Judgement and Decision Making in Clinical and Return-to-Sports Decision Making: A Narrative Review

Making return-to-sport decisions can be complex and multi-faceted, as it requires an evaluation of an individual's physical, psychological, and social well-being. Specifically, the timing of progression, regression, or return to sport can be difficult to determine due to the multitude of information that needs to be considered by clinicians. With the advent of new sports technology, the increasing volume of data poses a challenge to clinicians in effectively processing and utilising it to enhance the quality of their decisions. To gain a deeper understanding of the mechanisms underlying human decision making and associated biases, this narrative review provides a brief overview of different decision-making models that are relevant to sports rehabilitation settings. Accordingly, decisions can be made intuitively, analytically, and/or with heuristics. This narrative review demonstrates how the decision-making models can be applied in the context of return-to-sport decisions and shed light on strategies that may help clinicians improve decision quality.

Rethinking Norm Psychology

Norms permeate human life. Most of people's activities can be characterized by rules about what is appropriate, allowed, required, or forbidden-rules that are crucial in making people hyper-cooperative animals. In this article, I examine the current cognitive-evolutionary account of "norm psychology" and propose an alternative that is better supported by evidence and better placed to promote interdisciplinary dialogue. The incumbent theory focuses on rules and claims that humans genetically inherit cognitive and motivational mechanisms specialized for processing these rules. The cultural-evolutionary alternative defines normativity in relation to behavior-compliance, enforcement, and commentary-and suggests that it depends on implicit and explicit processes. The implicit processes are genetically inherited and domain-general; rather than being specialized for normativity, they do many jobs in many species. The explicit processes are culturally inherited and domain-specific; they are constructed from mentalizing and reasoning by social interaction in childhood. The cultural-evolutionary, or "cognitive gadget," perspective suggests that people alive today-parents, educators, elders, politicians, lawyers-have more responsibility for sustaining normativity than the nativist view implies. People's actions not only shape and transmit the rules, but they also create in each new generation mental processes that can grasp the rules and put them into action.

Does Thinking in Opposites in Order to Think Differently Improve Creativity?

In this paper, we focus on the link between thinking in opposites and creativity. Thinking in opposites requires an intuitive, productive strategy, which may enhance creativity. Given the importance of creativity for the well-being of individuals and society, finding new ways to enhance it represents a valuable goal in both professional and personal contexts. We discuss the body of evidence that exists concerning the importance of the first representation of the structure of a problem to be solved, which determines the baseline representation and sets limits on the area within which a problem solver will explore. We then review a variety of interventions described in the literature on creativity and insight problem solving that were designed to overcome fixedness and encourage people to move away from stereotypical solutions. Special attention is paid to the research carried out in the context of problem solving, which provides evidence that prompting people to "think in opposites" is beneficial. We suggest that an extended investigation of the effects of this strategy in various types of tasks related to creativity is an interesting line of research to follow. We discuss the rationale supporting this claim and identify specific questions, both theoretical and methodological, for future research to address.

Biased Estimates of Environmental Impact in the Negative Footprint Illusion: The Nature of Individual Variation

People consistently act in ways that harm the environment, even when believing their actions are environmentally friendly. A case in point is a biased judgment termed the negative footprint illusion, which arises when people believe that the addition of "eco-friendly" items (e.g., environmentally certified houses) to conventional items (e.g., standard houses), reduces the total carbon footprint of the whole item-set, whereas the carbon footprint is, in fact, increased because eco-friendly items still contribute to the overall carbon footprint. Previous research suggests this illusion is the manifestation of an "averaging-bias." We present two studies that explore whether people's susceptibility to the negative footprint illusion is associated with individual differences in: (i) environment-specific reasoning dispositions measured in terms of compensatory green beliefs and environmental concerns; or (ii) general analytic reasoning dispositions measured in terms of actively open-minded thinking, avoidance of impulsivity and reflective reasoning (indexed using the Cognitive Reflection Test; CRT). A negative footprint illusion was demonstrated when participants rated the carbon footprint of conventional buildings combined with eco-friendly buildings (Study 1 and 2) and conventional cars combined with eco-friendly cars (Study 2). However, the illusion was not identified in participants' ratings of the carbon footprint of apples (Study 1 and 2). In Studies 1 and 2, environment-specific dispositions were found to be unrelated to the negative footprint illusion. Regarding reflective thinking dispositions, reduced susceptibility to the negative footprint illusion was only associated with actively open-minded thinking measured on a 7-item scale (Study 1) and 17-item scale (Study 2). Our findings provide partial support for the existence of a negative footprint illusion and reveal a role of individual variation in reflective reasoning dispositions in accounting for a limited element of differential susceptibility to this illusion.

Differences in Performance of ASD and ADHD Subjects Facing Cognitive Loads in an Innovative Reasoning Experiment

We aim to investigate whether EEG dynamics differ in adults with ASD (Autism Spectrum Disorders) and ADHD (attention-deficit/hyperactivity disorder) compared with healthy subjects during the performance of an innovative cognitive task, Aristotle's valid and invalid syllogisms, and how these differences correlate with brain regions and behavioral data for each subject. We recorded EEGs from 14 scalp electrodes (channels) in 21 adults with ADHD, 21 with ASD, and 21 healthy, normal subjects. The subjects were exposed in a set of innovative cognitive tasks (inducing varying cognitive loads), Aristotle's two types of syllogism mentioned above. A set of 39 questions were given to participants related to valid-invalid syllogisms as well as a separate set of questionnaires, in order to collect a number of demographic and behavioral data, with the aim of detecting shared information with values of a feature extracted from EEG, the multiscale entropy (MSE), in the 14 channels ('brain regions'). MSE, a nonlinear information-theoretic measure of complexity, was computed to extract a feature that quantifies the complexity of the EEG. Behavior-Partial Least Squares Correlation, PLSC, is the method to detect the correlation between two sets of data, brain, and behavioral measures. -PLSC, a variant of PLSC, was applied to build a functional connectivity of the brain regions involved in the reasoning tasks. Graph-theoretic measures were used to quantify the complexity of the functional networks. Based on the results of the analysis described in this work, a mixed 14 × 2 × 3 ANOVA showed significant main effects of group factor and brain region* syllogism factor, as well as a significant brain region* group interaction. There are significant differences between the means of MSE (complexity) values at the 14 channels of the members of the 'pathological' groups of participants, i.e., between ASD and ADHD, while the difference in means of MSE between both ASD and ADHD and that of the control group is not significant. In conclusion, the valid-invalid type of syllogism generates significantly different complexity values, MSE, between ASD and ADHD. The complexity of activated brain regions of ASD participants increased significantly when switching from a valid to an invalid syllogism, indicating the need for more resources to 'face' the task escalating difficulty in ASD subjects. This increase is not so evident in both ADHD and control. Statistically significant differences were found also in the behavioral response of ASD and ADHD, compared with those of control subjects, based on the principal brain and behavior saliences extracted by PLSC. Specifically, two behavioral measures, the emotional state and the degree of confidence of participants in answering questions in Aristotle's valid-invalid syllogisms, and one demographic variable, age, statistically and significantly discriminate the three groups' ASD. The seed-PLC generated functional connectivity networks for ASD, ADHD, and control, were 'projected' on the regions of the Default Mode Network (DMN), the 'reference' connectivity, of which the structural changes were found significant in distinguishing the three groups. The contribution of this work lies in the examination of the relationship between brain activity and behavioral responses of healthy and 'pathological' participants in the case of cognitive reasoning of the type of Aristotle's valid and invalid syllogisms, using PLSC, a machine learning approach combined with MSE, a nonlinear method of extracting a feature based on EEGs that captures a broad spectrum of EEGs linear and nonlinear characteristics. The results seem promising in adopting this type of reasoning, in the future, after further enhancements and experimental tests, as a supplementary instrument towards examining the differences in brain activity and behavioral responses of ASD and ADHD patients. The application of the combination of these two methods, after further elaboration and testing as new and complementary to the existing ones, may be considered as a tool of analysis in helping detecting more effectively such types of disorders.

Complexity analysis of the brain activity in Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) due to cognitive loads/demands induced by Aristotle's type of syllogism/reasoning. A Power Spectral Density and multiscale entropy (MSE) analysis

OBJECTIVE

We aim to investigate whether EEG dynamics differ in adults with ASD (Autism Spectrum Disorders), ADHD (attention-deficit/hyperactivity disorder), compared with healthy subjects during the performance of an innovative cognitive task: Aristotle's valid and invalid syllogisms. We follow the Neuroanatomical differences type of criterion in assessing the results of our study in supporting or not the dual-process theory of Kahneman, 2011) (Systems I & II of thinking).

METHOD

We recorded EEGs from 14 scalp electrodes in 30 adults with ADHD, 30 with ASD and 24 healthy, normal subjects. The subjects were exposed in a set of innovative cognitive tasks (inducing varying cognitive loads), the Aristotle's four types of syllogism mentioned above. The multiscale entropy (MSE), a nonlinear information-theoretic measure or tool was computed to extract features that quantify the complexity of the EEG.

RESULTS

The dynamics of the curves of the grand average of MSE values of the ADHD and ASD participants was significantly in higher levels for the majority of time scales, than the healthy subjects over a number of brain regions (electrodes locations), during the performance of both valid and invalid types of syllogism. This result is seemingly not in accordance of the broadly accepted 'theory' of complexity loss in 'pathological' subjects, but actually this is not the case as explained in the text. ADHD subjects are engaged in System II of thinking, for both Valid and Invalid syllogism, ASD and Control in System I for valid and invalid syllogism, respectively. A surprising and 'provocative' result of this paper, as shown in the next sections, is that the Complexity-variability of ASD and ADHD subjects, when they face Aristotle's types of syllogisms, is higher than that of the control subjects. An explanation is suggested as described in the text. Also, in the case of invalid type of Aristotelian syllogisms, the linguistic and visuo-spatial systems are both engaged ONLY in the temporal and occipital regions of the brain, respectively, of ADHD subjects. In the case of valid type, both above systems are engaged in the temporal and occipital regions of the brain, respectively, of both ASD and ADHD subjects, while in the control subjects only the visuo-spatial type is engaged (Goel et al., 2000; Knauff, 2007).

CONCLUSION

Based on the results of the analysis described in this work, the differences in the EEG complexity between the three groups of participants lead to the conclusion that cortical information processing is changed in ASD and ADHD adults, therefore their level of cortical activation may be insufficient to meet the peculiar cognitive demand of Aristotle's reasoning.

SIGNIFICANCE

The present paper suggest that MSE, is a powerful and efficient nonlinear measure in detecting neural dysfunctions in adults with ASD and ADHD characteristics, when they are called on to perform in a very demanding as well as innovative set of cognitive tasks, that can be considered as a new diagnostic 'benchmark' in helping detecting more effectively such type of disorders. A linear measure alone, as the typical PSD, is not capable in making such a distinction. The work contributes in shedding light on the neural mechanisms of syllogism/reasoning of Aristotelian type, as well as toward understanding how humans reason logically and why 'pathological' subjects deviate from the norms of formal logic.

Opposites in Reasoning Processes: Do We Use Them More Than We Think, but Less Than We Could?

Our aim in this paper is to contribute toward acknowledging the general role of opposites as an organizing principle in the human mind. We support this claim in relation to human reasoning by collecting evidence from various studies which shows that "thinking in opposites" is not only involved in formal logical thinking, but can also be applied in both deductive and inductive reasoning, as well as in problem solving. We also describe the results of a series of studies which, although they have been developed within a number of different theoretical frameworks based on various methodologies, all demonstrate that giving hints or training reasoners to think in terms of opposites improves their performance in tasks in which spontaneous thinking may lead to classic biases and impasses. Since we all possess an intuitive idea of what opposites are, prompting people to "think in opposites" is something which is undoubtedly within everyone's reach and in the final section, we discuss the potential of this strategy and suggest possible future research directions of systematic testing the benefits that might arise from the use of this technique in contexts beyond those tested thus far. Ascertaining the conditions in which reasoners might benefit will also help in terms of clarifying the underlying mechanisms from the point of view, for instance, of analytical, conscious processing vs. automatic, unconscious processing.

Towards a resolution of some outstanding issues in transitive research: An empirical test on middle childhood

Transitive Inference (deduce B > D from B > C and C > D) can help us to understand other areas of sociocognitive development. Across three experiments, learning, memory, and the validity of two transitive paradigms were investigated. In Experiment 1 (N = 121), 7-year-olds completed a three-term nontraining task or a five-term task requiring extensive-training. Performance was superior on the three-term task. Experiment 2 presented 5–10-year-olds with a new five-term task, increasing learning opportunities without lengthening training (N = 71). Inferences improved, suggesting children can learn five-term series rapidly. Regarding memory, the minor (CD) premise was the best predictor of BD-inferential performance in both task-types. However, tasks exhibited different profiles according to associations between the major (BC) premise and BD inference, correlations between the premises, and the role of age. Experiment 3 (N = 227) helped rule out the possible objection that the above findings simply stemmed from three-term tasks with real objects being easier to solve than computer-tasks. It also confirmed that, unlike for five-term task (Experiments 1 & 2), inferences on three-term tasks improve with age, whether the age range is wide (Experiment 3) or narrow (Experiment 2). I conclude that the tasks indexed different routes within a dual-process conception of transitive reasoning: The five-term tasks indexes Type 1 (associative) processing, and the three-term task indexes Type 2 (analytic) processing. As well as demonstrating that both tasks are perfectly valid, these findings open up opportunities to use transitive tasks for educability, to investigate the role of transitivity in other domains of reasoning, and potentially to benefit the lived experiences of persons with developmental issues.

Dual Process Theories in Behavioral Economics and Neuroeconomics: a Critical Review

Despite their popularity, dual process accounts of human reasoning and decision-making have come under intense scrutiny in recent years. Cognitive scientists and philosophers alike have come to question the theoretical foundations of the ‘standard view’ of dual process theory and have challenged the validity and relevance of evidence in support of it. Moreover, attempts to modify and refine dual process theory in light of these challenges have generated additional concerns about its applicability and refutability as a scientific theory. With these concerns in mind, this paper provides a critical review of dual process theory in economics, focusing on its role as a psychological framework for decision modeling in behavioral economics and neuroeconomics. I argue that the influx of criticisms against dual process theory challenge the descriptive accuracy of dualistic decision models in economics. In fact, the case can be made that the popularity of dual process theory in economics has less to do with the empirical success of dualistic decision models, and more to do with the convenience that the dual process narrative provides economists looking to explain-away decision anomalies. This leaves behavioral economists and neuroeconomists with something of a dilemma: either they stick to their purported ambitions to give a realistic description of human decision-making and give up the narrative, or they revise and restate their scientific ambitions.

Exposing an "Intangible" Cognitive Skill Among Collegiate Football Players: II. Enhanced Response Impulse Control

American football is played in a dynamic environment that places considerable demands on a player’s ability to make fast, precise reactions while controlling premature, impulsive reactions to spatial misinformation. We investigated the hypothesis that collegiate football players are more proficient than their non-athlete counterparts at controlling impulsive motor actions. National Collegiate Athletic Association (NCAA) Division I football players (n = 280) and non-athlete controls (n = 32) completed a variant of the Simon conflict task, which quantifies choice reaction speed and the proficiency of controlling spatially driven response impulses. Overall, the choice reaction times (RTs) and accuracy rates of football players and controls were equivalent. Similarly, football players and controls were equally susceptible to producing incorrect impulsive motor responses. However, the slowing of RT attributed to the activation and successful inhibition of these impulses (i.e., the Simon effect) was reduced significantly among football players compared to controls. Moreover, differences in impulse control varied by position among the players, with the reduction being greater for offensive than for defensive players. Among offensive players, running backs, wide receivers, and offensive linemen had greater impulse control than did controls, whereas among defensive players only linebackers had greater control. Notably, the Simon effect was reduced by 60% in running backs compared to controls. These results contribute to emerging evidence that elite football players possess more proficient executive control over their motor systems than their age counterparts and suggest that the speed of controlling impulsive motor reactions may represent an enhanced cognitive “intangible” among football players.

When fast logic meets slow belief: Evidence for a parallel-processing model of belief bias

Two experiments pitted the default-interventionist account of belief bias against a parallel-processing model. According to the former, belief bias occurs because a fast, belief-based evaluation of the conclusion pre-empts a working-memory demanding logical analysis. In contrast, according to the latter both belief-based and logic-based responding occur in parallel. Participants were given deductive reasoning problems of variable complexity and instructed to decide whether the conclusion was valid on half the trials or to decide whether the conclusion was believable on the other half. When belief and logic conflict, the default-interventionist view predicts that it should take less time to respond on the basis of belief than logic, and that the believability of a conclusion should interfere with judgments of validity, but not the reverse. The parallel-processing view predicts that beliefs should interfere with logic judgments only if the processing required to evaluate the logical structure exceeds that required to evaluate the knowledge necessary to make a belief-based judgment, and vice versa otherwise. Consistent with this latter view, for the simplest reasoning problems (modus ponens), judgments of belief resulted in lower accuracy than judgments of validity, and believability interfered more with judgments of validity than the converse. For problems of moderate complexity (modus tollens and single-model syllogisms), the interference was symmetrical, in that validity interfered with belief judgments to the same degree that believability interfered with validity judgments. For the most complex (three-term multiple-model syllogisms), conclusion believability interfered more with judgments of validity than vice versa, in spite of the significant interference from conclusion validity on judgments of belief.

Can Intrinsic and Extrinsic Metacognitive Cues Shield Against Distraction in Problem Solving?

We investigated the capacity for two different forms of metacognitive cue to shield against auditory distraction in problem solving with Compound Remote Associates Tasks (CRATs). Experiment 1 demonstrated that an intrinsic metacognitive cue in the form of processing disfluency (manipulated using an easy-to-read vs. difficult-to-read font) could increase focal task engagement so as to mitigate the detrimental impact of distraction on solution rates for CRATs. Experiment 2 showed that an extrinsic metacognitive cue that took the form of an incentive for good task performance (i.e. 80% or better CRAT solutions) could likewise eliminate the negative impact of distraction on CRAT solution rates. Overall, these findings support the view that both intrinsic and extrinsic metacognitive cues have remarkably similar effects. This suggests that metacognitive cues operate via a common underlying mechanism whereby a participant applies increased focal attention to the primary task so as to ensure more steadfast task engagement that is not so easily diverted by task-irrelevant stimuli.

A Case for Thinking Without Consciousness

People can engage in prolonged thought processes, such as when they are facing an important decision or when they are working on a scientific discovery. Such thought processes can take months or even years. We argue that while people engage in such thinking, they make progress not only when they consciously think but also sometimes when they are consciously thinking about something else-that is, while they think unconsciously. We review the literature on unconscious thought (UT) processes and conclude that there is indeed quite some evidence for UT. Conceptualized as a form of unconscious goal pursuit, UT is likely to be especially fruitful for thought processes that are complex, important, or interesting to the thinker. In addition, we discuss other characteristics of the UT process. We end with proposing Type 3 processes, in addition to Type 1 and Type 2 (or Systems 1 and 2) processes, to accommodate prolonged thought processes in models on thought.

What makes us think? A three-stage dual-process model of analytic engagement

The distinction between intuitive and analytic thinking is common in psychology. However, while often being quite clear on the characteristics of the two processes ('Type 1' processes are fast, autonomous, intuitive, etc. and 'Type 2' processes are slow, deliberative, analytic, etc.), dual-process theorists have been heavily criticized for being unclear on the factors that determine when an individual will think analytically or rely on their intuition. We address this issue by introducing a three-stage model that elucidates the bottom-up factors that cause individuals to engage Type 2 processing. According to the model, multiple Type 1 processes may be cued by a stimulus (Stage 1), leading to the potential for conflict detection (Stage 2). If successful, conflict detection leads to Type 2 processing (Stage 3), which may take the form of rationalization (i.e., the Type 1 output is verified post hoc) or decoupling (i.e., the Type 1 output is falsified). We tested key aspects of the model using a novel base-rate task where stereotypes and base-rate probabilities cued the same (non-conflict problems) or different (conflict problems) responses about group membership. Our results support two key predictions derived from the model: (1) conflict detection and decoupling are dissociable sources of Type 2 processing and (2) conflict detection sometimes fails. We argue that considering the potential stages of reasoning allows us to distinguish early (conflict detection) and late (decoupling) sources of analytic thought. Errors may occur at both stages and, as a consequence, bias arises from both conflict monitoring and decoupling failures.

Probability in reasoning: a developmental test on conditionals

Probabilistic theories have been claimed to constitute a new paradigm for the psychology of reasoning. A key assumption of these theories is captured by what they call the Equation, the hypothesis that the meaning of the conditional is probabilistic in nature and that the probability of If p then q is the conditional probability, in such a way that P(if p then q)=P(q|p). Using the probabilistic truth-table task in which participants are required to evaluate the probability of If p then q sentences, the present study explored the pervasiveness of the Equation through ages (from early adolescence to adulthood), types of conditionals (basic, causal, and inducements) and contents. The results reveal that the Equation is a late developmental achievement only endorsed by a narrow majority of educated adults for certain types of conditionals depending on the content they involve. Age-related changes in evaluating the probability of all the conditionals studied closely mirror the development of truth-value judgements observed in previous studies with traditional truth-table tasks. We argue that our modified mental model theory can account for this development, and hence for the findings related with the probability task, which do not consequently support the probabilistic approach of human reasoning over alternative theories.

Double dissociation of neural responses supporting perceptual and cognitive components of social cognition: evidence from processing of others' pain

Models on how perceptual and cognitive information on others' mental states are treated by the cognitive architecture are often framed as duplex models considering two independent systems. In the context of the neuroscience of empathy analogous systems have been described. Using event-related potentials (i.e., ERPs) technique, we tested the hypothesis of temporal dissociation of two functional systems. We implemented a design in which perceptual (i.e., painful or neutral facial expressions) and contextual (i.e., painful or neutral related sentences) cues on others' mental states were orthogonally manipulated. Painful expressions selectively modulated the early activity at 110–360 ms over fronto-central and centro-parietal regions, whereas painful contexts selectively modulated the late activity at 400–840 ms over these same regions. Notably, the reactions to pain triggered by these cues added up when both were available, that is the joint reaction was characterized by additive effects. These findings favor a model assuming distinct neural paths of perceptual and cognitive processing, at least when the cognitive component is triggered by language.

Inhibitory mechanism of the matching heuristic in syllogistic reasoning

A number of heuristic-based hypotheses have been proposed to explain how people solve syllogisms with automatic processes. In particular, the matching heuristic employs the congruency of the quantifiers in a syllogism—by matching the quantifier of the conclusion with those of the two premises. When the heuristic leads to an invalid conclusion, successful solving of these conflict problems requires the inhibition of automatic heuristic processing. Accordingly, if the automatic processing were based on processing the set of quantifiers, no semantic contents would be inhibited. The mental model theory, however, suggests that people reason using mental models, which always involves semantic processing. Therefore, whatever inhibition occurs in the processing implies the inhibition of the semantic contents. We manipulated the validity of the syllogism and the congruency of the quantifier of its conclusion with those of the two premises according to the matching heuristic. A subsequent lexical decision task (LDT) with related words in the conclusion was used to test any inhibition of the semantic contents after each syllogistic evaluation trial. In the LDT, the facilitation effect of semantic priming diminished after correctly solved conflict syllogisms (match-invalid or mismatch-valid), but was intact after no-conflict syllogisms. The results suggest the involvement of an inhibitory mechanism of semantic contents in syllogistic reasoning when there is a conflict between the output of the syntactic heuristic and actual validity. Our results do not support a uniquely syntactic process of syllogistic reasoning but fit with the predictions based on mental model theory.

Public perceptions of cancer: a qualitative study of the balance of positive and negative beliefs

OBJECTIVES

Cancer's insidious onset and potentially devastating outcomes have made it one of the most feared diseases of the 20th century. However, advances in early diagnosis and treatment mean that death rates are declining, and there are more than 30 million cancer survivors worldwide. This might be expected to result in more sanguine attitudes to the disease. The present study used a qualitative methodology to provide an in-depth exploration of attitudes to cancer and describes the balance of negative and positive perspectives.

DESIGN

A qualitative study using semistructured interviews with thematic analysis.

SETTING

A university in London, UK.

PARTICIPANTS

30 participants (23-73 years), never themselves diagnosed with cancer.

RESULTS

Accounts of cancer consistently incorporated negative and positive views. In almost all respondents, the first response identified fear, trauma or death. However, this was followed-sometimes within the same sentence-by acknowledgement that improvements in treatment mean that many patients can survive cancer and may even resume a normal life. Some respondents spontaneously reflected on the contradictions, describing their first response as a 'gut feeling' and the second as a more rational appraisal-albeit one they struggled to believe. Others switched perspective without apparent awareness.

CONCLUSIONS

People appear to be 'in two minds' about cancer. A rapid, intuitive sense of dread and imminent death coexists with a deliberative, rational recognition that cancer can be a manageable, or even curable, disease. Recognising cancer's public image could help in the design of effective cancer control messages.