Perceived ambiguity about cancer prevention recommendations: associations with cancer-related perceptions and behaviours in a US population survey
Paul K. J. Han MD MA MPH
Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
Search for more papers by this authorRichard P. Moser PhD
Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
Search for more papers by this authorWilliam M. P. Klein PhD
Department of Psychology, University of Pittsburgh, PA, USA
Search for more papers by this authorPaul K. J. Han MD MA MPH
Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
Search for more papers by this authorRichard P. Moser PhD
Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
Search for more papers by this authorWilliam M. P. Klein PhD
Department of Psychology, University of Pittsburgh, PA, USA
Search for more papers by this authorAbstract
Background Health information reaching the public today is often characterized by what decision theorists have termed ‘ambiguity’– i.e. uncertainty regarding the information’s reliability, credibility or adequacy. This is a critical problem, as growing research suggests that ambiguity has important effects–promoting pessimistic judgments about risks and potential outcomes of risk-reducing behaviours, and lowering adoption of these behaviours. However, little is known about the public’s perceptions of ambiguity in the health information domain, the effects of these perceptions, and the factors that influence these effects.
Objective To examine associations between perceived ambiguity regarding cancer prevention recommendations and prevention-related perceptions and behaviours, and to explore how these associations differ by cancer type.
Study design and participants Cross-sectional analysis of data on 4070 adults participating in the 2005 US Health Information National Trends Survey.
Main variables and outcome measures We examined associations between perceived ambiguity about colon, skin and lung cancer prevention recommendations and two main outcome variables: (i) risk-related cognitions (perceived cancer risk and preventability, cancer-related worry) and (ii) risk-modifying behaviours (colon cancer screening, sunscreen use and smoking abstinence).
Results Perceived ambiguity was inversely associated with perceptions of the preventability of all three cancers, and with cancer-specific risk-modifying behaviours including sigmoidoscopy–colonoscopy testing, sunscreen use and smoking abstinence. Relationships with cancer risk perceptions and worry varied across different cancer types.
Conclusions Perceived ambiguity about cancer prevention recommendations has significant and predictable associations with cancer prevention-related cognitions and behaviours, and some associations differ by cancer type. These findings have implications for future research and communication efforts.
References
- 1 Viswanath K. Science and society: the communications revolution and cancer control. Nature Reviews. Cancer, 2005; 5: 828–835.
- 2 Copper CP, Yukimura D. Science writers’ reactions to a medical “breakthrough” story. Social Science and Medicine, 2002; 54: 1887–1896.
- 3 SM Friedman, S Dunwoody, CL Rogers, eds. Communicating Uncertainty: Media Coverage of New and Controversial Science. Mahway, NJ: Lawrence Erlbaum Associates, 1999 (LEA’s Communication Series).
- 4 Moynihan R, Heath I, Henry D. Selling sickness: the pharmaceutical industry and disease mongering. British Medical Journal, 2002; 324: 886–891.
- 5
Yamey G,
Wilkes M.
The PSA storm.
British Medical Journal, 2002; 324: 431.
10.1136/bmj.324.7334.431 Google Scholar
- 6 Bekker H, Thornton JG, Airey CM et al. Informed decision making: an annotated bibliography and systematic review. Health Technology Assessment, 1999; 3: 1–156.
- 7 Charles C, Gafni A, Whelan T. Shared decision-making in the medical encounter: what does it mean? (or it takes at least two to tango). Social Science and Medicine, 1997; 44: 681–692.
- 8 Emanuel EJ, Emanuel LL. Four models of the physician-patient relationship. The Journal of the American Medical Association, 1992; 267: 2221–2226.
- 9 Whitney SN, McGuire AL, McCullough LB. A typology of shared decision making, informed consent, and simple consent. Annals of Internal Medicine, 2004; 140: 54–59.
- 10 Whitney SN. A new model of medical decisions: exploring the limits of shared decision making. Medical Decision Making, 2003; 23: 275–280.
- 11 Institute of Medicine. Crossing the Quality Chasm: a New Health System for the Twenty-first Century. Washington: National Academies Press, 2001.
- 12 Woolf SH, Chan EC, Harris R et al. Promoting informed choice: transforming health care to dispense knowledge for decision making. Annals of Internal Medicine, 2005; 143: 293–300.
- 13 O’Connor AM, Stacey D, Entwistle V et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systemic Reviews, 2003; 2: CD001431.
- 14 O’Connor AM, Rostom A, Fiset V et al. Decision aids for patients facing health treatment or screening decisions: systematic review. British Medical Journal, 1999; 319: 731–734.
- 15 O’Connor AM, Llewellyn-Thomas HA, Flood AB. Modifying unwarranted variations in health care: shared decision making using patient decision aids. Health Affairs; 23 (6): VAR63–VAR72; Nov-Dec 2004.
- 16 Barry MJ. Health decision aids to facilitate shared decision making in office practice. Annals of Internal Medicine, 2002; 136: 127–135.
- 17 Molenaar S, Sprangers MA, Postma-Schuit FC et al. Feasibility and effects of decision aids. Medical Decision Making, 2000; 20: 112–127.
- 18 Iyengar SS, Lepper MR. When choice is demotivating: can one desire too much of a good thing? Journal of Personality and Social Psychology, 2000; 79: 995–1006.
- 19 Redelmeier DA, Shafir E. Medical decision making in situations that offer multiple alternatives. The Journal of the American Medical Association, 1995; 273: 302–305.
- 20 Schwartz B. The tyranny of choice. Scientific American, 2004; 290: 70–75.
- 21 Ubel PA. Is information always a good thing? Helping patients make “good” decisions. Medical Care, 2002; 9 (Suppl.): V39–V44.
- 22 Ellsberg D. Risk, ambiguity, and the savage axioms. Quarterly Journal of Economics, 1961; 75: 643–669.
- 23 Camerer C, Weber M. Recent developments in modeling preferences: uncertainty and ambiguity. Journal of Risk and Uncertainty, 1992; 5: 325–370.
- 24 Curley SP, Yates JF. An empirical evaluation of descriptive models of ambiguity reactions in choice situations. Journal of Mathematical Psychology, 1989; 33: 397–427.
- 25 Einhorn HJ, Hogarth RM. Decision making under ambiguity. Journal of Business, 1986; 59: S225–S250.
- 26 Einhorn HJ, Hogarth RM. Ambiguity and uncertainty in probabilistic inference. Psychological Review, 1985; 92: 433–461.
- 27 Rimer BK, Briss PA, Zeller PK, Chan EC, Woolf SH. Informed decision making: what is its role in cancer screening? Cancer, 2004; 101 (Suppl. 5): 1214–1228.
- 28 Briss P, Rimer B, Reilley B et al. Promoting informed decisions about cancer screening in communities and healthcare systems. American Journal of Preventive Medicine, 2004; 26: 67–80.
- 29 Han PK, Moser RP, Klein WM. Perceived ambiguity about cancer prevention recommendations: relationship to perceptions of cancer preventability, risk, and worry. Journal of Health Communication, 2006; 11 (Suppl. 1): 51–69.
- 30
Ritov I,
Baron J.
Reluctance to vaccinate: omission bias and ambiguity.
Journal of Behavioral Decision Making, 1990; 3: 263–277.
10.1002/bdm.3960030404 Google Scholar
- 31 Meszaros JR, Asch DA, Baron J, Hershey JC, Kunreuther H, Schwartz-Buzaglo J. Cognitive processes and the decisions of some parents to forego pertussis vaccination for their children. Journal of Clinical Epidemiology, 1996; 49: 697–703.
- 32 Viscusi WK, Magat WA, Huber J. Communication of ambiguous risk information. Theory and Decision, 1991; 31: 159–173.
- 33 Viscusi WK, Magat WA, Huber J. Smoking status and public responses to ambiguous scientific risk evidence. Southern Economic Journal, 1999; 66: 250–270.
- 34 Jepson RG, Forbes CA, Sowden AJ, Lewis RA. Increasing informed uptake and non-uptake of screening: evidence from a systematic review. Health Expectations, 2001; 4: 116–126.
- 35 Wolf AM, Nasser JF, Schorling JB. The impact of informed consent on patient interest in prostate-specific antigen screening. Archives of Internal Medicine, 1996; 156: 1333–1336.
- 36 Volk RJ, Spann SJ, Cass AR, Hawley ST. Patient education for informed decision making about prostate cancer screening: a randomized controlled trial with 1-year follow-up. Annals of Family Medicine, 2003; 1: 22–28.
- 37 Frosch DL, Kaplan RM, Felitti V. The evaluation of two methods to facilitate shared decision making for men considering the prostate-specific antigen test. Journal of General Internal Medicine, 2001; 16: 391–398.
- 38 Nelson DE, Kreps GL, Hesse BW et al. The Health Information National Trends Survey (HINTS): development, design, and dissemination. Journal of Health Community, 2004; 9: 443–460 (discussion 481–444).
- 39 Nijs HG, Essink-Bot ML, DeKoning HJ, Kirkels WJ, Schroder FH. Why do men refuse or attend population-based screening for prostate cancer? Journal of Public Health Medicine, 2000; 22: 312–316.
- 40
Myers RE,
Wolf TA,
McKee L
et al.
Factors associated with intention to undergo annual prostate cancer screening among African American men in Philadelphia.
Cancer, 1996; 78: 471–479.
10.1002/(SICI)1097-0142(19960801)78:3<471::AID-CNCR14>3.0.CO;2-W CAS PubMed Web of Science® Google Scholar
- 41 Wolf AM, Philbrick JT, Schorling JB. Predictors of interest in prostate-specific antigen screening and the impact of informed consent: what should we tell our patients? The American Journal of Medicine, 1997; 103: 308–314.
- 42 Myers RE, Hyslop T, Jennings-Dozier K et al. Intention to be tested for prostate cancer risk among African-American men. Cancer Epidemiology, Biomarkers and Prevention, 2000; 9: 1323–1328.
- 43 Myers RE. African American men, prostate cancer early detection examination use, and informed decision-making. Seminars in Oncology, 1999; 26: 375–381.
- 44 Demark-Wahnefried W, Strigo T, Catoe K et al. Knowledge, beliefs, and prior screening behavior among blacks and whites reporting for prostate cancer screening. Urology, 1995; 46: 346–351.
- 45 Shah B, Barnwell B, Bieler G. SUDAAN. Research Triangle Park, NC: Research Triangle Institute, 1997.
- 46 Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 1986; 51: 1173–1182.
- 47 Meissner HI, Rimer BK, Davis WW, Eisner EJ, Siegler IC. Another round in the mammography controversy. Journal of Women’s Health (Larchmt), 2003; 12: 261–276.
- 48 Han PKJ, Kobrin SC, Klein WMP, Davis WW, Stefanek ME, Taplin SH. Perceived ambiguity about screening mammography recommendations: association with future mammography uptake and perceptions. Cancer Epidemiology, Biomarkers and Prevention, 2007; 16: 458–466.
- 49 Rimer BK, Halabi S, Strigo TS, Crawford Y, Lipkus IM. Confusion about mammography: prevalence and consequences. Journal of Women’s Health and Gender-Based Medicine, 1999; 8: 509–520.
- 50 Leventhal H, Brissette I, Leventhal EA. The common-sense model of self-regulation of health and illness. In: LD Cameron, H Leventhal (eds) The Self-regulation of Health and Illness Behaviour. London: Routledge, 2003: 42–65.
- 51 Cameron LD. Conceptualizing and assessing risk perceptions: a self-regulatory perspective. Paper Presented at the National Cancer Institute Workshop on Conceptualizing and Measuring Risk Perceptions, Washington, DC, 13–14 February 2003.
- 52 Katz ML, Sheridan S, Pignone M et al. Prostate and colon cancer screening messages in popular magazines. Journal of General Internal Medicine, 2004; 19: 843–848.
- 53 Farrell MH, Murphy MA, Schneider CE. How underlying patient beliefs can affect physician–patient communication about prostate-specific antigen testing. Effective Clinical Practice, 2002; 5: 120–129.
- 54 Schwartz LM, Woloshin S. News media coverage of screening mammography for women in their 40s and tamoxifen for primary prevention of breast cancer. The Journal of the American Medical Association, 2002; 287: 3136–3142.
- 55 Schwartz LM, Woloshin S, Fowler FJ Jr, Welch HG. Enthusiasm for cancer screening in the United States. The Journal of the American Medical Association, 2004; 291: 71–78.
- 56 Shepperd JA, Helweg-Larsen M, Ortega L. Are comparative risk judgments stable across time and events? Personality and Social Psychology Bulletin, 2003; 29: 1169–1180.
- 57 Stefanek ME, Wilcox P. First degree relatives of breast cancer patients: screening practices and provision of risk information. Cancer Detection and Prevention, 1991; 15: 379–384.
- 58 Lipkus IM, Iden D, Terrenoire J, Feaganes JR. Relationships among breast cancer concern, risk perceptions, and interest in genetic testing for breast cancer susceptibility among African-American women with and without a family history of breast cancer. Cancer Epidemiology, Biomarkers and Prevention, 1999; 8: 533–539.
- 59 Diefenbach MA, Miller SM, Daly MB. Specific worry about breast cancer predicts mammography use in women at risk for breast and ovarian cancer. Health Psychology, 1999; 18: 532–536.
- 60 Goyder J, Warriner K, Miller S. Evaluating socio-economic status (SES) bias in survey nonresponse. Journal of Official Statistics, 2002; 18: 1–12.
- 61 De Leeuw E, De Heer W. Trends in household survey nonresponse: a longitudinal and international comparison. In: RM Groves DAD, JL Eltinge, RJA Little (eds) Survey Nonresponse. New York, NY: John Wiley, 2002: 121–134.
- 62 Sepucha KR, Fowler FJ, Mulley AG. Policy support for patient-centered care: the need for measurable improvements in decision quality. Health Affairs, 23 (6): VAR54–VAR62; Nov-Dec 2004.