain and predict the characteristics of risk information that are more and less likely to motivate behaviour change. Self-regulation theory describes how information about a health threat is processed within individuals' pre-existing cognitive schema, and how the cognitive representations within these schemas activate coping procedures for dealing with the perceived threat. We explore the proposition that the initial impact of information about a health threat depends upon how well it "fits" with existing cognitive representations of that threat. For example, in one study DNA risk information regarding an inherited form of bowel cancer was perceived as more accurate and had a greater impact on risk perceptions in those whose representation of the threat included genes as the single cause, as opposed to one of several. Since the cognitive representation of a threat activates coping procedures that fit with that representation, we also explore the proposition that cognitive representations of a threat that has a genetic identity are less likely to activate coping procedures that include risk-reducing behaviours. For example, using DNA risk information to assess an inherited predisposition to heart disease increased the extent to which the condition was seen as caused by genes, which in turn reduced the expectation that a behavioural means of coping would be effective (eating a low fat diet), but increased the expectation that a biological means was effective (taking lipid lowering medication). Describing the heuristics that operate between risk information, the cognitive representations of threat and coping procedures could be used to identify the cognitions to target so as to optimize the motivational impact of DNA and other risk information.

Repositioning the patient: the implications of being ‘at risk’

In the modern era of biomedical practice, genetic knowledge has redefined the idea of 'the patient' to include those who are 'at risk' of disease alongside those who are already sick. For such individuals, it is risk itself that constitutes the raison d'être of medical intervention. Using data from interviews with 58 users of a UK cancer genetics service together with data derived from clinical consultations, we consider the way such patients or clients make sense of a cancer genetic risk estimate and how they integrate genetic risk information into their lifeworld. In particular, we note that patient-clients who are 'at risk' tend to see themselves in a liminal position betwixt the healthy and the sick, and that such individuals consequently seek recourse to systems of medical surveillance that can continuously monitor their state of health. Our analysis also revealed the fact that many of those deemed by professionals to be at low risk of inheriting cancer-related mutations subsequently strove to be re-categorised as being at moderate or high risk of an adverse outcome. A number of explanations concerning lay health beliefs, lay 'representations' of health and the nature of the patient-client's lifeworld are examined and assessed in order to account for this apparent paradox.