News headlines feed on fear of cancer risk, experts say

Variability in Affect and Willingness to Take Medication

OBJECTIVE

To determine if 1) patients have distinct affective reaction patterns to medication information, and 2) whether there is an association between affective reaction patterns and willingness to take medication.

METHODS

We measured affect in real time as subjects listened to a description of benefits and side effects for a hypothetical new medication. Subjects moved a dial on a handheld response system to indicate how they were feeling from "Very Good" to "Very Bad". Patterns of reactions were identified using a cluster-analytic statistical approach for multiple time series. Subjects subsequently rated their willingness to take the medication on a 7-point Likert scale. Associations between subjects' willingness ratings and affect patterns were analyzed. Additional analyses were performed to explore the role of race/ethnicity regarding these associations.

RESULTS

Clusters of affective reactions emerged that could be classified into 4 patterns: "Moderate" positive reactions to benefits and negative reactions to side effects ( n = 186), "Pronounced" positive reactions to benefits and negative reactions to side effects ( n = 110), feeling consistently "Good" ( n = 58), and feeling consistently close to "Neutral" ( n = 33). Mean (standard error) willingness to take the medication was greater among subjects feeling consistently Good 4.72 (0.20) compared with those in the Moderate 3.76 (0.11), Pronounced 3.68 (0.14), and Neutral 3.62 (0.26) groups. Black subjects with a Pronounced pattern were less willing to take the medication compared with both Hispanic ( P = 0.0270) and White subjects ( P = 0.0001) with a Pronounced pattern.

CONCLUSION

Patients' affective reactions to information were clustered into specific patterns. Reactions varied by race/ethnicity and were associated with treatment willingness. Ultimately, a better understanding of how patients react to information may help providers develop improved methods of communication.

Communicating Uncertain Science to the Public: How Amount and Source of Uncertainty Impact Fatalism, Backlash, and Overload

Public dissemination of scientific research often focuses on the finding (e.g., nanobombs kill lung cancer) rather than the uncertainty/limitations (e.g., in mice). Adults (n = 880) participated in an experiment where they read a manipulated news report about cancer research (a) that contained either low or high uncertainty (b) that was attributed to the scientists responsible for the research (disclosure condition) or an unaffiliated scientist (dueling condition). Compared to the dueling condition, the disclosure condition triggered less prevention-focused cancer fatalism and nutritional backlash.

The Effects of Experienced Uncertainty and Patients' Assessments of Cancer-Related Information-Seeking Experiences on Fatalistic Beliefs and Trust in Physicians

Using the 2013 HINTS 4 Cycle 2 data representing a general population sample, this study investigates the effects of patients' experiences of uncertainty about prostate cancer during doctor-patient communication, as well as patients' positive assessments of their cancer-related information-seeking experiences, on their fatalistic beliefs regarding cancer and their trust in physicians. Our tests show significant differences in trust in physicians among men who do and do not experience uncertainty about the prostate-specific antigen (PSA) test during doctor-patient communication. The analysis also indicates that individuals with experiences of uncertainty about the PSA test are more likely than those without such experiences of uncertainty to place their trust in doctors. However, no apparent difference or association exists when there are uncertainties relating to treatment choices regarding slow-growing cancer or treatment side effects. Nevertheless, as hypothesized, individuals who positively evaluate their cancer-related information-seeking experiences are less likely to have fatalistic beliefs about cancer. Furthermore, patients' positive assessments are highly predictive of their levels of trust in their physicians. Additionally, tests of interaction effects show that individuals' levels of education moderate the association between uncertainty experiences about the PSA test and both cancer fatalism and trust in physicians. Further implications and limitations of the study are discussed.

The cancer information overload (CIO) scale: establishing predictive and discriminant validity

OBJECTIVE

Survey data suggests that approximately three-fourths of adults are overwhelmed by cancer information - a construct we label cancer information overload (CIO). A significant limitation of existing research is that it relies on a single-item measure. The objective of the current study is to develop and validate a multi-item measure of CIO.

METHODS

Study 1 (N=209) surveyed healthcare and manufacturing employees at eight worksites. Colonoscopy insurance claims data were culled eighteen months later to evaluate the predictive validity of CIO. Study 2 (N=399) surveyed adults at seven shopping malls. CIO and cancer fatalism were measured to examine the properties of the two constructs.

RESULTS

Study 1 identified a reliable 8-item CIO scale that significantly predicted colonoscopy insurance claims 18 months after the initial survey. Study 2 confirmed the factor structure identified in Study 1, and demonstrated that CIO, cancer fatalism about prevention, and cancer fatalism about treatment are best modeled as three distinct constructs.

CONCLUSION

The perception that there are too many recommendations about cancer prevention to know which ones to follow is an indicator of CIO, a widespread disposition that predicts colon cancer screening and is related to, but distinct from, cancer fatalism.

PRACTICE IMPLICATIONS

Many adults exhibit high CIO, a disposition that undermines health efforts. Communication strategies that mitigate CIO are a priority. In the short-term, health care providers and public health professionals should monitor the amount of information provided to patients and the public.

Including limitations in news coverage of cancer research: effects of news hedging on fatalism, medical skepticism, patient trust, and backlash

Past research has demonstrated that news coverage of cancer research, and scientific research generally, rarely contains discourse-based hedging, including caveats, limitations, and uncertainties. In a multiple message experiment (k = 4 news stories, N = 1082), the authors examined whether hedging shaped the perceptions of news consumers. The results revealed that participants were significantly less fatalistic about cancer (p = .039) and marginally less prone to nutritional backlash (p = .056) after exposure to hedged articles. Participants exposed to articles mentioning a second researcher (unaffiliated with the present study) exhibited greater trust in medical professions (p = .001). The findings provide additional support for the inclusion of discourse-based hedging in cancer news coverage and suggest that news consumers will use scientific uncertainty in illness representations.

People's perceptions of cancer survivability: implications for oncologists

Individuals typically overestimate survival for lung cancer and underestimate it for melanoma. However, reporting of results generally masks the extent of disagreement between people on survival rates. Most methods used to question individuals are of little use and are not comparable across studies. The topic of people's perceptions of survival for various cancers is under-researched. A clearer definition is needed of survivability, as is a standard way to measure it and then present the information. We have undertaken a review of studies reporting public perceptions of cancer survival rates and compared the results, where possible, with actual survival rates. We also investigate some potential implications of people's underestimation or overestimation of survival for screening and prevention behaviours and delineate implications for oncologists.

Treatment decision-making and the form of risk communication: results of a factorial survey

Background

Prospective users of preventive therapies often must evaluate complex information about therapeutic risks and benefits. The purpose of this study was to evaluate the effect of relative and absolute risk information on patient decision-making in scenarios typical of health information for patients.

Methods

Factorial experiments within a telephone survey of the Michigan adult, non-institutionalized, English-speaking population. Average interview lasted 23 minutes. Subjects and sample design: 952 randomly selected adults within a random-digit dial sample of Michigan households. Completion rate was 54.3%.

Results

When presented hypothetical information regarding additional risks of breast cancer from a medication to prevent a bone disease, respondents reduced their willingness to recommend a female friend take the medication compared to the baseline rate (66.8% = yes). The decrease was significantly greater with relative risk information. Additional benefit information regarding preventing heart disease from the medication increased willingness to recommend the medication to a female friend relative to the baseline scenario, but did not differ between absolute and relative risk formats. When information about both increased risk of breast cancer and reduced risk of heart disease were provided, typical respondents appeared to make rational decisions consistent with Expected Utility Theory, but the information presentation format affected choices. Those 11% – 33% making decisions contrary to the medical indications were more likely to be Hispanic, older, more educated, smokers, and to have children in the home.

Conclusions

In scenarios typical of health risk information, relative risk information led respondents to make non-normative decisions that were "corrected" when the frame used absolute risk information. This population sample made generally rational decisions when presented with absolute risk information, even in the context of a telephone interview requiring remembering rates given. The lack of effect of gender and race suggests that a standard strategy of presenting absolute risk information may improve patient decision-making.

Knowledge, attitudes, and behavioral intentions in relation to the early detection of colorectal cancer in the United Kingdom

BACKGROUND

Colorectal cancer (CRC) mortality is high. Understanding the social, psychological, and cognitive predictors of early detection practices such as screening may help improve CRC outcomes. This study examined knowledge of CRC and the relationship between knowledge, attitudes to cancer, and intentions to engage in early detection behaviors for CRC in a national representative population sample.

METHOD

An interview-based survey was carried out in a British population sample of adults ages 16 to 74 years (n = 1637), assessing knowledge, attitudes, and intention with regard to colorectal cancer.

RESULTS

Knowledge levels were very low; 58% (n = 995) of respondents could not list any colorectal cancer risk factors and 24% (n = 393) were unable to identify any warning signs for cancer. Knowledge was lower among men (chi(2)[2] = 52.8, P < 0.0001), younger respondents (chi(2)[10] = 79.9, P <.0001), and those with less education (chi(2)[4] = 73.9, P < 0.0001). Attitudes to cancer were more negative among women (chi(2) [2] = 7.4, P = 0.025), younger participants (chi(2)[10] = 22.4, P = 0.013), and those with less education (chi(2) [4] = 75.0, P < 0.0001). Low knowledge was associated with negative attitudes (P < 0.0001) and both factors were associated with lower intentions to participate in colorectal cancer screening (P < 0.0001). Multivariate analysis indicated that attitudes partially mediated the effect of knowledge on screening intentions.

CONCLUSIONS

Increasing knowledge may reduce negative public perceptions of cancer which may impact positively on intentions to participate in screening.