To Consent or Not to Consent to Screening, That Is the Question

The objective of this article is to address the controversial question of whether consent is relevant for persons invited to participate in screening programs. To do so, it starts by presenting a case where the provided information historically has not been sufficient for obtaining valid informed consent for screening. Then, the article investigates some of the most relevant biases that cast doubt on the potential for satisfying standard criteria for informed consent. This may indicate that both in theory and in practice, it can be difficult to obtain valid consent for screening programs. Such an inference is profoundly worrisome, as invitees to screening programs are healthy individuals most suited to make autonomous decisions. Thus, if consent is not relevant for screening, it may not be relevant for a wide range of other health services. As such, the lack of valid consent in screening raises the question of the relevance of one of the basic ethical principles in healthcare (respect for autonomy), one of the most prominent legal norms in health legislation (informed consent), and one of the most basic tenets of liberal democracies (individual autonomy). Thus, there are good reasons to provide open, transparent, and balanced information and minimize biases in order to ascertain informed consent in screening.

Analysis of the Conflict between Car Commuter's Route Choice Habitual Behavior and Traffic Information Search Behavior

Motivated by the conflict between travelers’ habitual choice behavior and traffic information search behavior, in this paper, a behavioral experiment under different types of traffic information (i.e., per-trip traffic information and en-route traffic information) was designed to obtain data regarding car commuters’ daily route choices. Based on the observed data, participants’ route choices, habit strength, response time, and information search behaviors were analyzed. It is concluded that, in the beginning, the traffic information had a great influence on the habit participants’ route choices, let them think more, and made most of them switch from habit route to the best route (as recommended by traffic information); however, as time went on, the impact of traffic information declined, and several features of habits, such as automatically responding and repeated behavior, would reappear in some participants’ decision-making. Meanwhile, the different way of traffic information search behaviors (i.e., in active performance or in passive reception) could cause different information compliance ratios. These results would help to understand the interrelationship between car commuters’ daily route choice behaviors and traffic information search behaviors in short-term and in long-term, respectively, and provide an interesting starting point for the development of practical traffic information issuing strategies to enhance the impact of traffic information to alleviate traffic congestion during morning commuting.

Motivation towards novel learning content: Perceived similarity of learning content, but not need for cognition, moderates the generalization of motivation

BACKGROUND

The generalization of established motivation hypothesis states that individuals use established motivational beliefs to predict motivational beliefs regarding novel learning content on the basis of the perceived similarity between academic domains.

AIMS

This study tests the generalization hypothesis by investigating the assumed moderating role of the extent of perceived similarity between known and novel learning content and need for cognition (NFC).

SAMPLE(S)

Participants were adult students (n = 576) from various study programs (Study 1) and non-students (n = 628) of whom the majority held at least a bachelor's degree (Study 2).

METHODS

In this prospective correlational survey study, we used online self-report measures to assess participants' self-concept of ability (SCA) and intrinsic task value (ITV) regarding their established and anticipated motivational beliefs regarding a set of school subjects (known learning content) and fields of study (novel learning content), perceptions of similarity, and their NFC. Data was analysed using structural equation modelling with latent interaction variables.

RESULTS

We found support for the generalization hypothesis and documented that the perceived similarity moderated the generalizing effect (i.e., SCA and ITV had stronger predictive validity for learning content that was perceived as more similar). However, the results obtained for the moderating effect of NFC were mostly nonsignificant.

CONCLUSION

Individuals generalize established motivation regarding known learning content to anticipated motivation regarding novel learning content perceived as being similar. The extent of perceived similarity enhances this effect, whereas NFC does not. Future research should address the underlying automatic and deliberate cognitive processes of generalization.

How different rewards tend to influence employee non-compliance with information security policies

Purpose

To help reduce the increasing number of information security breaches that are caused by insiders, past research has examined employee non-compliance with information security policy. However, existent studies have observed mixed results, which suggest that an interaction is likely to exist among the variables that explain employee non-compliance. In an effort to provide evidence for this possibility, this paper aims to better explain why employees routinely engage in non-compliant behaviors by examining the direct and interactive effects of employees’ perceived costs and rewards of compliance and non-compliance on their routinized non-compliant behaviors.

Design/methodology/approach

Based on rational choice theory, this study used 16 hypothetical scenarios in an experimental survey, collecting data from 326 respondents and analyzing them via structural equation modeling and a four-way factorial experiment.

Findings

The results suggest that routinized non-compliance of employees is more strongly influenced by the rewards than the costs they perceive in their non-compliance. Further, employees’ routinized non-compliance behavior was found to be positively influenced by an interactive effect of perceived rewards of compliance when their perceptions of their non-compliance costs and rewards were both high and low.

Originality/value

This paper’s key contribution is to suggest that non-compliance behavior is influenced by direct and interactive effects of perceived rewards of compliance and non-compliance.

First-Year Students' Initial Motivational Beliefs at University: Predicted by Motivational Beliefs Derived from Within and Out-of-School Experience and Malleable Regardless of the Extent of Students' Out-of-School Experience

The present study tested how academic self-concept of ability (ASC) and intrinsic task value (ITV) transpose onto novel university programs that depart from traditional subject areas within the framework of expectancy-value theory. The study focused on two potential sources of information used to anticipate one's ASC and ITV regarding new learning content (here: business administration). First, students' experiences from secondary school, especially their ASCs and ITVs established in a school subject they consider similar to business administration-mathematics-should predict their business administration-specific ASC and ITV. Second, students may have gained relevant experience in out-of-school settings such as internships with business companies or commercial vocational training prior to entering higher education. ASC and ITV developed from out-of-school experiences was hypothesized to predict students' business administration-specific ASC and ITV as well. However, the likely mismatch between anticipated and actual experience with new contents should lead to revisions of ASC and ITV after entering university reflected in a presumably lower stability compared to secondary school settings. In addition, the extent of students' out-of-school experience might act as a moderator. Data were collected from 341 first-year students in higher education in Germany before they began their study program and again 3-4 months later. Confirmatory factor analyses support the discriminant validity of the measures used in the study. Results from structural equation modeling show that students' ASC/ITV derived from relevant out-of-school experience make an important contribution to their initial business administration-specific ASC and ITV beyond their mathematics-specific ASC/ITV. Furthermore, both business administration-specific ASC and ITV showed significantly lower stability coefficients over the initial study phase than research from secondary school indicating revisions to them via experience. Multiple-group structural equation modeling showed no moderating effect of the extent of students' out-of-school experience. The discussion focuses on interpretations of the expectancy-value theory that explicitly include motivational beliefs derived from out-of-school settings as antecedents of expectancy and value. With respect to practical implications, results are discussed in the light of student counseling and support to help students develop an adequate picture of a study program's learning contents and overcome initial motivational setbacks.

Routinisation of informed consent in online health care systems

OBJECTIVES

To investigate (1) the extent to which informed consent is routinised, i.e., given habitually and without reflection, in relation to the use of web-portals containing personal health information, and (2) the reasons given by users for routinised and non-routinised consent behaviour.

DESIGN

Anonymous web-questionnaire among users of the official Danish health information web-portal, Sundhed.dk.

SETTING

Sundhed.dk allows Danish residents access to their electronic patient records and other personal health information and allows them to update some of this information. Use of the portal requires explicit consent to the terms and conditions of use and the data protection policies of the site.

MAIN OUTCOME MEASURES

Degree to which information materials are read before use of the portal. Reasons given for reading or not reading materials.

RESULT

Seventy-nine percent of respondents read half or less of the information materials before using the portal. The main reasons given for not reading (all) of the materials relate to the length of the materials, the frequency of having to read such things, and the perception that use of the portal is 'low risk'. The reasons given for reading and not reading indicate that the consent process is routinised.

CONCLUSIONS

Most users of Sundhed.dk do not provide informed consent before using the portal, since most do not read the information fully. The reasons given for not reading strongly supports the idea that consent has become a routinised behaviour in this context. This finding is important because web-portals offering access to personal health information held by the health care system are becoming ever more frequent.

The environment matters: Comparing individuals and dyads in their adaptive use of decision strategies

Individuals have been shown to adaptively select decision strategies depending on the environment structure. Two experiments extended this research to the group level. Subjects (N = 240) worked either individually or in two-person groups, or dyads, on a multi-attribute paired-comparison task. They were randomly assigned to two different environments that favored one of two prototypical decision strategies—weighted additive or take-the-best (between-subjects design in Experiment 1 and within-subject design in Experiment 2). Performance measures revealed that both individuals and dyads learned to adapt over time. A higher starting and overall performance rate in the environment in which weighted additive performed best led to the conclusion that weighted additive served as a default strategy. When this default strategy had to be replaced, because the environment structure favored take-the-best, the superior adaptive capacity of dyads became observable in the form of a steeper learning rate. Analyses of nominal dyads indicate that real dyads performed at the level of the best individuals. Fine-grained analyses of information-search data are presented. Results thus point to the strong moderating role of the environment structure when comparing individual with group performance and are discussed within the framework of adaptive strategy selection.

Pandemic H1N1 in Canada and the use of evidence in developing public health policies--a policy analysis

When responding to a novel infectious disease outbreak, policies are set under time constraints and uncertainty which can limit the ability to control the outbreak and result in unintended consequences including lack of public confidence. The H1N1 pandemic highlighted challenges in public health decision-making during a public health emergency. Understanding this process to identify barriers and modifiable influences is important to improve the response to future emergencies. The purpose of this study is to examine the H1N1 pandemic decision-making process in Canada with an emphasis on the use of evidence for public health decisions. Using semi-structured key informant interviews conducted after the pandemic (July–November 2010) and a document analysis, we examined four highly debated pandemic policies: use of adjuvanted vaccine by pregnant women, vaccine priority groups and sequencing, school closures and personal protective equipment. Data were analysed for thematic content guided by Lomas' policy decision-making framework as well as indicative coding using iterative methods. We interviewed 40 public health officials and scientific advisors across Canada and reviewed 76 pandemic policy documents. Our analysis revealed that pandemic pre-planning resulted in strong beliefs, which defined the decision-making process. Existing ideological perspectives of evidence strongly influenced how information was used such that the same evidentiary sources were interpreted differently according to the ideological perspective. Participants recognized that current models for public health decision-making failed to make explicit the roles of scientific evidence in relation to contextual factors. Conflict avoidance theory explained policy decisions that went against the prevailing evidence. Clarification of roles and responsibilities within the public health system would reduce duplication and maintain credibility. A more transparent and iterative approach to incorporating evidence into public health decision-making that reflects the realities of the external pressures present during a public health emergency is needed.

Accepting diagnostic suggestions by residents: a potential cause of diagnostic error in medicine

BACKGROUND

Psychological research has shown that people tend toward accepting rather than refuting hypotheses. Diagnostic suggestions may evoke such confirmatory tendencies in physicians, which may lead to diagnostic errors.

PURPOSE

This study investigated the influence of a suggested diagnosis on physicians' diagnostic decisions on written clinical cases. It was hypothesized that physicians would tend to go along with the suggestions and therefore would have more difficulty rejecting incorrect suggestions than accepting correct suggestions.

METHODS

Residents (N = 24) had to accept or reject suggested diagnoses on 6 cases. Three of those suggested diagnoses were correct, and 3 were incorrect.

RESULTS

Results showed the mean correct evaluation score on cases with a correct suggested diagnosis (M = 2.21, SD = 0.88) was significantly higher than the score on cases with an incorrect suggested diagnosis (M = 1.42, SD = 0.97), meaning physicians indeed found it easier to accept correct diagnoses than to reject incorrect diagnoses, t(23) = 2.74, p < .05, d = .85, despite equal experience with the diagnoses.

CONCLUSION

These findings indicate that suggested diagnoses may evoke confirmatory tendencies and consequently may lead to diagnostic errors.

Beyond frequency: Habit as mental construct

Progress in habit theory can be made by distinguishing habit from frequency of occurrence, and using independent measures for these constructs. This proposition was investigated in three studies using a longitudinal, cross-sectional and experimental design on eating, mental habits and word processing, respectively. In Study 1, snacking habit and past snacking frequency independently predicted later snacking behaviour, while controlling for the theory of planned behaviour variables. Habit fully mediated the effect of past on later behaviour. In Study 2, habitual negative self-thinking and past frequency of negative self-thoughts independently predicted self-esteem and the presence of depressive and anxiety symptoms. In Study 3, habit varied as a function of experimentally manipulated task complexity, while behavioural frequency was held constant. Taken together, while repetition is necessary for habits to develop, these studies demonstrate that habit should not be equated with frequency of occurrence, but rather should be considered as a mental construct involving features of automaticity, such as lack of awareness, difficulty to control and mental efficiency.

Adaptive flexibility and maladaptive routines in selecting fast and frugal decision strategies

Decision routines unburden the cognitive capacity of the decision maker. In changing environments, however, routines may become maladaptive. In 2 experiments with a hypothetical stock market game (n = 241), the authors tested whether decision routines tend to persist at the level of decision strategies rather than at the level of options in strategy selection. The payoff structure of the task was changed after 80 decision trials, rendering a new strategy optimal with respect to expected payoff. Whereas most participants detected the appropriate strategy at the beginning of the task, they tended to retain it even when it was no longer optimal. A hint about a possible change had only a small influence on this maladaptive routine; a monetary incentive had none. Switching to a similar but not identical task relaxed the routine, but not much.

Wie beeinflussen Routinen das Entscheidungsverhalten?

Zusammenfassung. Erwachsene Personen verfügen über ein großes Repertoire an Routinen, d.h. sie kennen Handlungen, die zielführend für wiederkehrende Entscheidungssituationen sind. Die kognitive Entscheidungsforschung vernachlässigte über lange Zeit die Rolle von Routinen. Das Papier gibt einen Überblick über rezente Forschungen, die sich mit dem Einfluss von Routinen auf Entscheidungen befassen. Es zeigt sich, dass Routinen systematisch die Generierung von Alternativen, die Informationssuche, die Bewertung, die Wahl und schließlich die Implementierung des gewählten Verhaltens beeinflussen. Mit Blick auf die Befunde wird ein breites Rahmenmodell vorgeschlagen, das das Lernen von Routinen als integralen Bestandteil von Entscheidung versteht.