Health Psychology

Loewenstein, George

doi: 10.1037/0278-6133.24.4.S49pmid: 16045419

Prior research hasshown that people mispredict their own behavior and preferences across affective states.When people are in an affectively “cold” state, they fail to fullyappreciate how “hot” states will affect their own preferences andbehavior. When in hot states, they underestimate the influence of those states and, as aresult, overestimate the stability of their current preferences. The same biases applyinterpersonally; for example, people who are not affectively aroused underappreciate theimpact of hot states on other people's behavior. After reviewing research documenting suchintrapersonal and interpersonal hot–cold empathy gaps, this article examinestheir consequences for medical, and specifically cancer-related, decision making, showing,for example, that hot–cold empathy gaps can lead healthy persons to exposethemselves excessively to health risks and can cause health care providers to undertreatpatients for pain.

Siminoff, Laura A.; Step, Mary M.

doi: 10.1037/0278-6133.24.4.S99pmid: 16045427

The authors present acommunication model of shared decision making (CMSDM) that explicitly identifies thecommunication process as the vehicle for decision making in cancer treatment. In thisview, decision making is necessarily a sociocommunicative process whereby people enterinto a relationship, exchange information, establish preferences, and choose a course ofaction. The model derives from contemporary notions of behavioral decision making andethical conceptions of the doctor-patient relationship. This article briefly reviews thetheoretical approaches to decision making, notes deficiencies, and embeds a more sociallybased process into the dynamics of the physician-patient relationship, focusing on cancertreatment decisions. In the CMSDM, decisions depend on (a) antecedent factors that havepotential to influence communication, (b) jointly constructed communication climate, and(c) treatment preferences established by the physician and the patient.

Schwartz, Marc D.; Peshkin, Beth N.; Tercyak, Kenneth P.; Taylor, Kathryn L.; Valdimarsdottir, Heiddis

doi: 10.1037/0278-6133.24.4.S78pmid: 16045423

Genetic testing fordisease susceptibility has the potential to revolutionize health care by allowing forindividually tailored disease prevention strategies. To achieve this promise, patients andphysicians must use the information obtained through genetic testing to make medicaldecisions that are consistent with patient preferences and that lead to reduced diseasemorbidity and mortality. However, decisions associated with genetic testing can becomplex. In this article, the authors review decision making associated with genetictesting and the medical management of hereditary breast-ovarian cancer susceptibility.They focus on decisions regarding BRCA1/2 testing and prophylactic surgery among BRCA1 andBRCA2 mutation carriers. They highlight the role of patient preferences and decisionsupport in this population. The studies reviewed indicate that although patients'preferences do predict genetic testing and management decisions, other factors alsoinfluence their decision making. In particular, the authors discuss the role of anxietyand worry in relation to testing and surgery decisions.

Luce, Mary Frances

doi: 10.1037/0278-6133.24.4.S23pmid: 16045414

This article reviews amodel of emotional trade-off difficulty in decision making. The model argues that decisionmakers are motivated to cope with the negative emotion associated with decision-processingoperations, notably emotion generated by explicit trade-offs between highly valuedattributes. The article begins to explore implications of this model for patient decisionmaking in the cancer control domain. For instance, the model points to emotional reactionsto decisions as both a cost and a barrier in the move toward greater patient participationin health care decision making.

Ditto, Peter H.; Hawkins, Nikki A.

doi: 10.1037/0278-6133.24.4.S63pmid: 16045421

Seriously illindividuals, including those seriously ill with cancer, are frequently encouraged tocomplete instructional advance directives (i.e., living wills) to ensure that their wishesabout the use of life-sustaining treatment are honored if they should lose the ability tomake decisions for themselves. The authors present a social psychological analysis makingexplicit a series of steps that must necessarily take place if living wills are to honorthe wishes of incapacitated patients. They then focus on 3 key steps in the analysis andreview relevant research from the medical and psychological literatures. In each case,this research raises serious questions about the psychological assumptions underlying theeffective use of living wills in end-of-life decision making. Discussion focuses on theneed for policy and law guiding the use of advance directives to be informed by both basicand applied research on judgment and decision making.

doi: 10.1037/0278-6133.24.4.S41pmid: 16045418

A tradeoff betweenshort-term costs and long-term gains characterizes many cancer control behaviors, such asbehavior change (e.g., quitting smoking), screening (e.g., mammography), and prevention(e.g., healthy diet). One factor that may influence these tradeoffs is time preference, orthe value assigned to future outcomes relative to immediate ones. Studies of therelationship between individual differences in time preference and preventive healthbehaviors, however, have yielded mixed results. Time preference is related to addictivebehaviors (e.g., smoking) but not to other preventive health behaviors (e.g.,vaccination). This pattern of results suggests that time preference measures reflect anability to forgo immediate gratification that is applicable to hot behaviors, such assmoking, but not to cold behaviors, such as vaccination.

Revenson, Tracey A.; Pranikoff, Julie R.

doi: 10.1037/0278-6133.24.4.S93pmid: 16045426

This article presentsa contextual model of adjustment to cancer that frames research inquiry on treatmentdecision making among long-term breast cancer survivors. Psychosocial adaptation, of whichtreatment decision making is a part, is viewed within a social ecological framework(T. A. Revenson, 1990,T. A. Revenson, 2003) thatencompasses 4 contexts: the situational context, the interpersonal context, thesociocultural context, and the temporal context. Examples of how each context mayinfluence decision-making processes are described, and guidelines for future research areprovided.

Loewenstein, George

doi: 10.1037/0278-6133.24.4.S49pmid: 16045419

Prior research hasshown that people mispredict their own behavior and preferences across affective states.When people are in an affectively “cold” state, they fail to fullyappreciate how “hot” states will affect their own preferences andbehavior. When in hot states, they underestimate the influence of those states and, as aresult, overestimate the stability of their current preferences. The same biases applyinterpersonally; for example, people who are not affectively aroused underappreciate theimpact of hot states on other people's behavior. After reviewing research documenting suchintrapersonal and interpersonal hot–cold empathy gaps, this article examinestheir consequences for medical, and specifically cancer-related, decision making, showing,for example, that hot–cold empathy gaps can lead healthy persons to exposethemselves excessively to health risks and can cause health care providers to undertreatpatients for pain.

Fischhoff, Baruch

doi: 10.1037/0278-6133.24.4.S9pmid: 16045425

Cancer poses many,often difficult choices. Studying these choices poses several strategic decisions forresearchers, including (a) whether to conduct formal analyses of the choices beingstudied, (b) whether to adopt a persuasive stance (or only facilitate independent decisionmaking), (c) whether to focus on optimizing specific choices or securing broader mastery,and (d) which individual differences to address. Behavioral decision research's strategicapproach is demonstrated in 4 contexts relevant to cancer-related decisions: (a) informedconsent, (b) prevention, (c) infectious disease, and (d) medical emergencies. Each examplecontains interacting elements of normative analysis, identifying optimalchoices; descriptive research, characterizing actual behavior; andprescriptive interventions, seeking to bridge the gap between thenormative ideal and the descriptive reality.

Nelson, Wendy; Stefanek, Michael; Peters, Ellen; McCaul, Kevin D.

doi: 10.1037/0278-6133.24.4.S3pmid: 16045416

Decision making isfundamental to all aspects of cancer care—prevention, detection, treatment,survivorship, and end of life—yet researchers and clinicians have limitedknowledge of the ways in which patients and their health care providers make criticalhealth decisions. Recognizing how important it is to understand how patients and theirproviders make potentially life-altering decisions, the National Cancer Institutedeveloped a decision making in cancer control initiative. The goal of this initiative isto enhance understanding of human decision-making processes so that individuals can makemore informed and satisfying choices regarding their health. This article describes themultidisciplinary meeting that provided the scientific foundation for thisinitiative.