“I don’t know” My Cancer Risk: Implications for Health Behavior Engagement

Waters, Erika A.; Kiviniemi, Marc T.; Orom, Heather; Hay, Jennifer L.

doi:10.1007/s12160-016-9789-5

Cited by 35 publications

(40 citation statements)

References 20 publications

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“…The rates of lack of knowledge of HIV/AIDS risk observed in this study equate to between 2.5 million and 5 million US adults not knowing their risk for HIV. Given the relation between risk perception and preventive action, this lack of knowledge is potentially a substantial barrier to risk reduction (Waters, Kiviniemi, Orom, & Hay, 2016) and a possible explanation for the observation that the relation of risk perception to protective behaviour is often not as strong as one would expect (e.g., Brewer, Weinstein, Cuite, & Herrington, 2004; Brewer et al , 2007; Sheeran et al , 2014; Taber & Klein, 2016). The education-based disparities in knowledge of personal risk presented here and elsewhere (Waters et al , 2013) are quite important because the populations who display a lack of risk knowledge are exactly those populations who suffer a greater burden from many chronic and infectious diseases.…”

Section: Discussionmentioning

confidence: 99%

Education‐based disparities in knowledge of novel health risks: The case of knowledge gaps in HIV risk perceptions

Kiviniemi

Orom

Waters

et al. 2018

British J Health Psychol

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We found support for the knowledge gap hypothesis. Over time, populations with greater education gained more knowledge about their HIV risk than populations with lower education. Results highlight the need to carefully consider health communication strategies to reach and address those individuals with low education and health knowledge. Statement of contribution What is already known on this subject? A meaningful potion of the population answers 'don't know' when asked to report their risk for health problems, indicating a lack of risk perception in the domain. Previous studies have shown that level of education is associated with don't know responding - those with lower educational attainment are more likely to respond don't know. The education-don't know responding relation suggests that lack of health information and health domain knowledge might be a factor in lacking risk perception, but this mechanism has not been previously tested. What does this study add? Patterns of changes in don't know responding over time as population-level knowledge of a health risk increase are consistent with the health information/health knowledge hypothesis outlined above. As population knowledge of HIV/AIDS risk in the United States increased over time (indicated by declining overall rates of don't know responses), the relation of education level to don't know responding actually became stronger. The pattern of change over time is the classic 'knowledge gap hypothesis' pattern, which has not been previously demonstrated for knowledge of personal health risk. The knowledge gap response pattern supports the health information/health knowledge hypothesis.

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Section: Discussionmentioning

confidence: 99%

Education‐based disparities in knowledge of novel health risks: The case of knowledge gaps in HIV risk perceptions

Kiviniemi

Orom

Waters

et al. 2018

British J Health Psychol

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“…Patients who overestimate their risk may be more vulnerable to pursuing aggressive testing and treatment even when there is no evidence-based rationale for such choices [2,7,21]. In addition, women who perceive no chance of recurrence may be less likely to adhere to survivorship recommendations including symptom surveillance, regular follow-up, and adjuvant endocrine therapy that plays an essential role in reducing distant recurrence risk [6–9]. …”

Section: Discussionmentioning

confidence: 99%

“…Overestimation has been associated with preference for more extensive treatment than necessary [2], greater ongoing worry [3], a hypervigilance about symptoms resulting in unscheduled visits [4,5] and worse quality of life [1]. In contrast, underestimation may lessen one’s commitment to surveillance recommendations regarding mammography [6–8] and/or adhering to endocrine therapy [9]. …”

Section: Introductionmentioning

confidence: 99%

The impact of doctor–patient communication on patients’ perceptions of their risk of breast cancer recurrence

Janz

Zikmund‐Fisher

et al. 2016

Breast Cancer Res Treat

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Purpose Doctor-patient communication is the primary way women diagnosed with breast cancer learn about their risk of distant recurrence. Yet little is known about how doctors approach these discussions. Methods A weighted random sample of newly diagnosed early stage breast cancer patients identified through SEER registries of Los Angeles and Georgia (2013–2015) were sent surveys ~about 2 months after surgery (Phase 2, N=3930, RR 68%). We assessed patient perceptions of doctor communication of risk of recurrence (i.e., amount, approach, inquiry about worry). Clinically-determined 10-year risk of distant recurrence was established for low and intermediate invasive cancer patients. Women’s perceived risk of distant recurrence (0–100%) was categorized into subgroups: overestimation, reasonably accurate, zero risk. Understanding of risk and patient factors (e.g., health literacy, numeracy and anxiety/worry) on physician communication outcomes was evaluated in multivariable regression models (analytic sample for substudy = 1295). Results About 33% of women reported doctors discussed risk of recurrence “quite a bit” or “a lot” while 14% said “not at all.” Over half of women reported doctors used words and numbers to describe risk, while 24% used only words. Overestimators (OR =.50, CI 0.31, 0.81) or those who perceived zero risk (OR =.46, CI 0.29,0.72) more often said their doctor did not discuss risk. Patients with low numeracy reported less discussion. Over 60% reported their doctor almost never inquired about worry. Conclusions Effective doctor-patient communication is critical to patient understanding of risk of recurrence. Efforts to enhance physicians’ ability to engage in individualized communication around risk are needed.

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“…Ample empirical evidence suggests that people who perceive that they are at higher risk of disease are more likely to take health protective actions (Sheeran, Harris, & Epton, 2013). However, a growing body of research shows that many people report that they don’t know their risk of cancer and other diseases (Hay, Orom, Kiviniemi, & Waters, 2015; Lipkus, Rimer, & Strigo, 1996; Waters, Hay, Orom, Kiviniemi, & Drake, 2013; Waters, Kiviniemi, Orom, & Hay, 2016). This “don’t know responding” (DKR) also seems to be more prevalent in populations affected by health disparities (e.g., those with less formal education) (Hay et al, 2015; Waters et al, 2013; Waters et al, 2016) and among people who have limited health knowledge (Hay et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Don't know responses to cognitive and affective risk perception measures: Exploring prevalence and socio‐demographic moderators

Janssen

Verduyn

Waters

2018

British J Health Psychol

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Lower uncertainty for affective (vs. cognitive) absolute perceived risk items is consistent with research stating: (1) Risk perceptions are grounded in people's feelings about a hazard, and (2) feelings are easier for people to access than facts. Including affective perceived risk items in health behaviour surveys may reduce missing data and improve data quality. Statement of contribution What is already known on this subject? Many people report that they don't know their risk (i.e., risk uncertainty). Evidence is growing for the importance of feelings of risk in explaining health behaviour. Feelings are easier for people to access than facts. What does this study add? Don't know responding is higher for absolute cognitive than absolute affective risk questions. This difference does not vary in magnitude by demographic characteristics. Affective perceived risk questions in surveys may reduce missing data and improve data quality.

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“I don’t know” My Cancer Risk: Implications for Health Behavior Engagement

Abstract: Background-Many people report uncertainty about their cancer risk. We examined whether such uncertainty was related to cancer prevention and detection behaviors.

Cited by 35 publications

References 20 publications

Education‐based disparities in knowledge of novel health risks: The case of knowledge gaps in HIV risk perceptions

Education‐based disparities in knowledge of novel health risks: The case of knowledge gaps in HIV risk perceptions

The impact of doctor–patient communication on patients’ perceptions of their risk of breast cancer recurrence

Don't know responses to cognitive and affective risk perception measures: Exploring prevalence and socio‐demographic moderators

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