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Grant Details

Grant Number: 5R01CA087595-10 Interpret this number
Primary Investigator: Ubel, Peter
Organization: Duke University
Project Title: Identifying and Reducing Cognitive Biases Created By Decision AIDS
Fiscal Year: 2011
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Abstract

DESCRIPTION (provided by applicant): Decision aids (DAs) provide patients with information about preference sensitive decisions in which patients' preferences are likely to play a key role in determining what the best decision is and allow them more time to process the information than they would in a typical clinical encounter. An international group of experts, the International Patient Decision Aids Standards (IPDAS) Collaboration, has established a list of content that decision aid developers are encouraged to put into DAs. However, it provided no guidance about how to present such content, or how to make sure such content does not create decision biases. Our original grant aimed to identify and reduce cognitive biases created by DAs. We identified multiple cognitive biases that could be created by DAs and have developed several practical techniques for reducing or eliminating these biases. But our work is not done. To extend our accomplishments and respond to the IPDAS recommendations, we are proposing to conduct research targeting several additional biases that are potentially created by DAs and developing techniques to eliminate or reduce them. In addition, we propose to conduct studies that focus not only on the role that cognition plays in people's decisions, but also the role of affect. We thus plan to identify the kind of decision biases likely to arise when patients use decision aids, regardless of whether those biases arise through cognitive or affective processes, and identify ways to reduce them. Specifically, we aim to explore four sources of biases relevant to decision aids: (1) presentation of ambiguous probabilities (2) presentation of contextual information about probabilities (3) people's affective reaction to health outcomes, and (4) people's methods of integrating probability and utility in a single decision. For each source, we will identify multiple factors which bias patient decisions. We propose to identify the scope of each problem, delineate the circumstances under which biases result, and test methods for reducing or eliminating the biases. All our studies will use materials from pre-existing decision aids. Our approach includes two distinct research stages. In the first stage, we use iterative randomized survey experiments to explore which decision aid elements generate bias. We will present people with hypothetical medical decisions, based on material from real decision aids, and vary aspects of the decision task across people, to test hypotheses about how to minimize decision biases. Our initial studies will consider a subset of the relevant factors, and follow-up studies will drill down on factors that are significant in our first experiments and also test additional factors not included due to power and complexity reasons. In the second stage, we will demonstrate the relevance of our first-stage results for patient care. For each source of bias, our research will culminate with a randomized trial of a debiasing technique delivered to a patient population. Relevance Statement Our research aims to improve patient decision aids, which are booklets, websites, or videos that provide patients with information about medical decisions and help them to make the decision that best matches their own preferences. While international standards exist for the content of decision aids, our results will help decision aid developers know how to best present the information in decision aids so as to avoid cognitive and emotional biases. This work is essential to ensuring that patients are fully informed and able to participate in decision making regarding their medical care.

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Publications

Helping patients decide: ten steps to better risk communication.
Authors: Fagerlin A, Zikmund-Fisher BJ, Ubel PA
Source: J Natl Cancer Inst, 2011 Oct 5;103(19), p. 1436-43.
EPub date: 2011 Sep 19.
PMID: 21931068
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'I'll do what they did": social norm information and cancer treatment decisions.
Authors: Zikmund-Fisher BJ, Windschitl PD, Exe N, Ubel PA
Source: Patient Educ Couns, 2011 Nov;85(2), p. 225-9.
EPub date: 2011 Mar 1.
PMID: 21367557
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The benefits of discussing adjuvant therapies one at a time instead of all at once.
Authors: Zikmund-Fisher BJ, Angott AM, Ubel PA
Source: Breast Cancer Res Treat, 2011 Aug;129(1), p. 79-87.
EPub date: 2010 Oct 14.
PMID: 20945090
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Risky feelings: why a 6% risk of cancer does not always feel like 6%.
Authors: Zikmund-Fisher BJ, Fagerlin A, Ubel PA
Source: Patient Educ Couns, 2010 Dec;81 Suppl, p. S87-93.
EPub date: 2010 Aug 23.
PMID: 20739135
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A demonstration of ''less can be more'' in risk graphics.
Authors: Zikmund-Fisher BJ, Fagerlin A, Ubel PA
Source: Med Decis Making, 2010 Nov-Dec;30(6), p. 661-71.
EPub date: 2010 Apr 7.
PMID: 20375419
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Are they really that happy? Exploring scale recalibration in estimates of well-being.
Authors: Lacey HP, Fagerlin A, Loewenstein G, Smith DM, Riis J, Ubel PA
Source: Health Psychol, 2008 Nov;27(6), p. 669-75.
PMID: 19025261
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Improving understanding of adjuvant therapy options by using simpler risk graphics.
Authors: Zikmund-Fisher BJ, Fagerlin A, Ubel PA
Source: Cancer, 2008 Dec 15;113(12), p. 3382-90.
PMID: 19012353
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The impact of the format of graphical presentation on health-related knowledge and treatment choices.
Authors: Hawley ST, Zikmund-Fisher B, Ubel P, Jancovic A, Lucas T, Fagerlin A
Source: Patient Educ Couns, 2008 Dec;73(3), p. 448-55.
EPub date: 2008 Aug 27.
PMID: 18755566
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The accuracy of predicting parity as a prerequisite for cesarean delivery on maternal request.
Authors: Keeton K, Zikmund-Fisher BJ, Ubel PA, Fenner DE, Fagerlin A
Source: Obstet Gynecol, 2008 Aug;112(2 Pt 1), p. 285-9.
PMID: 18669724
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The potential impact of decision role and patient age on end-of-life treatment decision making.
Authors: Zikmund-Fisher BJ, Lacey HP, Fagerlin A
Source: J Med Ethics, 2008 May;34(5), p. 327-31.
PMID: 18448709
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Alternate methods of framing information about medication side effects: incremental risk versus total risk of occurrence.
Authors: Zikmund-Fisher BJ, Fagerlin A, Roberts TR, Derry HA, Ubel PA
Source: J Health Commun, 2008 Mar;13(2), p. 107-24.
PMID: 18300064
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Making numbers matter: present and future research in risk communication.
Authors: Fagerlin A, Ubel PA, Smith DM, Zikmund-Fisher BJ
Source: Am J Health Behav, 2007 Sep-Oct;31 Suppl 1, p. S47-56.
PMID: 17931136
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"If I'm better than average, then I'm ok?": Comparative information influences beliefs about risk and benefits.
Authors: Fagerlin A, Zikmund-Fisher BJ, Ubel PA
Source: Patient Educ Couns, 2007 Dec;69(1-3), p. 140-4.
EPub date: 2007 Oct 17.
PMID: 17942271
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Does labeling prenatal screening test results as negative or positive affect a woman's responses?
Authors: Zikmund-Fisher BJ, Fagerlin A, Keeton K, Ubel PA
Source: Am J Obstet Gynecol, 2007 Nov;197(5), p. 528.e1-6.
EPub date: 2007 Sep 19.
PMID: 17880902
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Rethinking the objectives of decision aids: a call for conceptual clarity.
Authors: Nelson WL, Han PK, Fagerlin A, Stefanek M, Ubel PA
Source: Med Decis Making, 2007 Sep-Oct;27(5), p. 609-18.
EPub date: 2007 Sep 14.
PMID: 17873251
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Validation of the Subjective Numeracy Scale: effects of low numeracy on comprehension of risk communications and utility elicitations.
Authors: Zikmund-Fisher BJ, Smith DM, Ubel PA, Fagerlin A
Source: Med Decis Making, 2007 Sep-Oct;27(5), p. 663-71.
EPub date: 2007 Jul 24.
PMID: 17652180
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Measuring numeracy without a math test: development of the Subjective Numeracy Scale.
Authors: Fagerlin A, Zikmund-Fisher BJ, Ubel PA, Jankovic A, Derry HA, Smith DM
Source: Med Decis Making, 2007 Sep-Oct;27(5), p. 672-80.
EPub date: 2007 Jul 19.
PMID: 17641137
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Mortality versus survival graphs: improving temporal consistency in perceptions of treatment effectiveness.
Authors: Zikmund-Fisher BJ, Fagerlin A, Ubel PA
Source: Patient Educ Couns, 2007 Apr;66(1), p. 100-7.
EPub date: 2006 Nov 29.
PMID: 17137743
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A matter of perspective: choosing for others differs from choosing for yourself in making treatment decisions.
Authors: Zikmund-Fisher BJ, Sarr B, Fagerlin A, Ubel PA
Source: J Gen Intern Med, 2006 Jun;21(6), p. 618-22.
PMID: 16808746
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Cure me even if it kills me: preferences for invasive cancer treatment.
Authors: Fagerlin A, Zikmund-Fisher BJ, Ubel PA
Source: Med Decis Making, 2005 Nov-Dec;25(6), p. 614-9.
PMID: 16282212
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Medical study: aspiring parents, genotypes and phenotypes: the unexamined myth of the perfect baby.
Authors: Banger E, McGee G
Source: Albany Law Rev, 2005;68(4), p. 1097-111.
PMID: 16094768
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What's time got to do with it? Inattention to duration in interpretation of survival graphs.
Authors: Zikmund-Fisher BJ, Fagerlin A, Ubel PA
Source: Risk Anal, 2005 Jun;25(3), p. 589-95.
PMID: 16022692
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How making a risk estimate can change the feel of that risk: shifting attitudes toward breast cancer risk in a general public survey.
Authors: Fagerlin A, Zikmund-Fisher BJ, Ubel PA
Source: Patient Educ Couns, 2005 Jun;57(3), p. 294-9.
PMID: 15893211
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The importance of age in allocating health care resources: does intervention-type matter?
Authors: Johri M, Damschroder LJ, Zikmund-Fisher BJ, Ubel PA
Source: Health Econ, 2005 Jul;14(7), p. 669-78.
PMID: 15497189
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"Is 28% good or bad?" Evaluability and preference reversals in health care decisions.
Authors: Zikmund-Fisher BJ, Fagerlin A, Ubel PA
Source: Med Decis Making, 2004 Mar-Apr;24(2), p. 142-8.
PMID: 15090100
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