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Thompson CA, Mielicki MK, Rivera F, Fitzsimmons CJ, Scheibe DA, Sidney PG, Schiller LK, Taber JM, Waters EA. Leveraging Math Cognition to Combat Health Innumeracy. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2023; 18:152-177. [PMID: 35943825 DOI: 10.1177/17456916221083277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Rational numbers (i.e., fractions, percentages, decimals, and whole-number frequencies) are notoriously difficult mathematical constructs. Yet correctly interpreting rational numbers is imperative for understanding health statistics, such as gauging the likelihood of side effects from a medication. Several pernicious biases affect health decision-making involving rational numbers. In our novel developmental framework, the natural-number bias-a tendency to misapply knowledge about natural numbers to all numbers-is the mechanism underlying other biases that shape health decision-making. Natural-number bias occurs when people automatically process natural-number magnitudes and disregard ratio magnitudes. Math-cognition researchers have identified individual differences and environmental factors underlying natural-number bias and devised ways to teach people how to avoid these biases. Although effective interventions from other areas of research can help adults evaluate numerical health information, they circumvent the core issue: people's penchant to automatically process natural-number magnitudes and disregard ratio magnitudes. We describe the origins of natural-number bias and how researchers may harness the bias to improve rational-number understanding and ameliorate innumeracy in real-world contexts, including health. We recommend modifications to formal math education to help children learn the connections among natural and rational numbers. We also call on researchers to consider individual differences people bring to health decision-making contexts and how measures from math cognition might identify those who would benefit most from support when interpreting health statistics. Investigating innumeracy with an interdisciplinary lens could advance understanding of innumeracy in theoretically meaningful and practical ways.
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Affiliation(s)
| | | | - Ferdinand Rivera
- Department of Mathematics and Statistics, San Jose State University
| | | | | | | | - Lauren K Schiller
- Department of Human Development, Teachers College, Columbia University
| | | | - Erika A Waters
- Department of Surgery, Washington University School of Medicine in St. Louis
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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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Frequency or total number? A comparison of different presentation formats
on risk perception during COVID-19. JUDGMENT AND DECISION MAKING 2022. [DOI: 10.1017/s1930297500009086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Abstract
Curbing the COVID-19 pandemic remains an ongoing global challenge.
Institutions often release information about confirmed COVID-19 cases by
citing the total number of cases (e.g., 100,000), their (relative) frequency
(e.g., 100 per 1,000,000), or occasionally their proportion (e.g., 0.0001)
in a region. I compared the effect of these three presentation formats —
total cases, frequency, and proportion — on people’s perceived risk. I found
people perceived a higher risk of COVID-19 from a total-cases format than
from frequency formats when the denominators are relatively small, and the
lowest risk from a proportion format. Correspondingly, people underestimated
total infections when given frequency and overestimated frequency when given
total number of cases. Additional comparisons were made among mathematically
equivalent variations of frequency formats (e.g., 1 in 100, 10 in 1,000,
1,000 in 10,000, etc.). The results provided qualified support for
denominator neglect, which seems to occur in bins into which denominators
are grouped (e.g., 1–1000, 10000–100000), such that only across bins could
participants perceive differences. Finally, a mixed format of proportion and
total cases reduced perceived risks from total cases alone, while a mixed
format of frequency and total cases failed to produce similar results. I
conclude by providing concrete suggestions regarding COVID-19 information
releases.
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Beaudart C, Hiligsmann M, Li N, Lewiecki EM, Silverman S. Effective communication regarding risk of fracture for individuals at risk of fragility fracture: a scoping review. Osteoporos Int 2022; 33:13-26. [PMID: 34559256 PMCID: PMC8758611 DOI: 10.1007/s00198-021-06151-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 09/03/2021] [Indexed: 12/28/2022]
Abstract
Two scoping reviews were conducted to review recommendations and guidelines for communication regarding general health risk, and to investigate communication strategies regarding risk of fracture. Healthcare professionals are invited to apply these recommendations to optimize a patient-centered approach to reducing risk of fracture. INTRODUCTION To conduct a scoping review of the medical literature regarding recommendations and tools for effective communication between healthcare professionals and patients regarding general health risk and risk of fracture. METHODS The scoping review was divided into two parts to search for (1) studies presenting recommendations and guidelines for communication regarding general health risk; (2) studies investigating communication regarding risk of fracture for individuals at risk for fractures. Medline was searched in April 2020 to identify relevant studies. RESULTS The scoping review included 43 studies on communication with regard to general health risk and 25 studies about communication regarding risk of fracture. Recommendations for effective communication with regard to risk are presented. Communication of numeric data on risk should be adapted to the literacy and numeracy levels of the individual patient. Patient understanding of numerical data can be enhanced with appropriate use of visual aids (e.g., pie charts, icon arrays, bar charts, pictograms). The FRAX® tool is the most recommended and most used tool for assessing risk of fracture. Communication sent as individualized letters to patients following DXA scans has been studied, although patient understanding of their risk of fracture is often reported as low using this technique. Use of visual aids may improve patient understanding. CONCLUSION Healthcare professionals are encouraged to apply recommendations presented in this scoping review in their clinical practice. Patient understanding of risk of fracture should be confirmed by making sure that patients feel free to ask questions and express their concerns. This will contribute to an optimal patient-centered approach. Developing online tools to convert the probability of fracture into patient-friendly visual presentations could facilitate communication between healthcare professionals and patients about risk of fracture.
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Affiliation(s)
- Charlotte Beaudart
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
| | - Mickael Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Nannan Li
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | | | - Stuart Silverman
- New Mexico Clinical Research & Osteoporosis Center, Albuquerque, NM, USA
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Freeman ALJ, Kerr J, Recchia G, Schneider CR, Lawrence ACE, Finikarides L, Luoni G, Dryhurst S, Spiegelhalter D. Communicating personalized risks from COVID-19: guidelines from an empirical study. ROYAL SOCIETY OPEN SCIENCE 2021; 8:201721. [PMID: 33996117 PMCID: PMC8059635 DOI: 10.1098/rsos.201721] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 04/07/2021] [Indexed: 06/12/2023]
Abstract
As increasing amounts of data accumulate on the effects of the novel coronavirus SARS-CoV-2 and the risk factors that lead to poor outcomes, it is possible to produce personalized estimates of the risks faced by groups of people with different characteristics. The challenge of how to communicate these then becomes apparent. Based on empirical work (total n = 5520, UK) supported by in-person interviews with the public and physicians, we make recommendations on the presentation of such information. These include: using predominantly percentages when communicating the absolute risk, but also providing, for balance, a format which conveys a contrasting (higher) perception of risk (expected frequency out of 10 000); using a visual linear scale cut at an appropriate point to illustrate the maximum risk, explained through an illustrative 'persona' who might face that highest level of risk; and providing context to the absolute risk through presenting a range of other 'personas' illustrating people who would face risks of a wide range of different levels. These 'personas' should have their major risk factors (age, existing health conditions) described. By contrast, giving people absolute likelihoods of other risks they face in an attempt to add context was considered less helpful. We note that observed effect sizes generally were small. However, even small effects are meaningful and relevant when scaled up to population levels.
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Affiliation(s)
- Alexandra L. J. Freeman
- Winton Centre for Risk and Evidence Communication, Department of Pure Mathematics and Mathematical Statistics, University of Cambridge, Cambridge, UK
| | - John Kerr
- Winton Centre for Risk and Evidence Communication, Department of Pure Mathematics and Mathematical Statistics, University of Cambridge, Cambridge, UK
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Gabriel Recchia
- Winton Centre for Risk and Evidence Communication, Department of Pure Mathematics and Mathematical Statistics, University of Cambridge, Cambridge, UK
| | - Claudia R. Schneider
- Winton Centre for Risk and Evidence Communication, Department of Pure Mathematics and Mathematical Statistics, University of Cambridge, Cambridge, UK
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Alice C. E. Lawrence
- Winton Centre for Risk and Evidence Communication, Department of Pure Mathematics and Mathematical Statistics, University of Cambridge, Cambridge, UK
| | - Leila Finikarides
- Winton Centre for Risk and Evidence Communication, Department of Pure Mathematics and Mathematical Statistics, University of Cambridge, Cambridge, UK
| | - Giulia Luoni
- Winton Centre for Risk and Evidence Communication, Department of Pure Mathematics and Mathematical Statistics, University of Cambridge, Cambridge, UK
| | - Sarah Dryhurst
- Winton Centre for Risk and Evidence Communication, Department of Pure Mathematics and Mathematical Statistics, University of Cambridge, Cambridge, UK
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - David Spiegelhalter
- Winton Centre for Risk and Evidence Communication, Department of Pure Mathematics and Mathematical Statistics, University of Cambridge, Cambridge, UK
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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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Lacey HP, Lacey SC, Scherer LD, Zikmund‐Fisher BJ. What if I am the one? Measuring individual differences in emotional sensitivity to probability and emotional reactivity to possibility. JOURNAL OF BEHAVIORAL DECISION MAKING 2020. [DOI: 10.1002/bdm.2194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
| | | | - Laura D. Scherer
- Department of Medicine, Division of Cardiology University of Colorado Denver CO USA
| | - Brian J. Zikmund‐Fisher
- Department of Health Behavior and Health Education University of Michigan Ann Arbor MI USA
- Department of Internal Medicine University of Michigan Ann Arbor MI USA
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Juanchich M, Sirota M. Most family physicians report communicating the risks of adverse drug reactions in words (vs. numbers). APPLIED COGNITIVE PSYCHOLOGY 2020. [DOI: 10.1002/acp.3623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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9
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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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10
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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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11
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Petrova D, Traczyk J, Garcia-Retamero R. What shapes the probability weighting function? Influence of affect, numeric competencies, and information formats. JOURNAL OF BEHAVIORAL DECISION MAKING 2018. [DOI: 10.1002/bdm.2100] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Dafina Petrova
- Andalusian School of Public Health (EASP); Granada Spain
- Biomedical Research Institute ibs.GRANADA; Granada Spain
- Mind, Brain, and Behavior Research Center (CIMCYC); University of Granada; Granada Spain
| | - Jakub Traczyk
- Department of Economic Psychology, Wroclaw Faculty of Psychology; SWPS University of Social Sciences and Humanities; Wroclaw Poland
| | - Rocio Garcia-Retamero
- Mind, Brain, and Behavior Research Center (CIMCYC); University of Granada; Granada Spain
- Harding Center for Risk Literacy; Max Planck Institute for Human Development; Berlin Germany
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12
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Reen GK, Silber E, Langdon DW. Best Methods of Communicating Clinical Trial Data to Improve Understanding of Treatments for Patients with Multiple Sclerosis. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:762-766. [PMID: 30005747 DOI: 10.1016/j.jval.2017.12.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 12/07/2017] [Accepted: 12/21/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND Patients' understanding of treatment risks and benefits is a prerequisite for shared decision making. Yet, patients with multiple sclerosis (MS) do not accurately understand treatment information provided in regular clinical consultations. OBJECTIVES To identify the best methods of communicating clinical trial data to improve the understanding of treatments among patients with MS and to also examine the relationship between patients' understanding with decisional conflict, individual traits, and MS symptoms. METHODS A repeated-measures study was used. A sample of relapsing-remitting patients with MS was recruited from National Health Service sites in the United Kingdom. Patients were presented with hypothetical treatment risks and benefits from faux clinical trials. Treatments were communicated using absolute terms, relative terms, and numbers needed to treat/harm. The presence of baseline information with each method was also manipulated. Patients' understanding and conflict in treatment decisions were assessed. Individual traits and MS symptoms were also recorded. RESULTS Understanding was better when treatments were communicated in absolute terms (mean 3.99 ± 0.93) compared with relative terms (mean 2.93 ± 0.91; P < 0.001) and numbers needed to treat/harm (mean 2.89 ± 0.88; P < 0.001). Adding baseline information to all methods significantly improved understanding (mean 5.04 ± 0.96) compared with no baseline information (mean 1.50 ± 0.74; P < 0.001). Understanding was not related to conflict in treatment decisions (r = -0.131; P = 0.391). Numeracy, IQ, and cognitive impairments were significantly related to patients' understanding of treatments. CONCLUSIONS Treatment risks and benefits should ideally be communicated using absolute terms, alongside baseline information. Patients with MS with low numeracy, low IQ, and reduced cognitive skills should be supported during treatment education.
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Affiliation(s)
- Gurpreet K Reen
- Department of Psychology, Royal Holloway, University of London, Egham, UK.
| | - Eli Silber
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - Dawn W Langdon
- Department of Psychology, Royal Holloway, University of London, Egham, UK
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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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14
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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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What do patients really want to know? The effects of age and of different approaches to presenting risk on patient preferences for information on medication side effects. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2016.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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16
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Pighin S, Savadori L, Barilli E, Galbiati S, Smid M, Ferrari M, Cremonesi L. Communicating Down syndrome risk according to maternal age: “1-in-X
” effect on perceived risk. Prenat Diagn 2015; 35:777-82. [DOI: 10.1002/pd.4606] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 04/15/2015] [Accepted: 04/15/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Stefania Pighin
- Center for Experimental Research on Management and Economics, DCP; University IUAV of Venice; Venice Italy
| | - Lucia Savadori
- Department of Economics and Management; University of Trento; Trento Italy
| | - Elisa Barilli
- Department of Cognitive Science and Education; University of Trento; Trento Italy
| | - Silvia Galbiati
- Unit of Genomic for the Diagnosis of Human Pathologies, Division of Genetics and Cell Biology; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - Maddalene Smid
- Department of Obstetrics and Gynecology; San Raffaele Hospital; Milan Italy
| | - Maurizio Ferrari
- Unit of Genomic for the Diagnosis of Human Pathologies, Division of Genetics and Cell Biology; IRCCS San Raffaele Scientific Institute; Milan Italy
- Laboratory of Clinical Molecular Biology; IRCCS Ospedale San Raffaele; Milan Italy
- Università Vita-Salute San Raffaele; Milan Italy
| | - Laura Cremonesi
- Unit of Genomic for the Diagnosis of Human Pathologies, Division of Genetics and Cell Biology; IRCCS San Raffaele Scientific Institute; Milan Italy
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17
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Oudhoff JP, Timmermans DRM. The effect of different graphical and numerical likelihood formats on perception of likelihood and choice. Med Decis Making 2015; 35:487-500. [PMID: 25769496 DOI: 10.1177/0272989x15576487] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 12/20/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Quantitative risk information plays an important role in decision making about health. This study focuses on commonly used numerical and graphical formats and examines their effect on perception of different likelihoods and choice preferences. METHODS An experimental study was conducted with 192 participants, who evaluated 2 sets of 4 lotteries. Numerical formats to describe likelihood varied systematically between participants (X%, X-in-100, or 1-in-X). The effect of graphic formats (bar charts, icon charts) was assessed as a within-subjects factor. Dependent measures included perceived likelihood, choice preferences about participating in the lottery, and processing times. RESULTS Numerical likelihoods presented as 1-in-X were processed fastest and were perceived as conveying larger likelihoods than the X-in-100 and percentages formats (mean response times in seconds: 5.65 v. 7.31 and 6.50; mean rating on a 1-9 scale: 4.38 v. 3.30 and 3.31, respectively). The 1-in-X format also evoked a stronger willingness to participate in a lottery than the 2 other numerical formats. The effect of adding graphs on perceived likelihood was moderated by numerical aptitude. Graphs reduced ratings of perceived likelihood of participants with lower numeracy, while there was no overall effect for participants with higher numeracy. CONCLUSION Perception of likelihood differs significantly depending on the numerical format used. The 1-in-X format yields higher perceived likelihoods and it appears to be the easiest format to interpret. Graphs primarily affect perception of likelihood of people with lower numerical aptitude. These effects should be taken into account when discussing medical risks with patients.
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Affiliation(s)
- Jurriaan P Oudhoff
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands (JPO, DRMT)
| | - Daniëlle R M Timmermans
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands (JPO, DRMT)
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18
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Chapman AR, Litton E, Chamberlain J, Ho KM. The effect of prognostic data presentation format on perceived risk among surrogate decision makers of critically ill patients: a randomized comparative trial. J Crit Care 2014; 30:231-5. [PMID: 25480457 DOI: 10.1016/j.jcrc.2014.11.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 09/23/2014] [Accepted: 11/07/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this study is to determine whether varying the format used to present prognostic data alters the perception of risk among surrogate decision makers in the intensive care unit (ICU). METHODS This was a prospective randomized comparative trial conducted in a 23-bed adult tertiary ICU. Enrolled surrogate decision makers were randomized to 1 of 2 questionnaires, which presented hypothetical ICU scenarios, identical other than the format in which prognostic data were presented (eg, frequencies vs percentages). Participants were asked to rate the risk associated with each prognostic statement. RESULTS We enrolled 141 surrogate decision makers. The perception of risk varied significantly dependent on the presentation format. For "quantitative data," risks were consistently perceived as higher, when presented as frequencies (eg, 1 in 50) compared with equivalent percentages (eg, 2%). Framing "qualitative data" in terms of chance of "death" rather than "survival" led to a statistically significant increase in perceived risks. Framing "quantitative" data in this way did not significantly affect risk perception. CONCLUSION Data format had a significant effect on how surrogate decision makers interpreted risk. Qualitative statements are interpreted widely and affected by framing. Where possible, multiple quantitative formats should be used for presenting prognostic information.
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Affiliation(s)
- Andy R Chapman
- Department of Intensive Care Medicine, Royal Perth Hospital, Perth, 6000, Western Australia.
| | - Edward Litton
- Department of Intensive Care Medicine, Royal Perth Hospital, Perth, 6000, Western Australia; School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia
| | - Jenny Chamberlain
- Department of Intensive Care Medicine, Royal Perth Hospital, Perth, 6000, Western Australia
| | - Kwok M Ho
- Department of Intensive Care Medicine, Royal Perth Hospital, Perth, 6000, Western Australia; School of Population Health, University of Western Australia, Perth, Western Australia
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Zikmund-Fisher BJ. Continued Use of 1-in-X Risk Communications Is a Systemic Problem. Med Decis Making 2013; 34:412-3. [DOI: 10.1177/0272989x13516198] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Brian J. Zikmund-Fisher
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA (BJZ-F)
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA (BJZ-F)
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA (BJZ-F)
- Risk Science Center, University of Michigan, Ann Arbor, MI, USA (BJZ-F)
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20
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Sirota M, Juanchich M, Kostopoulou O, Hanak R. Decisive Evidence on a Smaller-Than-You-Think Phenomenon. Med Decis Making 2013; 34:419-29. [DOI: 10.1177/0272989x13514776] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Accurate perception of medical probabilities communicated to patients is a cornerstone of informed decision making. People, however, are prone to biases in probability perception. Recently, Pighin and others extended the list of such biases with evidence that “1-in-X” ratios (e.g., “1 in 12”) led to greater perceived probability and worry about health outcomes than “N-in-X*N” ratios (e.g., “10 in 120”). Subsequently, the recommendation was to avoid using “1-in-X” ratios when communicating probabilistic information to patients. To warrant such a recommendation, we conducted 5 well-powered replications and synthesized the available data. We found that 3 out of the 5 replications yielded statistically nonsignificant findings. In addition, our results showed that the “1-in-X” effect was not moderated by numeracy, cognitive reflection, age, or gender. To quantify the evidence for the effect, we conducted a Bayes factor meta-analysis and a traditional meta-analysis of our 5 studies and those of Pighin and others (11 comparisons, N = 1131). The meta-analytical Bayes factor, which allowed assessment of the evidence for the null hypothesis, was very low, providing decisive evidence to support the existence of the “1-in-X” effect. The traditional meta-analysis showed that the overall effect was significant (Hedges’ g = 0.42, 95% CI 0.29–0.54). Overall, we provide decisive evidence for the existence of the “1-in-X” effect but suggest that it is smaller than previously estimated. Theoretical and practical implications are discussed.
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Affiliation(s)
- Miroslav Sirota
- School of Medicine, King’s College London, UK (MS, OK)
- Kingston Business School, Kingston University London, UK (MJ)
- Faculty of Business Management, University of Economics in Bratislava, Bratislava, Slovakia (RH)
| | - Marie Juanchich
- School of Medicine, King’s College London, UK (MS, OK)
- Kingston Business School, Kingston University London, UK (MJ)
- Faculty of Business Management, University of Economics in Bratislava, Bratislava, Slovakia (RH)
| | - Olga Kostopoulou
- School of Medicine, King’s College London, UK (MS, OK)
- Kingston Business School, Kingston University London, UK (MJ)
- Faculty of Business Management, University of Economics in Bratislava, Bratislava, Slovakia (RH)
| | - Robert Hanak
- School of Medicine, King’s College London, UK (MS, OK)
- Kingston Business School, Kingston University London, UK (MJ)
- Faculty of Business Management, University of Economics in Bratislava, Bratislava, Slovakia (RH)
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21
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Trevena LJ, Zikmund-Fisher BJ, Edwards A, Gaissmaier W, Galesic M, Han PKJ, King J, Lawson ML, Linder SK, Lipkus I, Ozanne E, Peters E, Timmermans D, Woloshin S. Presenting quantitative information about decision outcomes: a risk communication primer for patient decision aid developers. BMC Med Inform Decis Mak 2013; 13 Suppl 2:S7. [PMID: 24625237 PMCID: PMC4045391 DOI: 10.1186/1472-6947-13-s2-s7] [Citation(s) in RCA: 300] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Making evidence-based decisions often requires comparison of two or more options. Research-based evidence may exist which quantifies how likely the outcomes are for each option. Understanding these numeric estimates improves patients' risk perception and leads to better informed decision making. This paper summarises current "best practices" in communication of evidence-based numeric outcomes for developers of patient decision aids (PtDAs) and other health communication tools. METHOD An expert consensus group of fourteen researchers from North America, Europe, and Australasia identified eleven main issues in risk communication. Two experts for each issue wrote a "state of the art" summary of best evidence, drawing on the PtDA, health, psychological, and broader scientific literature. In addition, commonly used terms were defined and a set of guiding principles and key messages derived from the results. RESULTS The eleven key components of risk communication were: 1) Presenting the chance an event will occur; 2) Presenting changes in numeric outcomes; 3) Outcome estimates for test and screening decisions; 4) Numeric estimates in context and with evaluative labels; 5) Conveying uncertainty; 6) Visual formats; 7) Tailoring estimates; 8) Formats for understanding outcomes over time; 9) Narrative methods for conveying the chance of an event; 10) Important skills for understanding numerical estimates; and 11) Interactive web-based formats. Guiding principles from the evidence summaries advise that risk communication formats should reflect the task required of the user, should always define a relevant reference class (i.e., denominator) over time, should aim to use a consistent format throughout documents, should avoid "1 in x" formats and variable denominators, consider the magnitude of numbers used and the possibility of format bias, and should take into account the numeracy and graph literacy of the audience. CONCLUSION A substantial and rapidly expanding evidence base exists for risk communication. Developers of tools to facilitate evidence-based decision making should apply these principles to improve the quality of risk communication in practice.
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Affiliation(s)
- Lyndal J Trevena
- Primary Health Care, School of Public Health, Room 321b, Edward Ford Building (A27), University of Sydney, NSW 2006, Australia
| | - Brian J Zikmund-Fisher
- Department of Health Behavior & Health Education, School of Public Health, Department of Internal Medicine, School of Medicine, and Center for Bioethics and Social Sciences in Medicine, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - Adrian Edwards
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - Wolfgang Gaissmaier
- Harding Center for Risk Literacy, Max Planck Institute for Human Development, Lentzeallee 94, 14195 Berlin, Germany
| | - Mirta Galesic
- Center for Adaptive Behavior and Cognition, Max Planck Institute for Human Development, Lentzeallee 94, 14195 Berlin, Germany
| | - Paul KJ Han
- Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, 509 Forest Avenue, Portland, ME 04101, USA
| | - John King
- Department of Family Medicine, University of Vermont College of Medicine, 235 Rowell, 106 Carrigan Drive, University of Vermont, Burlington, Vermont 05405, USA
| | - Margaret L Lawson
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | - Suzanne K Linder
- Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030, USA
| | - Isaac Lipkus
- Duke University School of Nursing, 307 Trent Drive, Durham, NC 27710, USA
| | - Elissa Ozanne
- Department of Surgery and Institute for Health Policy Studies, University of California, San Francisco, 3333 California St. Suite 265, San Francisco, CA 94143-0936, USA
| | - Ellen Peters
- Department of Psychology, Ohio State University, 235 Psychology Building, 1835 Neil Avenue, Columbus, OH 43210, USA
| | - Danielle Timmermans
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Steven Woloshin
- Departments of Medicine and of Community & Family Medicine and The Dartmouth Institute for Health Policy & Clinical Practice at the Geisel School of Medicine at Dartmouth and the VA Outcomes Group, VA Medical Center, 215 North Main Street, White River Junction, VT 05009-0001, USA
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Perzynski AT, Terchek JJ, Blixen CE, Dawson NV. Playing the numbers: how hepatitis C patients create meaning and make healthcare decisions from medical test results. SOCIOLOGY OF HEALTH & ILLNESS 2013; 35:610-627. [PMID: 23009649 DOI: 10.1111/j.1467-9566.2012.01516.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In this article we describe how patients assign meanings to medical test results and use these meanings to justify their actions. Evidence is presented from lay interpretations of medical tests for monitoring hepatitis C viral infection (HCV) to show how numeracy becomes embodied in the absence of physical symptoms. Illness narratives from 307 individuals infected with HCV were collected from the internet and analysed qualitatively. As part of standard medical care, chronically infected HCV patients are required to have periodic blood tests for laboratory testing. The lab results are presented numerically and compared with established physiological standards. HCV patients' knowledge and interpretations of test results have important consequences for their health behaviour and their medical decisions. In their stories, the patients described their decisions to begin, delay or stop treatment and developed strategies to alter their diet, exercise and use alternative therapies according to changes in their test result. The perceived meanings of test results are powerful signifiers that are capable of altering the course of HCV patients' illness, lives and stories. An interpretive model of health numeracy has the advantage of promoting understanding between patients and healthcare providers over a model that views innumeracy as a skill deficit.
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Affiliation(s)
- Adam T Perzynski
- Center for Health Care Research and Policy, Case Western Reserve University at MetroHealth Medical Center, Cleveland OH 44109–1998, USA.
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Pighin S, Savadori L, Barilli E, Rumiati R, Bonalumi S, Ferrari M, Cremonesi L. Using Comparison Scenarios to Improve Prenatal Risk Communication. Med Decis Making 2012; 33:48-58. [DOI: 10.1177/0272989x12464433] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present research provides empirical evidence of whether communicating the prenatal risk of chromosomal anomalies using comparison scenarios influences women’s ability to distinguish between different risk levels. In 2 experiments, participants read a description of a hypothetical woman who was learning of the risk of chromosomal anomaly as a result of a prenatal screening test. Both experiments used a 3 (risk level) × 3 (scenario) full between-subjects design. In accordance with the experimental condition, participants were presented with a low (e.g., 1 in 5390), a medium (e.g., 1 in 770), or a high risk value (e.g., 1 in 110). Such risk values were presented either on their own or along with additional information illustrating a comparison scenario that provided 2 numerical comparison points. Participants were asked to evaluate the risk of chromosomal anomaly. In Experiment 2, participants’ numeracy skills were also assessed. Results showed that the use of comparison scenarios results in significant differences in perceived risk across risk levels whereas such differences are not significant without the comparison scenario, but such a technique has differential effects according to participants’ capacity to deal with numbers. Although the technique is beneficial for high-numerate participants, it has no effect on low-numerate participants.
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Affiliation(s)
- Stefania Pighin
- Department of Cognitive Sciences and Education, University of Trento, Rovereto, Italy (SP, LS, EB)
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy (RR)
- Genomic Unit for the Diagnosis of Human Pathologies, San Raffaele Scientific Institute, Milan, Italy (SB, MF, LC)
- Università Vita-Salute, San Raffaele, Milan, Italy (MF)
- Diagnostica e Ricerca San Raffaele S.p.A., Milan, Italy (MF)
| | - Lucia Savadori
- Department of Cognitive Sciences and Education, University of Trento, Rovereto, Italy (SP, LS, EB)
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy (RR)
- Genomic Unit for the Diagnosis of Human Pathologies, San Raffaele Scientific Institute, Milan, Italy (SB, MF, LC)
- Università Vita-Salute, San Raffaele, Milan, Italy (MF)
- Diagnostica e Ricerca San Raffaele S.p.A., Milan, Italy (MF)
| | - Elisa Barilli
- Department of Cognitive Sciences and Education, University of Trento, Rovereto, Italy (SP, LS, EB)
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy (RR)
- Genomic Unit for the Diagnosis of Human Pathologies, San Raffaele Scientific Institute, Milan, Italy (SB, MF, LC)
- Università Vita-Salute, San Raffaele, Milan, Italy (MF)
- Diagnostica e Ricerca San Raffaele S.p.A., Milan, Italy (MF)
| | - Rino Rumiati
- Department of Cognitive Sciences and Education, University of Trento, Rovereto, Italy (SP, LS, EB)
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy (RR)
- Genomic Unit for the Diagnosis of Human Pathologies, San Raffaele Scientific Institute, Milan, Italy (SB, MF, LC)
- Università Vita-Salute, San Raffaele, Milan, Italy (MF)
- Diagnostica e Ricerca San Raffaele S.p.A., Milan, Italy (MF)
| | - Sara Bonalumi
- Department of Cognitive Sciences and Education, University of Trento, Rovereto, Italy (SP, LS, EB)
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy (RR)
- Genomic Unit for the Diagnosis of Human Pathologies, San Raffaele Scientific Institute, Milan, Italy (SB, MF, LC)
- Università Vita-Salute, San Raffaele, Milan, Italy (MF)
- Diagnostica e Ricerca San Raffaele S.p.A., Milan, Italy (MF)
| | - Maurizio Ferrari
- Department of Cognitive Sciences and Education, University of Trento, Rovereto, Italy (SP, LS, EB)
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy (RR)
- Genomic Unit for the Diagnosis of Human Pathologies, San Raffaele Scientific Institute, Milan, Italy (SB, MF, LC)
- Università Vita-Salute, San Raffaele, Milan, Italy (MF)
- Diagnostica e Ricerca San Raffaele S.p.A., Milan, Italy (MF)
| | - Laura Cremonesi
- Department of Cognitive Sciences and Education, University of Trento, Rovereto, Italy (SP, LS, EB)
- Department of Developmental Psychology and Socialization, University of Padua, Padua, Italy (RR)
- Genomic Unit for the Diagnosis of Human Pathologies, San Raffaele Scientific Institute, Milan, Italy (SB, MF, LC)
- Università Vita-Salute, San Raffaele, Milan, Italy (MF)
- Diagnostica e Ricerca San Raffaele S.p.A., Milan, Italy (MF)
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Affiliation(s)
- Brian J. Zikmund-Fisher
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA (BJZ)
- Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA (BJZ)
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA (BJZ); and Risk Science Center, University of Michigan, Ann Arbor, MI, USA (BJZ)
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