Interventions to Engage Affective Forecasting in Health-Related Decision Making: A Meta-Analysis

Emotions and Narrative Reappraisal Strategies of Users of Breast Cancer Screening: Reconstructing the Past, Passing Through the Present, and Predicting Emotions

Emotional forecasting, meaning how a person anticipates feeling as a consequence of their choices, drives healthcare decision-making. Research, however, suggests that people often do not fully anticipate or otherwise grasp the future emotional impacts of their decisions. Emotional reappraisal strategies, such as putting emotions into words and sharing emotions with others, may mitigate potential undesirable effects of emotions on decision-making. The use of such strategies is important for consequential decisions, such as obtaining timely mammography screening for breast cancer, whereby earlier diagnosis may impact the success of treatment. In this study, we explored the use of emotional reappraisal strategies for decision-making regarding breast cancer screening attendance among women aged 50-69 years. Data were collected through semi-structured interviews following mammography with a reflexive thematic methodological approach employed for analysis. Results shed light on how participants' emotional response narratives were reconstructed before the mammography, felt during the mammography, and forecasted while awaiting the results. Future research should consider how individuals experience and manage their emotions as they access breast screening services.

The comprehensiveness and comprehensibility of publicly-available, state-approved advance directive documents

The COVID-19 pandemic has increased attention to end-of-life decision-making and advance care planning. Advance directives (ADs) are documents that express an individual's wishes regarding their medical care if they are incapacitated and may appoint someone to make decisions for them. The purpose of the current study was to evaluate the comprehensiveness and comprehensibility of the widely available state-approved AD documents provided to the public online. Their content was coded using a grounded theory approach, and the reading level of the documents was assessed. Preferences related to important issues, such as pain relief, were commonly included (92.2% of forms), but other issues, such as whether someone would approve of artificial respiration (39.2%) or CPR (35.3%), were less often addressed. The average reading level of the forms (M = grade 7.64; SD = 1.28) was above the recommended 5th grade level. Overall, there was meaningful variability in the comprehensiveness and comprehensibility of AD documents, suggesting incompatibility for those recording their end-of-life preferences across states and the need for future work to increase their user-friendliness and ability to record authentic advance care wishes.

Accuracy of Expected Symptoms and Subsequent Quality of Life Measures Among Adults With COPD

Importance

Patients' expectations for future health guide their decisions and enable them to prepare, adapt, and cope. However, little is known about how inaccurate expectations may affect patients' illness outcomes.

Objective

To assess the association between patients' expectation inaccuracies and health-related quality of life.

Design, Setting, and Participants

This cohort study of patients with severe chronic obstructive pulmonary disease (COPD) was conducted from 2017 to 2021, which included a 24-month follow-up period. Eligible participants received outpatient primary care at pulmonary clinics of a single large US health system. Data were analyzed between 2021 and 2023.

Exposure

Expectation accuracy, measured by comparing patients' self-reported expectations of their symptom burden with their actual physical and emotional symptoms 3, 12, and 24 months in the future.

Main Outcome and Measure

Health-related quality of life, measured by the St George's Respiratory Questionnaire-COPD at 3, 12, and 24 months.

Results

A total of 207 participants were included (median age, 65.5 years [range, 42.0-86.0 years]; 120 women [58.0%]; 118 Black [57.0%], 79 White [38.2%]). The consent rate among approached patients was 80.0%. Most patients reported no or only limited discussions of future health and symptom burdens with their clinicians. Across physical and emotional symptoms and all 3 time points, patients' expectations were more optimistic than their experiences. There were no consistent patterns of measured demographic or behavioral characteristics associated with expectation accuracy. Regression models revealed that overoptimistic expectations of future burdens of dyspnea (linear regression estimate, 4.68; 95% CI, 2.68 to 6.68) and negative emotions (linear regression estimate, -3.04; 95% CI, -4.78 to 1.29) were associated with lower health-related quality of life at 3 months after adjustment for baseline health-related quality of life, forced expiratory volume over 1 second, and interval clinical events (P < .001 for both). Similar patterns were observed at 12 months (dyspnea: linear regression estimate, 2.41; 95% CI, 0.45 to 4.37) and 24 months (negative emotions: linear regression estimate, -2.39; 95% CI, -4.67 to 0.12; dyspnea: linear regression estimate, 3.21; 95% CI, 0.82 to 5.60), although there was no statistically significant association between expectation of negative emotions and quality of life at 12 months.

Conclusions and Relevance

In this cohort study of patients with COPD, we found that patients are overoptimistic in their expectations about future negative symptom burdens, and such inaccuracies were independently associated with worse well-being over time. Developing and implementing strategies to improve patients' symptom expectations may improve patient-centered outcomes.

'A good decision is the one that feels right for me': Codesign with patients to inform theoretical underpinning of a decision aid website

INTRODUCTION

Patient decision aids (PtDA) complement shared decision-making with healthcare professionals and improve decision quality. However, PtDA often lack theoretical underpinning. We are codesigning a PtDA to help people with increased genetic cancer risks manage choices. The aim of an innovative workshop described here was to engage with the people who will use the PtDA regarding the theoretical underpinning and logic model outlining our hypothesis of how the PtDA would lead to more informed decision-making.

METHODS

Short presentations about psychological and behavioural theories by an expert were interspersed with facilitated, small-group discussions led by patients. Patients were asked what is important to them when they make health decisions, what theoretical constructs are most meaningful and how this should be applied to codesign of a PtDA. An artist created a visual summary. Notes from patient discussions and the artwork were analysed using reflexive thematic analysis.

RESULTS

The overarching theme was: It's personal. Contextual factors important for decision-making were varied and changed over time. There was no one 'best fit' theory to target support needs in a PtDA, suggesting an inductive, flexible framework approach to programme theory would be most effective. The PtDA logic model was revised based on patient feedback.

CONCLUSION

Meaningful codesign of PtDA including discussions about the theoretical mechanisms through which they support decision-making has the potential to lead to improved patient care through understanding the intricately personal nature of health decisions, and tailoring content and format for holistic care.

PATIENT CONTRIBUTION

Patients with lived experience were involved in codesign and coproduction of this workshop and analysis as partners and coauthors. Patient discussions were the primary data source. Facilitators provided a semi-structured guide, but they did not influence the patient discussions or provide clinical advice. The premise of this workshop was to prioritise the importance of patient lived experience: to listen, learn, then reflect together to understand and propose ideas to improve patient care through codesign of a PtDA.

Maintaining distance and avoiding going out during the COVID-19 pandemic: a longitudinal examination of an integrated social cognition model

Objective: To test an integrated social cognition model predicting two forms of social distancing behavior (maintaining distance and avoiding going out in public) during COVID-19.Design: Participants from the U.S. (Sample 1, n = 433) and Canada (Sample 2, n = 239) completed online measures, reflecting the theory of planned behavior (attitudes, norms, perceived control, intention), COVID-19-specific risk, anticipated regret, fear of catching COVID-19, and perceived capacity related to using technology to connect with others. Self-reported behavior was collected from the U.S. sample at 6-month follow-up.Results: Intention to maintain distance and avoid going out predicted behavior within the U.S. sample. For both samples, intention was predicted by attitudes, subjective norms and perceived behavioral control. Perceived severity of COVID-19, anticipated inaction regret, and fear of catching COVID-19 predicted intention to maintain distance and avoid going out across both samples. Finally, within the U.S. sample, significant indirect effects were present for perceived behavioral control predicting future maintaining distance and avoiding going out via intention to engage in these behaviors.Conclusion: The integrated social cognition model predicts social distancing intentions and long-term social distancing behaviors. Hazard-specific risk and affect were relevant determinants added to the models. Potential avenues for intervention research are described.Supplemental data for this article is available online at https://doi.org/10.1080/08870446.2021.2023746 .

Synergistic Opportunities for Affective Science and Behavior Change

Behavior change can be challenging to facilitate and achieve. Behavior change frameworks largely focus on social cognitive determinants, omitting affective determinants or including them in a superficial way. However, evidence points to the role of affect in decision-making and behavior, particularly when the behavior at focus for change is affectively pleasant or when the behavior to be facilitated is affectively unpleasant. This paper identifies challenges and opportunities to further affective science by using behavior change as a context and, relatedly, to further the science of behavior change by leveraging theoretical and methodological innovations in affective science.

Effect of an Internet-Delivered Cognitive Behavioral Therapy-Based Sleep Improvement App for Shift Workers at High Risk of Sleep Disorder: Single-Arm, Nonrandomized Trial

BACKGROUND

Shift workers are at high risk of developing sleep disorders such as shift worker sleep disorder or chronic insomnia. Cognitive behavioral therapy (CBT) is the first-line treatment for insomnia, and emerging evidence shows that internet-based CBT is highly effective with additional features such as continuous tracking and personalization. However, there are limited studies on internet-based CBT for shift workers with sleep disorders.

OBJECTIVE

This study aimed to evaluate the impact of a 4-week, physician-assisted, internet-delivered CBT program incorporating machine learning-based well-being prediction on the sleep duration of shift workers at high risk of sleep disorders. We evaluated these outcomes using an internet-delivered CBT app and fitness trackers in the intensive care unit.

METHODS

A convenience sample of 61 shift workers (mean age 32.9, SD 8.3 years) from the intensive care unit or emergency department participated in the study. Eligible participants were on a 3-shift schedule and had a Pittsburgh Sleep Quality Index score ≥5. The study comprised a 1-week baseline period, followed by a 4-week intervention period. Before the study, the participants completed questionnaires regarding the subjective evaluation of sleep, burnout syndrome, and mental health. Participants were asked to wear a commercial fitness tracker to track their daily activities, heart rate, and sleep for 5 weeks. The internet-delivered CBT program included well-being prediction, activity and sleep chart, and sleep advice. A job-based multitask and multilabel convolutional neural network-based model was used for well-being prediction. Participant-specific sleep advice was provided by sleep physicians based on daily surveys and fitness tracker data. The primary end point of this study was sleep duration. For continuous measurements (sleep duration, steps, etc), the mean baseline and week-4 intervention data were compared. The 2-tailed paired t test or Wilcoxon signed rank test was performed depending on the distribution of the data.

RESULTS

In the fourth week of intervention, the mean daily sleep duration for 7 days (6.06, SD 1.30 hours) showed a statistically significant increase compared with the baseline (5.54, SD 1.36 hours; P=.02). Subjective sleep quality, as measured by the Pittsburgh Sleep Quality Index, also showed statistically significant improvement from baseline (9.10) to after the intervention (7.84; P=.001). However, no significant improvement was found in the subjective well-being scores (all P>.05). Feature importance analysis for all 45 variables in the prediction model showed that sleep duration had the highest importance.

CONCLUSIONS

The physician-assisted internet-delivered CBT program targeting shift workers with a high risk of sleep disorders showed a statistically significant increase in sleep duration as measured by wearable sensors along with subjective sleep quality. This study shows that sleep improvement programs using an app and wearable sensors are feasible and may play an important role in preventing shift work-related sleep disorders.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/24799.

Activation Versus Change as a Principle Underlying Intervention Strategies to Promote Health Behaviors

BACKGROUND AND PURPOSE

Interventions are effective in promoting health behavior change to the extent that (a) intervention strategies modify targets (i.e., mechanisms of action), and (b) modifying targets leads to changes in behavior. To complement taxonomies that characterize the variety of strategies used in behavioral interventions, we outline a new principle that specifies how strategies modify targets and thereby promote behavior change. We distinguish two dimensions of targets-value (positive vs. negative) and accessibility (activation level)-and show that intervention strategies operate either by altering the value of what people think, feel, or want (target change) or by heightening the accessibility of behavior-related thoughts, feelings, and goals (target activation).

METHODS AND RESULTS

We review strategies designed to promote target activation and find that nudges, cue-reminders, goal priming, the question-behavior effect, and if-then planning are each effective in generating health behavior change, and that their effectiveness accrues from heightened accessibility of relevant targets. We also identify several other strategies that may operate, at least in part, via target activation (e.g., self-monitoring, message framing, anticipated regret inductions, and habits).

CONCLUSIONS

The Activation Vs. Change Principle (AVCP) offers a theoretically grounded and parsimonious means of distinguishing among intervention strategies. By focusing on how strategies modify targets, the AVCP can aid interventionists in deciding which intervention strategies to deploy and how to combine different strategies in behavioral trials. We outline a research agenda that could serve to further enhance the design and delivery of interventions to promote target activation.

What helps to form a healthy nutrition habit? Daily associations of intrinsic reward, anticipated regret, and self-efficacy with automaticity

BACKGROUND

High automaticity in healthy nutrition behaviors is related to long-term maintenance of these behaviors. Drawing upon theoretical frameworks of habit formation, proposed antecedents such as intrinsic reward, anticipated regret, and self-efficacy are important correlates of automaticity, but not much is known about their day-by-day relationships with automaticity in healthy nutrition behaviors. This study tested previous-day within-person (i.e., from one day to the next) and same-day within-person associations of intrinsic reward, anticipated regret, and self-efficacy with automaticity of a healthy nutrition behavior, for which participants attempted to form a new habit.

METHODS

Secondary analyses of a randomized controlled trial with two planning intervention conditions including a longitudinal sample of n = 135 participants (age: M = 24.82 years; SD = 7.27) are reported. Participants formed a plan on a self-selected healthy nutrition behavior to become a new habit and were followed up over 12 weeks assessing daily levels of plan-specific intrinsic reward, anticipated regret, self-efficacy, and automaticity. Lagged multilevel models with 84 study days nested in participants estimated previous-day within-person, same-day within-person, and between-person relationships of intrinsic reward, anticipated regret, and self-efficacy with automaticity.

FINDINGS

Regarding within-level relationships, higher-than-usual levels of intrinsic reward, anticipated regret, and self-efficacy of the same day but not of the previous day were associated with higher within-person automaticity. With respect to between-level relationships, higher between-levels (i.e., higher person mean levels across the study period) of intrinsic reward, anticipated regret, and self-efficacy were linked with higher automaticity.

DISCUSSION

Findings point towards the potential to intervene on intrinsic reward, anticipated regret, and self-efficacy when aiming to promote a new healthy nutrition habit.

Encouraging hindsight in advance: Age progression in therapy - and life

Each person forms a relationship to the dimension of time, called a "temporal orientation." How that relationship is defined and prioritized, whether consciously or non-consciously, plays a huge role in the way people go about living their lives. In psychotherapy, the quality of one's expectations plays a pivotal role in virtually every phase of treatment. As a class of hypnotic interventions, age progression treatment strategies are intricately connected to expectancy since they typically involve guiding the client experientially, i.e., subjectively, into the future. While absorbed in this suggested projection, clients may have the opportunity to imagine and experience the consequences of current or new choices, integrate suggestions at deeper levels for eventual activation, rehearse new patterns of thought, feeling or behavior, and, in general, obtain a greater overview of his or her life than a narrower focus on day-to-day living typically affords. To paraphrase Milton Erickson, one can think of it as encouraging hindsight while it is still foresight.

The role of future-oriented affect in engagement with genomic testing results

Future-oriented emotions such as anticipatory affect (i.e., current affect experienced regarding a potential future outcome) and anticipated affect (i.e., expectations about potential future affect), are uniquely associated with health decision-making (e.g., electing to receive results of genomic testing). This study investigated the degree to which negative anticipated and anticipatory emotions predict health decision making over time, and whether such emotions predict social, emotional, and behavioral responses to anticipated information (e.g., genomic testing results). 461 participants (M age = 63.9, SD = 5.61, 46% female) in a genomic sequencing cohort who elected to receive genomic sequencing (carrier) results were included in the current study. Anticipated and anticipatory affect about sequencing results were assessed at baseline. Psychological and behavioral responses to sequencing results, including participants' reported anxiety, decisional conflict, and distress about sequencing results, whether they shared results with family members, and their intentions to continue learning results in the future, were collected immediately, one month, and/or six months after receiving results. More negative anticipated and anticipatory affect at baseline was significantly and independently associated with lower intentions to continue learning results in the future, as well as higher levels of anxiety and uncertainty at multiple time points after receiving results. Anticipated negative affect was also associated with greater decisional conflict, and anticipatory negative affect was also associated with greater distress after receiving results. Future-oriented emotions may play an important role in decisions that unfold over time, with implications for genomic testing, behavioral medicine, and health decision-making broadly.

Patient, Caregiver, and Oncologist Predictions of Quality of Life in Advanced Cancer: Accuracy and Associations with End-of-Life Care and Caregiver Bereavement

OBJECTIVE

Informed treatment decision-making necessitates accurate prognostication,including predictions about quality of life. We examined whether oncologists, patients with advanced cancer, and caregivers accurately predict patients' future quality of life and whether these predictions are prospectively associated with end-of-life care and bereavement.

METHODS

We secondary analyses of clinical trial data. Patients with advanced cancer (n=156), caregivers (n=156), and oncologists (n=38) predicted patient quality of life 3 months into the future. Patients subsequently rated their quality of life 3 months later. Medical record data documented chemotherapy and emergency department (ED)/inpatient visits in the 30 days before death (n=79 decedents). Caregivers self-reported on depression, anxiety, grief, purpose, 21 and regret 7-months post-mortem. In mixed-effects models, patient, caregiver, and oncologist quality-of-life predictions at study entry were used to predict end-of-life care and caregiver outcomes, controlling for patients' quality of life at 3-month follow-up, demographic and clinical characteristics, and nesting within oncologists.

RESULTS

Caregivers (P<.0001) and oncologists (P=.001) predicted lower quality of life than what patients actually experienced. Among decedents, 24.0% received chemotherapy and 54.5% had an ED/inpatient visit. When caregivers' predictions were more negative, patients were less likely to receive chemotherapy (P=.028) or have an ED/inpatient visit (P=.033), and caregivers reported worse depression (P=.002), anxiety (P=.019), and grief (P=.028) and less purpose in life (P<.001) 7-months post-mortem.

CONCLUSION

When caregivers have more negative expectations about patients' quality of life, patients receive less intensive end-of-life care, and caregivers report worse bereavement This article is protected by copyright. All rights reserved.

Subclinical psychopathology and affective forecasting: Role of in-the-moment feelings

It is important for positive well-being and social engagement to understand how people predict future emotions, an ability known as affective forecasting. However, mechanisms underpinning the change to affective forecasting are not well understood in people with subclinical psychiatric symptoms. The current study differentiated components that comprise affective forecasting and investigated how non-clinical features relate to these. We recruited 319 participants to complete the social affective forecasting task and respond to questionnaires that captured schizotypal and autistic traits as well as depressive symptoms. Associations between affective forecasting and subclinical features were investigated using correlations, regression, and structure equation modeling. Results showed that interpersonal features of schizotypal traits negatively predicted anticipated emotions in positive social conditions via in-the-moment feelings but not via mental simulation. Findings highlight that in-the-moment feelings may be an intervention target to help people who have difficulties with social interactions to anticipate more pleasure for future social events.

Opportunities for theory-informed decision science in cancer control

Cancer prevention and control involves navigation of complex clinical decisions, often laden with uncertainty and/or intricate interpersonal dynamics, which have implications for both physical health and quality of life. Cancer decision-making research in recent decades has primarily focused on working to improve the quality of decisions by providing patients with detailed information about their choices and through an increased emphasis in medicine on the importance of shared decision making. This emphasis is reflective of a model of decision making that emphasizes knowledge, options, and deliberative synthesis of information as primary to decision making; yet, decades of research in psychology, decision science, and behavioral economics have taught us that our decisions are not influenced only by our objective knowledge of facts, but by our emotions, by the influence of others, and by biased cognitive processes. We present a conceptual framework for a future of research in decision science and cancer that is informed by decision science theories. Our framework incorporates greater recognition of the interpersonal dynamics of shared decision making, including the biases (including cognitive heuristics and race-based bias) that may affect multiple actors in the decision-making process, and emphasizes study of the interaction between deliberative and affective psychological processes as they relate to decision making. This work should be conducted with an eye toward informing efforts to improve decision making across the cancer care continuum, through interventions that are also informed by theory.

The Burden of Living With HIV is Mostly Overestimated by HIV-Negative and Never-Tested Men Who Have Sex With Men

To assess whether HIV-negative men who have sex with men (MSM) have realistic views of the current implications of living with HIV, we compared data of 950 tested HIV-negative and 122 never-tested MSM on anticipated consequences of an HIV-infection to the actual experiences of 438 MSM living with HIV. Data were collected with a self-reported, web-based survey conducted between May-June 2019 in the Netherlands. Results indicated that, compared to HIV-positive MSM, HIV-negative MSM significantly overestimated 95% (37/39) of items assessing HIV-related burden. Never-tested participants overestimated 85% (33/39) of items. Overestimation in never-tested MSM was modified with increasing age and having HIV-positive friends/relatives. The high level of overestimation suggests the ongoing need to correct for misperceptions, as this could help reduce stigma towards those living with HIV and diminish fear of an HIV-diagnosis. The latter might be important to improve testing uptake in older never-tested MSM with outdated views on HIV.

Decision Science Can Inform Clinical Trade-Offs Regarding Cardiotoxic Cancer Treatments

Cancer treatment-related cardiotoxicity (ie, heart failure, coronary artery disease, vascular diseases, arrhythmia) is a growing cancer survivorship concern within oncology practice; heart disease is the leading cause of noncancer death in cancer survivors and surpasses cancer as the leading cause of death for some cancers with higher survival rates. The issue of cardiotoxicity introduces a critical tradeoff that must be acknowledged and reconciled in clinical oncology practice: treating cancer aggressively and effectively in the present vs preventing future cardiotoxicity. Although many cancers must be treated as aggressively as possible, for others, multiple treatment options are available. Yet even when effective and less cardiotoxic treatments are available, they are not always chosen. Wariness to choose equally effective but less cardiotoxic treatment options may result in part from providers' and patients' reliance on "cognitive heuristics," or mental shortcuts that people (including, research shows, medical professionals) use to simplify complex judgments. These heuristics include delay discounting, availability and affect heuristics, and default bias. In the current commentary, we describe relevant research that illuminates how use of heuristics leads to biased medical decision making and translate how this research may apply when the tradeoff between aggressive cancer treatment and preventing future cardiotoxicity is considered. We discuss the implications of these biases in oncology practice, offer potential solutions to reduce bias, and call for future research in this area.

Behavioral Research in Cancer Prevention and Control: Emerging Challenges and Opportunities

It is estimated that behaviors such as poor diet, alcohol consumption, tobacco use, sedentary behavior, and excessive ultraviolet exposure account for nearly one-half of all cancer morbidity and mortality. Accordingly, the behavioral, social, and communication sciences have been important contributors to cancer prevention and control research, with methodological advances and implementation science helping to produce optimally effective interventions. To sustain these contributions, it is vital to adapt to the contemporary context. Efforts must consider ancillary effects of the 2019 coronavirus disease pandemic, profound changes in the information environment and public understanding of and trust in science, renewed attention to structural racism and social determinants of health, and the rapidly increasing population of cancer survivors. Within this context, it is essential to accelerate reductions in tobacco use across all population subgroups; consider new models of energy balance (diet, physical activity, sedentary behavior); increase awareness of alcohol as a risk factor for cancer; and identify better communication practices in the context of cancer-related decisions such as screening and genetic testing. Successful integration of behavioral research and cancer prevention depends on working globally and seamlessly across disciplines, taking a multilevel approach where possible. Methodological and analytic approaches should be emphasized in research training programs and should use new and underused data sources and technologies. As the leadership core of the National Cancer Institute’s Behavioral Research Program, we reflect on these challenges and opportunities and consider implications for the next phase of behavioral research in cancer prevention and control.

Factors Associated With Obtaining Lung Cancer Screening Among Persons Who Smoke

Background. Screening with low-dose computed tomography scans can reduce lung cancer deaths but uptake remains low. This study examines psychosocial factors associated with obtaining lung cancer screening (LCS) among individuals. Methods. This is a secondary analysis of a randomized clinical trial conducted with 13 state quitlines’ clients. Participants who met age and smoking history criteria were enrolled and followed-up for 6 months. Only participants randomized to the intervention group (a patient decision aid) were included in this analysis. A logistic regression was performed to identify determinants of obtaining LCS 6 months after the intervention. Results. There were 204 participants included in this study. Regarding individual attitudes, high and moderate levels of concern about overdiagnosis were associated with a decreased likelihood of obtaining LCS compared with lower levels of concern (high levels of concern, odds ratio [OR] 0.17, 95% confidence interval [CI] 0.04–0.65; moderate levels of concern, OR 0.15, 95% CI 0.05–0.53). In contrast, higher levels of anticipated regret about not obtaining LCS and later being diagnosed with lung cancer were associated with an increased likelihood of being screened compared with lower levels of anticipated regret (OR 5.59, 95% CI 1.72–18.10). Other potential harms related to LCS were not significant. Limitations. Follow-up may not have been long enough for all individuals who wished to be screened to complete the scan. Additionally, participants may have been more health motivated due to recruitment via tobacco quitlines. Conclusions. Anticipated regret about not obtaining screening is associated with screening behavior, whereas concern about overdiagnosis is associated with decreased likelihood of LCS. Implications. Decision support research may benefit from further examining anticipated regret in screening decisions. Additional training and information may be helpful to address concerns regarding overdiagnosis.

Temporal and social comparative self-assessments of physical health in young, middle-aged, and young-old adults in the MIDUS study

This study examined temporal and social comparisons of physical health status. Participants in two waves of the MIDUS cohort ranging in age from young adult to young-old (N = 2,408) rated current, past, and future physical health, as well as peer health. Past health was generally rated as better than current health (particularly among young adults). Young adults expected better future health; young-old adults expected declining health. All groups recalled their health as better than they reported a decade earlier. Middle-aged and young-old respondents expected more decline than they reported ten years later; young adults' ratings were consistent. The two older groups believed they were healthier than same-age peers, whereas younger respondents believed they were less healthy (though as healthy as the other age groups). The nature and trajectories of temporal and social comparisons of physical health across the lifespan suggest the need to examine their consequences for health behaviors.

Sociodemographic, Cognitive, and Emotional Determinants of Two Health Behaviors during SARS-CoV-2 Outbreak: An Online Study among French-Speaking Belgian Responders during the Spring Lockdown

To contain the SARS-CoV-2 infection rate, health authorities have encouraged the population to enhance protective behaviors such as physical distancing and handwashing. Behavioral sciences emphasize the role of sociocognitive determinants to explain health behaviors, while largely ignoring emotional factors. In a large online study (N > 4000), we investigated the role of sociodemographic, cognitive, emotional, and social factors that can facilitate or hinder handwashing and limitation of social contacts. Data were collected from March 18 until April 19, 2020, which corresponds to the spring lockdown and the first peak of the pandemic in Belgium. Logistic regressions showed that sociodemographic factors (gender, age, level of education) and the dimensions of the Theory of Planned Behavior (intentions, attitudes, perceived behavioral control and subjective norms) had a strong impact on health behaviors, but that emotional factors explained an additional part of the variance. Being more attentive/determined and frightened/anxious, along with scoring higher on health anxiety were related to a higher frequency of handwashing. In contrast, being enthusiastic/happy was related to lower adherence to limiting social contacts. Our results suggest that the type of predictors and the direction of associations depend on the type of health behavior considered. The role of specific emotional factors in addition to more classical predictors is discussed. The study offers new perspectives regarding the factors that are associated with the adherence to behaviors recommended to adopt when faced with a pandemic.

"Worse than I anticipated" or "This isn't so bad"?: The impact of affective forecasting accuracy on self-reported task performance

Various motivational theories emphasize that desired emotional outcomes guide behavioral choices. Although motivational theory and research has emphasized that behavior is affected by desired emotional outcomes, little research has focused on the impact of anticipated feelings about engaging in behavior. The current research seeks to partly fill that void. Specifically, we borrow from affective forecasting research in suggesting that forecasts about engaging in performance-relevant behaviors can be more or less accurate. Furthermore, we suggest that the degree of accuracy has implications for self-reported task performance. To examine these ideas, we conducted two studies in which individuals made affective predictions about engaging in tasks and then later reported how they actually felt during task engagement. We also assessed their self-reported task performance. In Study 1, 214 workers provided affective forecasts about upcoming work tasks, and in Study 2, 185 students made forecasts about studying for an exam. Results based on polynomial regression were largely consistent across the studies. The accuracy of the forecasts did not conform to the pattern of affective forecasting accuracy typically found outside the performance domain. Furthermore, anticipated and experienced affect jointly predicted self-reported task performance in a consistent manner. Collectively, these findings suggest that taking into account anticipated affect, and its relationship with later experienced affect, provides a more comprehensive account of affect’s role in task performance.

Perceived importance of affective forecasting in cancer treatment decision making

PURPOSE

To examine whether adults with cancer view affective forecasting as important for treatment decisions, and to examine these perceptions among key subgroups.

DESIGN

Adults with cancer (N = 376) completed a cross-sectional survey that included demographic and clinical characteristics, the IPIP five-factor personality measure, and a rating of the perceived importance of affective forecasting for cancer treatment decisions. Descriptive statistics characterized the importance of affective forecasting. Multivariate analyses examined whether health and personality variables were associated with affective forecasting importance.

FINDINGS

Most participants (89.6%) identified affective forecasting as important for treatment decisions. Affective forecasting was more likely to be rated as important among patients with prostate cancer (p < .001), patients lower in neuroticism (p = .02), and patients higher in agreeableness (p = .004). Conclusions/Implications: Patients believe it is important to understand how treatments will impact their emotional well-being. Oncology clinicians should discuss with patients these consequences during healthcare decision-making.

Moving beyond categorization to understand affective influences on real world health decisions

This paper provides an overview of affect and health decision-making research, with a focus on identifying gaps, opportunities, and challenges to guide future research. We begin by defining common categorical distinctions of affective processes that influence health decisions: integral (i.e., related to the decision) and incidental (i.e., normatively unrelated to the decision) influences, and current (experienced in the moment) and anticipated ("cognitive representations" of future affect) affect. We then summarize key discoveries within the most common categories of affective influences on health decision making: current integral affect, current incidental affect, and anticipated integral affect. Finally, we highlight research gaps, challenges, and opportunities for future directions for research aimed at translating affective and decision science theory to improve our understanding of, and ability to intervene upon, health decision making.

Impact of Timing on Measurement of Decision Quality and Shared Decision Making: Longitudinal Cohort Study of Breast Cancer Patients

Purpose.The objective of this study was to examine whether scores of shared decision-making measures differ when collected shortly after (1 month) or long after (1 year) breast cancer surgical treatment decisions. Methods. Longitudinal, multisite survey of breast cancer (BC) patients, with measurements at 1 month and 1 year after surgery at 4 cancer centers. Patients completed the BC Surgery Decision Quality Instrument (used to generate a knowledge score, ratings of goals, and concordance with treatment preferences) and Shared Decision Making (SDM) Process survey at both time points. We tested several hypotheses related to the scores over time, including whether the scores discriminated between sites that did and did not offer formal decision support services. Exploratory analyses examined factors associated with large increases and decreases in scores over time. Results. Across the 4 sites, 229 patients completed both assessments. The mean total knowledge scores (69.2% [SD 16.6%] at 1 month and 69.4% [SD 17.7%] at 1 year, P = 0.86), SDM Process scores (2.7 [SD 1.1] 1 month v. 2.7 [SD 1.2] 1 year, P = 0.68), and the percentage of patients receiving their preferred treatment (92% at 1 month and 92% at 1 year, P = 1.0) were not significantly different over time. The site using formal decision support had significantly higher knowledge and SDM Process scores at 1 month, and only the SDM Process scores remained significantly higher at 1 year. A significant percentage of patients had large changes in their individual knowledge and SDM Process scores, with increases balancing out decreases. Conclusion. For population-level assessments, it is reasonable to survey BC patients up to a year after the decision, greatly increasing feasibility of measurement. For those evaluating decision support interventions, shorter follow-up is more likely to detect an impact on knowledge scores.

Theory Content, Question-Behavior Effects, or Form of Delivery Effects for Intention to Become an Organ Donor? Two Randomized Trials

Eliciting different attitudes with survey questionnaires may impact on intention to donate organs. Previous research used varying numbers of questionnaire items, or different modes of intervention delivery, when comparing groups. We aimed to determine whether intention to donate organs differed among groups exposed to different theoretical content, but similar questionnaire length, in different countries. We tested the effect of excluding affective attitudinal items on intention to donate, using constant item numbers in two modes of intervention delivery. Study 1: A multi-country, interviewer-led, cross-sectional randomized trial recruited 1007 participants, who completed questionnaires as per group assignment: including all affective attitude items, affective attitude items replaced, negatively-worded affective attitude items replaced. Study 2 recruited a UK-representative, cross-sectional sample of 616 participants using an online methodology, randomly assigned to the same conditions. Multilevel models assessed effects of group membership on outcomes: intention to donate (primary), taking a donor card, following a web-link (secondary). In study 1, intention to donate did not differ among groups. Study 2 found a small, significantly higher intention to donate in the negatively-worded affective attitudes replaced group. Combining data yielded no group differences. No differences were seen for secondary outcomes. Ancillary analyses suggest significant interviewer effects. Contrary to previous research, theoretical content may be less relevant than number or valence of questionnaire items, or form of intervention delivery, for increasing intention to donate organs.

Threat appeals reduce impulsive decision making associated with texting while driving: A behavioral economic approach

The primary purpose of the present study was to examine the effectiveness of threat appeals in influencing impulsive decision making associated with texting while driving. The participants in the treatment group were exposed to a threatening message about the danger of texting while driving, whereas those in the control group were exposed to a non-threatening message. Following the exposure to either message, the participants completed a delay-discounting task that assessed the degree of impulsive decision making in a hypothetical texting-while-driving scenario. A comparison between the groups revealed that the threat appeals reduced the degree of impulsive decision making associated with texting while driving. In addition, the threat appeals led to greater anticipated regret from texting while driving, less favorable attitudes toward texting while driving, and decreased intentions to text while driving in the future in the treatment group. These results suggest that video-based threat appeals are promising intervention strategies for the public health challenge of texting while driving. Implications from the behavioral economic perspective are discussed.

Feel good now or regret it later? The respective roles of affective attitudes and anticipated affective reactions for explaining health-promoting and health risk behavioral intentions

Evidence supporting the incorporation of affective constructs, such as affective attitudes and anticipated regret, into theoretical models of health behavior has been mounting in recent years; however, the role of positive anticipated affective reactions (e.g., pride) has been largely unexplored. The purpose of the present investigation was to assess how affective attitudes and anticipated affective reactions (both pride and regret for performing a behavior or not) may provide distinct utility for understanding intentions to perform health-promoting and health risk behaviors over and above cognitive attitudes and other established theoretical constructs from the theory of planned behavior (TPB). Participants (N = 210) were recruited via Amazon's Mechanical Turk to complete a one-time online battery assessing TPB and affective constructs. Self-reported intentions served as the main outcome measure, and hierarchical linear modeling was used to examine the effects of TPB and affective constructs across behaviors. Controlling for TPB constructs, more positive affective attitudes and greater anticipated regret, but not anticipated pride, predicted intentions to engage in future health behaviors. Anticipated affective reactions contributed explanatory variance for intentions to perform health risk behaviors, but anticipated pride and regret were not associated with intentions to perform health risk behaviors. Contributions made via the inclusion of both positively and negatively valence anticipated affective reactions for both action and inaction (performing a behavior or not) across a range of health promoting and health risk behaviors are discussed, as well as implications for future intervention work.