Projection in surrogate decisions about life-sustaining medical treatments.

To honor the wishes of an incapacitated patient, surrogate decision makers must predict the treatment decisions patients would make for themselves if able. Social psychological research, however, suggests that surrogates' own treatment preferences may influence their predictions of others' preferences. In 2 studies (1 involving 60 college student surrogates and a parent, the other involving 361 elderly outpatients and their chosen surrogate decision maker), surrogates predicted whether a close other would want life-sustaining treatment in hypothetical end-of-life scenarios and stated their own treatment preferences in the same scenarios. Surrogate predictions more closely resembled surrogates' own treatment wishes than they did the wishes of the individual they were trying to predict. Although the majority of prediction errors reflected inaccurate use of surrogates' own treatment preferences, projection was also found to result in accurate prediction more often than counterprojective predictions. The rationality and accuracy of projection in surrogate decision making is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Explanations for side effect aversion in preventive medical treatment decisions.

Objective: Many laypeople demonstrate excessive sensitivity to negative side effects of medical treatments, which may lead them to refuse beneficial therapies. This Internet-based experiment investigated three possible explanations for such “side effect aversion.” One was derived from mental accounting, one examined the mere presence of a side effect, and one focused on computational difficulties. Design: Participants (N = 5,379) were presented with a hypothetical cancer preventive treatment situation that was or was not accompanied by one or two small side effects. The side effects were either beneficial or harmful. In all conditions, the net absolute risk reduction associated with the treatment was 15%. Main Outcome Measures: Participants indicated their willingness to accept treatment and their perceptions of the treatment's effects on their overall cancer risk. Results: Data were consistent only with the “mere presence” explanation of side effect aversion, the idea that side effects act as a strong negative cue that directly affects treatment appraisal. The number of negative side effects did not influence treatment willingness. Conclusion: Side effect aversion is a challenge to informed decision making. Specific mechanisms that produce side effect aversion should be identified. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Why older adults make more immediate treatment decisions about cancer than younger adults.

Literature relevant to medical decision making was reviewed, and a model was outlined for testing. Two studies examined whether older adults make more immediate decisions than younger adults about treatments for prostate or breast cancer in authentic scenarios. Findings clearly showed that older adults were more likely to make immediate decisions than younger adults. The research is important because it not only demonstrates the consistency of this age-related effect across disease domains, gender, ethnic groups, and prevalent education levels but begins to investigate a model to explain the effect. Major reasons for the effect focus on treatment knowledge, interest and engagement, and cognitive resources. Treatment knowledge, general cancer knowledge, interest, and cognitive resources relate to different ways of processing treatment information and preferences for immediate versus delayed decision making. Adults with high knowledge of treatments on a reliable test tended to make immediate treatment decisions, which supports the knowledge explanation. Adults with more cognitive resources and more interest tended to delay their treatment decisions. Little support was found for a cohort explanation for the relationship between age and preference for immediate medical decision making. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Older adults prefer less choice than young adults.

Previous research has demonstrated that older adults prefer less autonomy and seek less information when making decisions on their own relative to young adults (for a review, see M. Mather, 2006). Would older adults also prefer fewer options from which to choose? The authors tested this hypothesis in the context of different decision domains. Participants completed a choice preferences survey in which they indicated their desired number of choices across 6 domains of health care and everyday decisions. The hypothesis was confirmed across all decision domains. The authors discuss implications from these results as they relate to theories of aging and health care policy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The perceived diversity heuristic: The case of pseudodiversity.

One of the normative ways to decrease the risk of a pool with uncertainty prospects is to diversify its resources. Thus, decision makers are advised not to put all their eggs in one basket. The authors suggest that decision makers use a perceived diversity heuristic (PDH) to evaluate the risk of a pool by intuitively assessing the diversity of its sources. This heuristic yields biased judgments in cases of pseudodiversity, in which the perceived diversity of a pool is enhanced, although this fact does not change the pool's normative values. The first 3 studies introduce 2 independent sources of pseudodiversity—distinctiveness and multiplicity—showing that these two sources can lead to overdiversification under conditions of gain. In another set of 3 studies, the authors examine the effect of framing on diversification level. The results support the PDH predictions, according to which diversity seeking is obtained under conditions of gain, whereas diversity aversion is obtained under conditions of loss. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reducing aversion to side effects in preventive medical treatment decisions.

Laypeople tend to be overly sensitive to side effects of treatments that prevent illness, possibly leading them to refuse beneficial therapies. This Internet-based study attempted to reduce such side effect aversion by adding graphic displays to the numerical risk probabilities. It also explored whether graphics reduce side effect aversion by making it easier for respondents to determine how the treatment might change their net cancer risk. Participants (N=4,248) were presented with a hypothetical preventive treatment situation that was or was not accompanied by a small side effect. In both conditions, the net absolute risk reduction was 12%. Adding an array of stick figures to risk probabilities reduced side effect aversion substantially, but adding a bar graph was not beneficial. The ability of arrays to reduce side effect aversion was not attributable to greater accuracy in evaluating the treatment's net benefit. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Knowing others' preferences degrades the quality of group decisions.

Results from 4 experiments demonstrate that learning the other group members' preferences at the beginning of a discussion impedes the solution of hidden profiles. In Experiments 1–3, participants who were not informed about their fellow group members' preferences were more likely to solve a hidden profile than those who received bogus information about the others' preferences. The negative effect of learning the others' preferences on decision quality was mediated by participants paying less attention to the information exchanged when they had been made aware of the others' preferences. Experiments 1 and 2 further ruled out that the effect of learning the others' preferences is due to participants bolstering their position or due to an increase in informational load. Experiment 3 showed that learning the other group members' preferences impedes the solution of hidden profiles even if one of the other members favors the correct alternative. Finally, Experiment 4 replicated these results in face-to-face interacting 3-person groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How numeracy influences risk comprehension and medical decision making.

We review the growing literature on health numeracy, the ability to understand and use numerical information, and its relation to cognition, health behaviors, and medical outcomes. Despite the surfeit of health information from commercial and noncommercial sources, national and international surveys show that many people lack basic numerical skills that are essential to maintain their health and make informed medical decisions. Low numeracy distorts perceptions of risks and benefits of screening, reduces medication compliance, impedes access to treatments, impairs risk communication (limiting prevention efforts among the most vulnerable), and, based on the scant research conducted on outcomes, appears to adversely affect medical outcomes. Low numeracy is also associated with greater susceptibility to extraneous factors (i.e., factors that do not change the objective numerical information). That is, low numeracy increases susceptibility to effects of mood or how information is presented (e.g., as frequencies vs. percentages) and to biases in judgment and decision making (e.g., framing and ratio bias effects). Much of this research is not grounded in empirically supported theories of numeracy or mathematical cognition, which are crucial for designing evidence-based policies and interventions that are effective in reducing risk and improving medical decision making. To address this gap, we outline four theoretical approaches (psychophysical, computational, standard dual-process, and fuzzy trace theory), review their implications for numeracy, and point to avenues for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Following your heart or your head: Focusing on emotions versus information differentially influences the decisions of younger and older adults.

[Correction Notice: An erratum for this article was reported in Vol 16(2) of Journal of Experimental Psychology: Applied (see record 2010-12508-005). The wrong author order was listed. The correct order is presented in the erratum.] Research on aging has indicated that whereas deliberative cognitive processes decline with age, emotional processes are relatively spared. To examine the implications of these divergent trajectories in the context of health care choices, we investigated whether instructional manipulations emphasizing a focus on feelings or details would have differential effects on decision quality among younger and older adults. We presented 60 younger and 60 older adults with health care choices that required them to hold in mind and consider multiple pieces of information. Instructional manipulations in the emotion-focus condition asked participants to focus on their emotional reactions to the options, report their feelings about the options, and then make a choice. In the information-focus condition, participants were instructed to focus on the specific attributes, report the details about the options, and then make a choice. In a control condition, no directives were given. Manipulation checks indicated that the instructions were successful in eliciting different modes of processing. Decision quality data indicate that younger adults performed better in the information-focus than in the control condition whereas older adults performed better in the emotion-focus and control conditions than in the information-focus condition. Findings support and extend extant theorizing on aging and decision making as well as suggest that interventions to improve decision-making quality should take the age of the decision maker into account. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Aggregation in memory of episodic influences on rule-guided decisions.

The authors confirmed E. Z. Rothkopf and M. L,. Dashen's (1905) finding that specific problem context, such as thematic surface features, forms associative connections with deep problem features and thus speeds particular decisions (particularization). In 5 experiments, using a 3-bit decision task and pre-memorized decision rules, the authors found that the ability of a situational context to reinstate was decreased by its replacement by another modal surface context. Context reinstatement, as measured by decision speed, depended on both global and recent local densities of specific problem features linked in a particular decision. The authors' results are consistent with J. R. Anderson and I. J. Schooler's (1991) needs/odds analysis and suggest a push-down file model for diverse context influences as a mechanism for responding to changing situational demands. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Getting the message across: Age differences in the positive and negative framing of health care messages.

Although valenced health care messages influence impressions, memory, and behavior (Levin, Schneider, & Gaeth, 1998) and the processing of valenced information changes with age (Carstensen & Mikels, 2005), these 2 lines of research have thus far been disconnected. This study examined impressions of, and memory for, positively and negatively framed health care messages that were presented in pamphlets to 25 older adults and 24 younger adults. Older adults relative to younger adults rated positive pamphlets more informative than negative pamphlets and remembered a higher proportion of positive to negative messages. However, older adults misremembered negative messages to be positive. These findings demonstrate the age-related positivity effect in health care messages with promise as to the persuasive nature and lingering effects of positive messages. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Increased cognitive load leads to impaired mobility decisions in seniors at risk for falls.

Successful mobility requires appropriate decision-making. Seniors with reduced executive functioning—such as senior fallers—may be prone to poor mobility judgments, especially under dual-task conditions. We classified participants as “At-Risk” and “Not-At-Risk” for falls using a validated physiological falls-risk assessment. Dual-task performance was assessed in a virtual reality environment where participants crossed a simulated street by walking on a manual treadmill while listening to music or conversing on a phone. Those “At-Risk” experienced more collisions with oncoming cars and had longer crossing times in the Phone condition compared to controls. We conclude that poor mobility judgments during a dual-task leads to unsafe mobility for those at-risk for falls. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Experiences of collaborative research.

The author's personal history of the research that led to his recognition in economics is described, focusing on the process of collaboration and on the experience of controversy. The author's collaboration with Amos Tversky dealt with 3 major topics: judgment under uncertainty, decision making, and framing effects. A subsequent collaboration, with the economist Richard Thaler, played a role in the development of behavioral economics. Procedures to make controversies more productive and constructive are suggested. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Learning to choose: Cognitive aging and strategy selection learning in decision making.

Decision makers often have to learn from experience. In these situations, people must use the available feedback to select the appropriate decision strategy. How does the ability to select decision strategies on the basis of experience change with age? We examined younger and older adults' strategy selection learning in a probabilistic inference task using a computational model of strategy selection learning. Older adults showed poorer decision performance compared with younger adults. In particular, older adults performed poorly in an environment favoring the use of a more cognitively demanding strategy. The results suggest that the impact of cognitive aging on strategy selection learning depends on the structure of the decision environment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Game relativity: How context influences strategic decision making.

Existing models of strategic decision making typically assume that only the attributes of the currently played game need be considered when reaching a decision. The results presented in this article demonstrate that the so-called "cooperativeness" of the previously played prisoner's dilemma games influence choices and predictions in the current prisoner's dilemma game, which suggests that games are not considered independently. These effects involved reinforcement-based assimilation to the previous choices and also a perceptual contrast of the present game with preceding games, depending on the range and the rank of their cooperativeness. A. Parducci's (1965) range frequency theory and H. Helson's (1964) adaptation level theory are plausible theories of relative judgment of magnitude information, which could provide an account of these context effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stability of Older Adults' Preferences for Life-Sustaining Medical Treatment.

The use of instructional advance directives assumes that preferences for life-sustaining medical treatment remain stable over time and across changes in life condition. A sample of 332 older adults recorded their preferences for 4 life-sustaining treatments in 9 illness scenarios. These preferences were elicited again 1 and 2 years after the original interview. Overall, preferences for life-sustaining treatment were moderately stable over time, but stability varied significantly across judgments. Preferences were most stable for illness scenarios that were most and least serious and for decisions to refuse treatment. Age, gender, education, and prior completion of an advance directive were all related to preference stability, and evidence indicated that declines in physical or psychological functioning resulted in decreased interest in life-sustaining treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive niches: An ecological model of strategy selection.

How do people select among different strategies to accomplish a given task? Across disciplines, the strategy selection problem represents a major challenge. We propose a quantitative model that predicts how selection emerges through the interplay among strategies, cognitive capacities, and the environment. This interplay carves out for each strategy a cognitive niche, that is, a limited number of situations in which the strategy can be applied, simplifying strategy selection. To illustrate our proposal, we consider selection in the context of 2 theories: the simple heuristics framework and the ACT–R (adaptive control of thought—rational) architecture of cognition. From the heuristics framework, we adopt the thesis that people make decisions by selecting from a repertoire of simple decision strategies that exploit regularities in the environment and draw on cognitive capacities, such as memory and time perception. ACT–R provides a quantitative theory of how these capacities adapt to the environment. In 14 simulations and 10 experiments, we consider the choice between strategies that operate on the accessibility of memories and those that depend on elaborate knowledge about the world. Based on Internet statistics, our model quantitatively predicts people's familiarity with and knowledge of real-world objects, the distributional characteristics of the associated speed of memory retrieval, and the cognitive niches of classic decision strategies, including those of the fluency, recognition, integration, lexicographic, and sequential-sampling heuristics. In doing so, the model specifies when people will be able to apply different strategies and how accurate, fast, and effortless people's decisions will be. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Evaluation of a decision-making aid for parents regarding childhood immunizations.

This intervention study evaluates a decision-making aid for parents considering childhood immunizations. Participants (women in 3rd trimester of pregnancy, n = 100) rated likelihood of immunizing their child, anxiety, and perceptions of risk of the diseases and immunizations. Individuals were allocated to intervention group (received a decision aid) or control group (received standard care). Ratings were then repeated, and further ratings were obtained when the infant was 10 weeks old. The intervention compared with the comparison condition was associated with significant increase in likelihood of immunizing the infant on time, decreased perceptions of risks of immunizations, increased perceptions of risk of the diseases, reduced anxiety, and increased satisfaction. This intervention may form a useful basis for decision aids in health care settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

User settings of cue thresholds for binary categorization decisions.

The output of binary cuing systems, such as alerts or alarms, depends on the threshold setting—a parameter that is often user-adjustable. However, it is unknown if users are able to adequately adjust thresholds and what information may help them to do so. Two experiments tested threshold settings for a binary classification task based on binary cues. During the task, participants decided whether a product was intact or faulty. Experimental conditions differed in the information participants received: all participants were informed about a product’s fault probability and the payoffs associated with decision outcomes; one third also received information regarding conditional probabilities for a fault when the system indicated or did not indicate the existence of one (predictive values); and another third received information about conditional probabilities for the system indicating a fault, in the instance of the existence or lack thereof, of an actual fault (diagnostic values). Threshold settings in all experimental groups were nonoptimal, with settings closest to the optimum with predictive-values information. Results corresponded with a model describing threshold settings as a function of the conditional probabilities for the different outcomes. From a practical perspective, results indicate that predictive-values information best supports decisions about threshold settings. Consequently, for users to adjust thresholds, they should receive information about predictive-values, provided that such values can be computed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)