Genetic Testing and Medical Decision Making

Reyna, Valerie F.

doi:10.1001/archinte.161.20.2406

Cited by 58 publications

(40 citation statements)

References 16 publications

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“…For example, in a study examining triage decisions for patients presenting to emergency rooms with chest pain, expert cardiologists processed information in a cruder all-or-none fashion (patients were either at risk or not at risk of an imminent heart attack) and they processed fewer dimensions of information than less expert physicians or students did (see also . Consistent with fuzzy-trace theory, the evidence suggests a shift to increasingly qualitative, simplified processing with increasing expertise in a domain (Reyna, Lloyd, & Whalen, 2001; Reyna, Lloyd, & Woodward, 1997;Shanteau, 1992). …”

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confidence: 64%

Risk taking under the influence: A fuzzy-trace theory of emotion in adolescence

Rivers

Reyna

Mills

2008

Developmental Review

199

228

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Fuzzy-trace theory explains risky decision making in children, adolescents, and adults, incorporating social and cultural factors as well as differences in impulsivity. Here, we provide an overview of the theory, including support for counterintuitive predictions (e.g., when adolescents "rationally" weigh costs and benefits, risk taking increases, but it decreases when the core gist of a decision is processed). Then, we delineate how emotion shapes adolescent risk taking-from encoding of representations of options, to retrieval of values/principles, to application of those values/principles to representations of options. Our review indicates that: (i) Gist representations often incorporate emotion including valence, arousal, feeling states, and discrete emotions; and (ii) Emotion determines whether gist or verbatim representations are processed. We recommend interventions to reduce unhealthy risk-taking that inculcate stable gist representations, enabling adolescents to identify quickly and automatically danger even when experiencing emotion, which differs sharply from traditional approaches emphasizing deliberation and precise analysis. Keywords adolescence; risk taking; fuzzy-trace theory; decision making; emotion; affect; mood; memory It seems oxymoronic to apply the term "decision making" to describe adolescent risk taking. After all, if adolescents were making decisions, perhaps they would not be getting into so much trouble. Adolescents appear to react rather than decide. But this view of decision making betrays an assumption that mature decision making is cold and deliberative, that it is the result of an intentional, analytical thinking process that eschews emotion (Nisbett & Ross, 1980). We argue just the opposite. Instead of assuming that development progresses from hot intuitive thinking to cold calculation bypassing emotion, we present research showing that intuition is developmentally advanced and that emotion is integral to intuition.Correspondence concerning this article should be addressed to Valerie F. Reyna, Departments of Human Development and Psychology, Cornell University, B44 Martha Van Rensselaer Hall, Ithaca, NY 14853. Email: vr53@cornell.edu. Phone: (607) 255-9856. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptIn this article, we outline a theory of risk taking in adolescence-fuzzy-trace theory-that is grounded in research on how people represent, retrieve, and process information when they make decisions, and how decision making changes with d...

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confidence: 64%

Risk taking under the influence: A fuzzy-trace theory of emotion in adolescence

Rivers

Reyna

Mills

2008

Developmental Review

199

228

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“…Understanding risks and making good decisions requires health literacy and "numeracy" (Reyna & Brainerd, 2007; 2008) to interpret the meaning of base rates, joint probabilities (Wolfe & Reyna, 2010a,b) conditional probabilities, (Peters, McCaul, Stefanek, Nelson, 2006; Wolfe, Fisher & Reyna, 2012) and other quantitative concepts. Systematic biases in risk estimation have been demonstrated for both patients and providers (Offit, 2006; Reyna, Lloyd, & Whalen, 2001; Reyna, Nelson, Han, & Dieckmann, 2009). Women must also reason with ambiguous technical information in the context of conflicting attitudes and competing goals and constraints.…”

Section: 2 Breast Cancer and Genetic Riskmentioning

confidence: 99%

Understanding genetic breast cancer risk: Processing loci of the BRCA Gist Intelligent Tutoring System

Wolfe

Reyna

Widmer

et al. 2016

Learning and Individual Differences

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The BRCA Gist Intelligent Tutoring System helps women understand and make decisions about genetic testing for breast cancer risk. BRCA Gist is guided by Fuzzy-Trace Theory, (FTT) and built using AutoTutor Lite. It responds differently to participants depending on what they say. Seven tutorial dialogues requiring explanation and argumentation are guided by three FTT concepts: forming gist explanations in one’s own words, emphasizing decision-relevant information, and deliberating the consequences of decision alternatives. Participants were randomly assigned to BRCA Gist, a control, or impoverished BRCA Gist conditions removing gist explanation dialogues, argumentation dialogues, or FTT images. All BRCA Gist conditions performed significantly better than controls on knowledge, comprehension, and risk assessment. Significant differences in knowledge, comprehension, and fine-grained dialogue analyses demonstrate the efficacy of gist explanation dialogues. FTT images significantly increased knowledge. Providing more elements in arguments against testing correlated with increased knowledge and comprehension.

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“…In his seminal work, Eddy (1982) showed that various health care professionals-doctors, nurses, and midwives-have difficulties understanding, communicating, and correctly solving statistical problems. Similarly, Reyna (2001) argued that health care professionals ''experience predictable difficulties in interpreting probabilities associated with genetic testing'' (p. 2406; see also Gigerenzer, 2002). Yet this is some of the very information that the American College of Obstetricians and Gynecologists recommends that patients be given.…”

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confidence: 99%

Presentation Format Affects Comprehension and Risk Assessment: The Case of Prenatal Screening

Miron‐Shatz

Hanoch

Graef

et al. 2009

Journal of Health Communication

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We studied the effects of presentation formats (frequency, 1-in-N, and visual) and numeracy level on students' understanding of prenatal screening results, as well as their risk assessment for having a fetus with Down syndrome. Frequency format (vs. 1-in-N and visual formats) improved participants' ability to accurately assess the chances of having a fetus with Down syndrome, and was associated with lower risk estimates. High numeracy levels were associated with a better ability to judge risk likelihood. For individuals of low numeracy levels, however, the frequency format significantly facilitated accurate understanding of probability information. This suggests that presenting information in frequency format is particularly beneficial for certain populations.

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Genetic Testing and Medical Decision Making

Cited by 58 publications

References 16 publications

Risk taking under the influence: A fuzzy-trace theory of emotion in adolescence

Risk taking under the influence: A fuzzy-trace theory of emotion in adolescence

Understanding genetic breast cancer risk: Processing loci of the BRCA Gist Intelligent Tutoring System

Presentation Format Affects Comprehension and Risk Assessment: The Case of Prenatal Screening

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