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 |
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.
Publications
Physician Recommendations Trump Patient Preferences in Prostate Cancer Treatment Decisions.
Authors: Scherr K.A.
, Fagerlin A.
, Hofer T.
, Scherer L.D.
, Holmes-Rovner M.
, Williamson L.D.
, Kahn V.C.
, Montgomery J.S.
, Greene K.L.
, Zhang B.
, et al.
.
Source: Medical Decision Making : An International Journal Of The Society For Medical Decision Making, 2017 01; 37(1), p. 56-69.
EPub date: 2016-08-10 00:00:00.0.
PMID: 27510740
Related Citations
What Matters to Women When Making Decisions About Breast Cancer Chemoprevention?
Authors: Martinez K.A.
, Fagerlin A.
, Witteman H.O.
, Holmberg C.
, Hawley S.T.
.
Source: The Patient, 2016 Apr; 9(2), p. 149-59.
PMID: 26115846
Related Citations
Study Of Physician And Patient Communication Identifies Missed Opportunities To Help Reduce Patients' Out-of-pocket Spending
Authors: Ubel P.A.
, Zhang C.J.
, Hesson A.
, Davis J.K.
, Kirby C.
, Barnett J.
, Hunter W.G.
.
Source: Health Affairs (project Hope), 2016 Apr; 35(4), p. 654-61.
PMID: 27044966
Related Citations
Blocks, Ovals, Or People? Icon Type Affects Risk Perceptions And Recall Of Pictographs
Authors: Zikmund-Fisher B.J.
, Witteman H.O.
, Dickson M.
, Fuhrel-Forbis A.
, Kahn V.C.
, Exe N.L.
, Valerio M.
, Holtzman L.G.
, Scherer L.D.
, Fagerlin A.
.
Source: Medical Decision Making : An International Journal Of The Society For Medical Decision Making, 2014 May; 34(4), p. 443-53.
PMID: 24246564
Related Citations
The psychology of 'regrettable substitutions': Examining consumer judgements of Bisphenol A and its alternatives.
Authors: Scherer L.D.
, Maynard A.
, Dolinoy D.C.
, Fagerlin A.
, Zikmund-Fisher B.J.
.
Source: Health, Risk & Society, 2014; 16(7-8), p. 649-666.
EPub date: 2014-11-07 00:00:00.0.
PMID: 29386966
Related Citations
Imagining Life With An Ostomy: Does A Video Intervention Improve Quality-of-life Predictions For A Medical Condition That May Elicit Disgust?
Authors: Angott A.M.
, Comerford D.A.
, Ubel P.A.
.
Source: Patient Education And Counseling, 2013 Apr; 91(1), p. 113-9.
PMID: 23177398
Related Citations
In a survey, marked inconsistency in how oncologists judged value of high-cost cancer drugs in relation to gains in survival.
Authors: Ubel P.A.
, Berry S.R.
, Nadler E.
, Bell C.M.
, Kozminski M.A.
, Palmer J.A.
, Evans W.K.
, Strevel E.L.
, Neumann P.J.
.
Source: Health Affairs (project Hope), 2012 Apr; 31(4), p. 709-17.
PMID: 22492887
Related Citations
'i'll Do What They Did": Social Norm Information And Cancer Treatment Decisions
Authors: Zikmund-Fisher B.J.
, Windschitl P.D.
, Exe N.
, Ubel P.A.
.
Source: Patient Education And Counseling, 2011 Nov; 85(2), p. 225-9.
PMID: 21367557
Related Citations
Helping patients decide: ten steps to better risk communication.
Authors: Fagerlin A.
, Zikmund-Fisher B.J.
, Ubel P.A.
.
Source: Journal Of The National Cancer Institute, 2011-10-05 00:00:00.0; 103(19), p. 1436-43.
EPub date: 2011-10-05 00:00:00.0.
PMID: 21931068
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Creating a knowledge translation trainee collaborative: from conceptualization to lessons learned in the first year.
Authors: Cornelissen E.
, Urquhart R.
, Chan V.W.
, Deforge R.T.
, Colquhoun H.L.
, Sibbald S.
, Witteman H.
.
Source: Implementation Science : Is, 2011-08-25 00:00:00.0; 6, p. 98.
EPub date: 2011-08-25 00:00:00.0.
PMID: 21867500
Related Citations
The Benefits Of Discussing Adjuvant Therapies One At A Time Instead Of All At Once
Authors: Zikmund-Fisher B.J.
, Angott A.M.
, Ubel P.A.
.
Source: Breast Cancer Research And Treatment, 2011 Aug; 129(1), p. 79-87.
PMID: 20945090
Related Citations
Physicians Recommend Different Treatments For Patients Than They Would Choose For Themselves
Authors: Ubel P.A.
, Angott A.M.
, Zikmund-Fisher B.J.
.
Source: Archives Of Internal Medicine, 2011-04-11 00:00:00.0; 171(7), p. 630-4.
PMID: 21482835
Related Citations
Risk Estimates From An Online Risk Calculator Are More Believable And Recalled Better When Expressed As Integers
Authors: Witteman H.O.
, Zikmund-Fisher B.J.
, Waters E.A.
, Gavaruzzi T.
, Fagerlin A.
.
Source: Journal Of Medical Internet Research, 2011; 13(3), p. e54.
PMID: 21908265
Related Citations
Risky feelings: why a 6% risk of cancer does not always feel like 6%.
Authors: Zikmund-Fisher B.J.
, Fagerlin A.
, Ubel P.A.
.
Source: Patient Education And Counseling, 2010 Dec; 81 Suppl, p. S87-93.
PMID: 20739135
Related Citations
Images Of Illness: How Causal Claims And Racial Associations Influence Public Preferences Toward Diabetes Research Spending
Authors: Gollust S.E.
, Lantz P.M.
, Ubel P.A.
.
Source: Journal Of Health Politics, Policy And Law, 2010 Dec; 35(6), p. 921-59.
PMID: 21451158
Related Citations
A demonstration of ''less can be more'' in risk graphics.
Authors: Zikmund-Fisher B.J.
, Fagerlin A.
, Ubel P.A.
.
Source: Medical Decision Making : An International Journal Of The Society For Medical Decision Making, 2010 Nov-Dec; 30(6), p. 661-71.
PMID: 20375419
Related Citations
Testing whether decision aids introduce cognitive biases: results of a randomized trial.
Authors: Ubel P.A.
, Smith D.M.
, Zikmund-Fisher B.J.
, Derry H.A.
, McClure J.
, Stark A.
, Wiese C.
, Greene S.
, Jankovic A.
, Fagerlin A.
.
Source: Patient Education And Counseling, 2010 Aug; 80(2), p. 158-63.
PMID: 20004545
Related Citations
The Polarizing Effect Of News Media Messages About The Social Determinants Of Health
Authors: Gollust S.E.
, Lantz P.M.
, Ubel P.A.
.
Source: American Journal Of Public Health, 2009 Dec; 99(12), p. 2160-7.
PMID: 19833981
Related Citations
Improving understanding of adjuvant therapy options by using simpler risk graphics.
Authors: Zikmund-Fisher B.J.
, Fagerlin A.
, Ubel P.A.
.
Source: Cancer, 2008-12-15 00:00:00.0; 113(12), p. 3382-90.
PMID: 19012353
Related Citations
The Impact Of The Format Of Graphical Presentation On Health-related Knowledge And Treatment Choices
Authors: Hawley S.T.
, Zikmund-Fisher B.
, Ubel P.
, Jancovic A.
, Lucas T.
, Fagerlin A.
.
Source: Patient Education And Counseling, 2008 Dec; 73(3), p. 448-55.
PMID: 18755566
Related Citations
Are They Really That Happy? Exploring Scale Recalibration In Estimates Of Well-being
Authors: Lacey H.P.
, Fagerlin A.
, Loewenstein G.
, Smith D.M.
, Riis J.
, Ubel P.A.
.
Source: Health Psychology : Official Journal Of The Division Of Health Psychology, American Psychological Association, 2008 Nov; 27(6), p. 669-75.
PMID: 19025261
Related Citations
The accuracy of predicting parity as a prerequisite for cesarean delivery on maternal request.
Authors: Keeton K.
, Zikmund-Fisher B.J.
, Ubel P.A.
, Fenner D.E.
, Fagerlin A.
.
Source: Obstetrics And Gynecology, 2008 Aug; 112(2 Pt 1), p. 285-9.
PMID: 18669724
Related Citations
The Potential Impact Of Decision Role And Patient Age On End-of-life Treatment Decision Making
Authors: Zikmund-Fisher B.J.
, Lacey H.P.
, Fagerlin A.
.
Source: Journal Of Medical Ethics, 2008 May; 34(5), p. 327-31.
PMID: 18448709
Related Citations
Alternate methods of framing information about medication side effects: incremental risk versus total risk of occurrence.
Authors: Zikmund-Fisher B.J.
, Fagerlin A.
, Roberts T.R.
, Derry H.A.
, Ubel P.A.
.
Source: Journal Of Health Communication, 2008 Mar; 13(2), p. 107-24.
PMID: 18300064
Related Citations
"If I'm better than average, then I'm ok?": Comparative information influences beliefs about risk and benefits.
Authors: Fagerlin A.
, Zikmund-Fisher B.J.
, Ubel P.A.
.
Source: Patient Education And Counseling, 2007 Dec; 69(1-3), p. 140-4.
PMID: 17942271
Related Citations
Does labeling prenatal screening test results as negative or positive affect a woman's responses?
Authors: Zikmund-Fisher B.J.
, Fagerlin A.
, Keeton K.
, Ubel P.A.
.
Source: American Journal Of Obstetrics And Gynecology, 2007 Nov; 197(5), p. 528.e1-6.
PMID: 17880902
Related Citations
Measuring Numeracy Without A Math Test: Development Of The Subjective Numeracy Scale
Authors: Fagerlin A.
, Zikmund-Fisher B.J.
, Ubel P.A.
, Jankovic A.
, Derry H.A.
, Smith D.M.
.
Source: Medical Decision Making : An International Journal Of The Society For Medical Decision Making, 2007 Sep-Oct; 27(5), p. 672-80.
PMID: 17641137
Related Citations
Validation of the Subjective Numeracy Scale: effects of low numeracy on comprehension of risk communications and utility elicitations.
Authors: Zikmund-Fisher B.J.
, Smith D.M.
, Ubel P.A.
, Fagerlin A.
.
Source: Medical Decision Making : An International Journal Of The Society For Medical Decision Making, 2007 Sep-Oct; 27(5), p. 663-71.
PMID: 17652180
Related Citations
Rethinking The Objectives Of Decision Aids: A Call For Conceptual Clarity
Authors: Nelson W.L.
, Han P.K.
, Fagerlin A.
, Stefanek M.
, Ubel P.A.
.
Source: Medical Decision Making : An International Journal Of The Society For Medical Decision Making, 2007 Sep-Oct; 27(5), p. 609-18.
PMID: 17873251
Related Citations
Making numbers matter: present and future research in risk communication.
Authors: Fagerlin A.
, Ubel P.A.
, Smith D.M.
, Zikmund-Fisher B.J.
.
Source: American Journal Of Health Behavior, 2007 Sep-Oct; 31 Suppl 1, p. S47-56.
PMID: 17931136
Related Citations
Mortality Versus Survival Graphs: Improving Temporal Consistency In Perceptions Of Treatment Effectiveness
Authors: Zikmund-Fisher B.J.
, Fagerlin A.
, Ubel P.A.
.
Source: Patient Education And Counseling, 2007 Apr; 66(1), p. 100-7.
PMID: 17137743
Related Citations
A matter of perspective: choosing for others differs from choosing for yourself in making treatment decisions.
Authors: Zikmund-Fisher B.J.
, Sarr B.
, Fagerlin A.
, Ubel P.A.
.
Source: Journal Of General Internal Medicine, 2006 Jun; 21(6), p. 618-22.
PMID: 16808746
Related Citations
Cure Me Even If It Kills Me: Preferences For Invasive Cancer Treatment
Authors: Fagerlin A.
, Zikmund-Fisher B.J.
, Ubel P.A.
.
Source: Medical Decision Making : An International Journal Of The Society For Medical Decision Making, 2005 Nov-Dec; 25(6), p. 614-9.
PMID: 16282212
Related Citations
The Importance Of Age In Allocating Health Care Resources: Does Intervention-type Matter?
Authors: Johri M.
, Damschroder L.J.
, Zikmund-Fisher B.J.
, Ubel P.A.
.
Source: Health Economics, 2005 Jul; 14(7), p. 669-78.
PMID: 15497189
Related Citations
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 B.J.
, Ubel P.A.
.
Source: Patient Education And Counseling, 2005 Jun; 57(3), p. 294-9.
PMID: 15893211
Related Citations
What's time got to do with it? Inattention to duration in interpretation of survival graphs.
Authors: Zikmund-Fisher B.J.
, Fagerlin A.
, Ubel P.A.
.
Source: Risk Analysis : An Official Publication Of The Society For Risk Analysis, 2005 Jun; 25(3), p. 589-95.
PMID: 16022692
Related Citations
Medical Study: Aspiring Parents, Genotypes And Phenotypes: The Unexamined Myth Of The Perfect Baby
Authors: Gurmankin A.
, Ubel P.
, Banger E.
, McGee G.
.
Source: Albany Law Review, 2005; 68(4), p. 1097-111.
PMID: 16094768
Related Citations
"is 28% Good Or Bad?" Evaluability And Preference Reversals In Health Care Decisions
Authors: Zikmund-Fisher B.J.
, Fagerlin A.
, Ubel P.A.
.
Source: Medical Decision Making : An International Journal Of The Society For Medical Decision Making, 2004 Mar-Apr; 24(2), p. 142-8.
PMID: 15090100
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