Developmental differences in description-based versus experience-based decision making under risk in children.

The willingness to take a risk is shaped by temperaments and cognitive abilities, both of which develop rapidly during childhood. In the adult developmental literature, a distinction is drawn between description-based tasks, which provide explicit choice-reward information, and experience-based tasks, which require decisions from past experience, each emphasizing different cognitive demands. Although developmental trends have been investigated for both types of decisions, few studies have compared description-based and experience-based decision making in the same sample of children. In the current study, children (N = 112; 5-9 years of age) completed both description-based and experience-based decision tasks tailored for use with young children. Child temperament was reported by the children's primary teacher. Behavioral measures suggested that the willingness to take a risk in a description-based task increased with age, whereas it decreased in an experience-based task. However, computational modeling alongside further inspection of the behavioral data suggested that these opposite developmental trends across the two types of tasks both were associated with related capacities: older (vs. younger) children's higher sensitivity to experienced losses and higher outcome sensitivity to described rewards and losses. From the temperamental characteristics, higher attentional focusing was linked with a higher learning rate on the experience-based task and a bias to accept gambles in the gain domain on the description-based task. Our findings demonstrate the importance of comparing children's behavior across qualitatively different tasks rather than studying a single behavior in isolation.

Perception of Risk for Older Adults: Differences in Evaluations for Self versus Others and across Risk Domains.

BACKGROUND AND OBJECTIVES: Proxy decision-making may be flawed by inaccurate perceptions of risk. This may be particularly true when older adults are the targets of the decisions, given the pervasive negative stereotypes about older adults. METHODS: In study 1, individuals aged 18- to 87 years (as target persons) as well as one of their close social partners (as informants) reported on the risks they perceived for the target person in various life domains. Study 2 additionally explored potential differences in how people make risky decisions on behalf of younger and older adult targets. Younger (age 18-35 years) and older (age 60-81 years) adults (as target persons of the risk evaluations) as well as informants reported on risk perceptions and the likelihood of risk-taking for health, financial, and social scenarios concerning the target persons. Congruence between self-rated and informant-rated risk perceptions and risk-taking were computed on a dyadic as well as a group level. RESULTS: Informants' risk perceptions were positively associated with the risks their partners perceived for themselves. Informants and their partners agreed that social risks vary little across adulthood, but they disagreed in terms of recreational, financial, and health risks, and in terms of the decisions they would make. CONCLUSION: Family members, partners, and close friends are sensitive to vulnerabilities of their social partners, but in some domains and according to their partners' age they perceive a greater (or smaller) risk than their partners perceive for themselves. In situations requiring surrogate decision-making, people may decide differently from how their social partners would decide for themselves.

Risk-Exposure Density and Mileage Bias in Crash Risk for Older Drivers.

Crash rates per mile indicate a high risk of vehicle crash in older drivers. A reliance on mileage alone may underestimate the risk exposure of older drivers because they tend to avoid highways and travel more on nonfreeways (e.g., urban roads), which present greater hazards. We introduce risk-exposure density as an index of exposure that incorporates mileage, frequency of travel, and travel duration. Population-wide driver fatalities in the United States during 2002-2012 were assessed according to driver age range (in years: 16-20, 21-29, 30-39, 40-49, 50-59, 60-69, ≥70) and sex. Mileage, frequency, and duration of travel per person were used to assess risk exposure. Mileage-based fatal crash risk increased greatly among male (relative risk (RR) = 1.73; 95% CI: 1.62, 1.83) and female (RR = 2.08; 95% CI: 1.97, 2.19) drivers from ages 60-69 years to ages ≥70 years. Adjusting for their density of risk exposure, fatal crash risk increased only slightly from ages 60-69 years to ages ≥70 years among male (RR = 1.09; 95% CI: 1.03, 1.15) and female (RR = 1.22; 95% CI: 1.16, 1.29) drivers. While ubiquitous in epidemiologic research, mileage-based assessments can produce misleading accounts of driver risk. Risk-exposure density incorporates multiple components of travel and reduces bias caused by any single indicator of risk exposure.

Invasive Prenatal Diagnostic Testing Recommendations are Influenced by Maternal Age, Statistical Misconception and Perceived Liability.

Funding policy and medico-legal climate are part of physicians' reality and might permeate clinical decisions. This study evaluates the influence of maternal age and government funding on obstetrician/gynecologist recommendation for invasive prenatal testing (i.e. amniocentesis) for Down syndrome (DS), and its association with the physician's assessment of the risk of liability for medical malpractice unless they recommend amniocentesis. Israeli physicians (N = 171) completed a questionnaire and provided amniocentesis recommendations for women at 18 weeks gestation with normal preliminary screening results, identical except aged 28 and 37. Amniocentesis recommendations were reversed for the younger ('yes' regardless of testing results: 6.4%; 'no' regardless of testing results: 31.6%) versus older woman ('yes' regardless of testing results: 40.9%; 'no' regardless of testing results: 7.0%; χ2 = 71.55, p < .01). About half of the physicians endorsed different recommendations per scenario; of these, 65.6% recommended amniocentesis regardless of testing results for the 37-year-old woman. Physicians routinely performing amniocentesis and those advocating for amniocentesis for all women ≥ age 35 were approximately twice as likely to vary their recommendations per scenario. Physicians who perceived risk of liability for malpractice as large were nearly one-and-a-half times more likely to vary recommendations. The results indicate physicians' recommendations are influenced by maternal age, though age is already incorporated in prenatal DS risk evaluations. The physician's assessment of the risk that they will be sued unless they recommend amniocentesis may contribute to this spurious influence.

Does Medical Risk Perception and Risk Taking Change with Age?

Across adulthood, people face increasingly more risky medical problems and decisions. However, little is known about changes in medical risk taking across adulthood. Therefore, the current cross-sectional study investigated age-related differences in medical risk taking with N = 317 adults aged 20-77 years using newly developed scenarios to assess medical risk taking, and additional measures designed to evaluate risk-taking behavior in the medical domain. Greater expected benefits on the Domain-Specific Risk-Taking Scale-Medical (DOSPERT-M) predicted more active risk taking, whereas higher perceived risk predicted less active risk taking. Next, we examined differences in active and passive risk taking, where passive risk taking refers to risk taking that is associated with inaction. Age was associated with less passive risk taking, but not with active risk taking, risk perception, or expected benefits on the DOSPERT-M. Participants were overall more likely to opt for taking medical action than not, even more so for a scenario about a vaccine for a deadly flu than for a scenario about a chemotherapy treatment for cancer. Overall, participants were more likely to accept medication (vaccine or chemotherapy) for their child than for themselves. Increasing age was associated with a lower likelihood of accepting the treatment or vaccine for oneself. Taken together, our study provides important insights about changes in medical risk taking across adulthood when people face an increasing number of complex and risky medical decisions.

The Influence of Genotype Information on Psychiatrists' Treatment Recommendations: More Experienced Clinicians Know Better What to Ignore.

BACKGROUND: This study applies attribute nonattendance to medical decision making. We aimed to demonstrate how this type of analysis can be used in medical decision making to assess whether psychiatrists were influenced in their treatment recommendations by information on the genotype of a patient, despite knowing the patient's response to treatment as measured by the Positive and Negative Syndrome Scale. A patient's genetic information may be used to predict their response to therapy; such information, however, becomes redundant, and should not influence decisions, once a clinician knows the patient's actual response to treatment. METHODS: Sixty-seven psychiatrists were presented with patients' pre- or post-treatment scores on the Positive and Negative Syndrome Scale for two hypothetical treatments for schizophrenia. Psychiatrists were also informed whether the patient possessed a genotype linked to hyper-responsiveness to one of the treatments, and were asked to recommend one of these two treatments. Attribute nonattendance assessed whether the information on genotype influenced psychiatrists' treatment recommendations. RESULTS: Years of experience predicted whether psychiatrists were influenced by the genetic information. Psychiatrists with 1 year or less of experience had a 46% probability of considering genetic information, whereas psychiatrists with at least 15 years of experience had a lower probability (7%). CONCLUSIONS: Psychiatrists and other clinicians should be cautious about allowing a patient's genetic information to carry unnecessary weight in their clinical decision making.

Questioning the preparatory function of counterfactual thinking.

Why do individuals mentally modify reality (e.g., "If it hadn't rained, we would have won the game")? According to the dominant view, counterfactuals primarily serve to prepare future performance. In fact, individuals who have just failed a task tend to modify the uncontrollable features of their attempt (e.g., "If the rules of the game were different, I would have won it"), generating counterfactuals that are unlikely to play any preparatory role. By contrast, they generate prefactuals that focus on the controllable features of their ensuing behavior (e.g., "If I concentrate more, I will win the next game"). Here, we test whether this tendency is robust and general. Studies 1a and 1b replicate this tendency and show that it occurs regardless of whether individuals think about their failures or their successes. Study 2 shows that individuals generate relatively few controllable counterfactuals, unless explicitly prompted to do so. These results raise some questions regarding the generality of the dominant view according to which counterfactuals mainly serve a preparatory function.

Age and Adaptation: Stronger Decision Updating about Real World Risks in Older Age.

In later life, people are faced with a multitude of risky decisions that concern their health, finance, and personal security. Older adults often exercise caution in situations that involve risk. In this research, we asked whether older adults are also more responsive to warnings about potential risk. An answer to this question could reveal a factor underlying increased cautiousness in older age. In Study 1, participants decided whether they would engage in risky activities (e.g., using an ATM machine in the street) in four realistic scenarios about which participants could be expected to have relevant knowledge or experience. They then made posterior decisions after listening to audio extracts of real reports relevant to each activity. In Study 2, we explored the role that emotions play in decision updating. As in Study 1, participants made prior and posterior decisions, with the exception that for each scenario the reports were presented in their original audio format (high emotive) or in a written transcript format (low emotive). Following each posterior decision, participants indicated their emotional valence and arousal responses to the reports. In both studies, older adults engaged in fewer risky activities than younger adults, indicative of increased cautiousness in older age, and exhibited stronger decision updating in response to the reports. Older adults also showed stronger emotional responses to the reports, even though emotional responses did not differ for audio and written transcript formats. Finally, age differences in emotional responses to the reports accounted for age differences in decision updating.

Shared decision making in patients at risk of cancer: the role of domain and numeracy.

BACKGROUND: Shared decision making has become an integral part of medical consultation. Research has, however, reported wide differences in individuals' desires to be involved in the decision-making process, and these differences in preferences are likely to be the result of a number of factors including age, education and numeracy. OBJECTIVE: To investigate whether patients at genetic risk for cancer had preferences for shared decision making that differed depending on medical domain (general health vs. cancer) and whether decision preferences are linked to numeracy abilities. METHODS: Four hundred and seventy-six women who consented to participate in response to an email sent by a local branch of the U.S.-based Cancer Genetics Network (CGN) to its members. Participants completed the Control Preference Scale, as well as an objective and subjective numeracy scales. RESULTS: Decision domain (cancer vs. general health) was not associated with women's preferences for involvement in decision making. Objective and subjective numeracy predicted a preference for decision involvement in general, and only objective numeracy was predictive with regard to cancer. CONCLUSION: Participants were equally likely to state they wanted to play an active, collaborative or passive role in both medical domains (general and cancer). High-numeracy participants were more likely to express a desire for an active role in general and in case they were diagnosed with cancer. PRACTICE IMPLICATIONS: Health authorities' recommendations to clinicians to include patients in their medical decisions are supported by patients' desires, and clinicians should be cognizant of their patients' preferences as well as their numeracy skills.

Understanding of BRCA1/2 genetic tests results: the importance of objective and subjective numeracy.

BACKGROUND: The majority of women (71%) who undergo BRCA1/2 testing-designed to identify genetic mutations associated with increased risk of cancer-receive results that are termed 'ambiguous' or 'uninformative negative'. How women interpret these results and the association with numerical ability was examined. METHODS: In this study, 477 women at increased risk for breast and ovarian cancer were recruited via the Cancer Genetics Network. They were presented with information about the four different possible BRCA1/2 test results-positive, true negative, ambiguous and uninformative negative-and asked to indicate which of six options represents the best response. Participants were then asked which treatment options they thought a woman receiving the results should discuss with her doctor. Finally, participants completed measures of objective and subjective numeracy. RESULTS: Almost all of the participants correctly interpreted the positive and negative BRCA1/2 genetic test results. However, they encountered difficulties interpreting the uninformative and ambiguous BRCA1/2 genetic test results. Participants were almost equally likely to think either that the woman had learned nothing from the test result or that she was as likely to develop cancer as the average woman. Highly numerate participants were more likely to correctly interpret inconclusive test results (ambiguous, OR = 1.62; 95% CI [1.28, 2.07]; p < 0.001; uninformative, OR = 1.40; 95% CI [1.10, 1.80]). DISCUSSION: Given the medical and psychological ramifications of genetic testing, healthcare professionals should consider devoting extra effort to ensuring proper comprehension of ambiguous and uninformative negative test results by women.

Offenders' risk-taking attitude inside and outside the prison walls.

It has long been assumed that risk taking is closely associated with criminal behavior. One reason for placing criminals behind bars--aside from punishment and protecting the public--is to prevent them from engaging in further risky criminal activities. Limited attention has been paid to whether being inside or outside prison affects offenders' risk-taking behaviors and attitudes. We compared risk-taking behaviors and attitudes in five risk domains (ethical, financial, health/safety, recreational, social) among 75 incarcerated offenders (i.e., offenders who are currently in prison) and 45 ex-offenders (i.e., offenders who have just been released from prison). Ex-offenders reported higher likelihood of engaging in risky behavior, driven largely by a willingness to take more risks in the recreational and ethical domains. Benefits attributed to risk taking as well as risk perception did not differ between incarcerated and ex-offenders, indicating that the opportunity to take risks might underlie behavioral risk intentions. Our results also indicate that risk-taking activities are better predicted by the expected benefits rather than by risk perception, aside from the health/safety domain. These results highlight the importance of studying the person and the environment and examining risk taking in a number of content domains.

Diversity in the study of aging and lifespan development.

In psychology, authors have shined a light on a lack of ethnic/racial and cultural diversity in sampling and scholarship. These issues pertain also to the study of aging and lifespan development. This article presents examples of how diverse sampling, across ethnic/racial groups and cultures, enriches theories of aging and adult development. There remain, however, numerous theoretical insights that are yet to be uncovered by future research that seeks to further diversify this sub-discipline. Good practices and avenues to diversification are considered, including targeted sampling of minority groups in the community, online sampling with use of data screening tools, lifespan-orientated surveys initiated in non-Western countries, and a redress of the balance in the perceived value of research from different regions of the world.

Who should decide how limited healthcare resources are prioritized? Autonomous technology as a compelling alternative to humans.

Who should decide how limited resources are prioritized? We ask this question in a healthcare context where patients must be prioritized according to their need and where advances in autonomous artificial intelligence-based technology offer a compelling alternative to decisions by humans. Qualitative (Study 1a; N = 50) and quantitative (Study 1b; N = 800) analysis identified agency, emotional experience, bias-free, and error-free as four main qualities describing people's perceptions of autonomous computer programs (ACPs) and human staff members (HSMs). Yet, the qualities were not perceived to be possessed equally by HSMs and ACPs. HSMs were endorsed with human qualities of agency and emotional experience, whereas ACPs were perceived as more capable than HSMs of bias- and error-free decision-making. Consequently, better than average (Study 2; N = 371), or relatively better (Studies 3, N = 181; & 4, N = 378), ACP performance, especially on qualities characteristic of ACPs, was sufficient to reverse preferences to favor ACPs over HSMs as the decision makers for how limited healthcare resources should be prioritized. Our findings serve a practical purpose regarding potential barriers to public acceptance of technology, and have theoretical value for our understanding of perceptions of autonomous technologies.

Physician recommendation for invasive prenatal testing: the case of the 'precious baby'.

STUDY QUESTION: Do clinicians manage pregnancies conceived by assisted reproductive technologies (ART) differently from spontaneous pregnancies? SUMMARY ANSWER: Clinicians' decisions about prenatal testing during pregnancy depend, at least partially, on the method of conception. WHAT IS KNOWN ALREADY: Research thus far has shown that patients' decisions regarding prenatal screening are different in ART pregnancies compared with spontaneous ones, such that ART pregnancies may be considered more valuable or 'precious' than pregnancies conceived without treatment. STUDY DESIGN, SIZE AND DURATION: In this cross-sectional study, preformed during the year 2011, 163 obstetricians and gynecologists in Israel completed an anonymous online questionnaire. PARTICIPANTS, SETTING, METHODS: Clinicians were randomly assigned to read one of two versions of a vignette describing the case of a pregnant woman. The two versions differed only with regard to the method of conception (ART; n = 78 versus spontaneous; n = 85). Clinicians were asked to provide their recommendations regarding amniocentesis. MAIN RESULTS AND THE ROLE OF CHANCE: The response rate among all clinicians invited to complete the questionnaire was 16.7%. Of the 85 clinicians presented with the spontaneous pregnancy scenario, 37 (43.5%) recommended amniocentesis. In contrast, of the 78 clinicians presented with the ART pregnancy scenario, only 15 (19.2%) recommended the test. Clinicians were 3.2 (95% confidence interval [CI]: 1.6-6.6) times more likely to recommend amniocentesis for a spontaneous pregnancy than for an ART pregnancy. LIMITATIONS AND REASONS FOR CAUTION: The study is limited by a low response rate, the relatively small sample and the hypothetical nature of the decision, as clinician recommendations may have differed in an actual clinical setting. WIDER IMPLICATIONS OF THE FINDINGS: Our findings show that fertility history and use of ART may affect clinicians' recommendations regarding amniocentesis following receipt of screening test results. This raises the question of how subjective factors influence clinicians' decisions regarding other aspects of pregnancy management. STUDY FUNDING AND COMPETING INTEREST: There was no funding source to this study. The authors declare no conflicts of interest.

Risks of high-powered motorcycles among younger adults.

OBJECTIVES: We assessed whether policies designed to safeguard young motorcyclists would be effective given shifts in ownership toward high-powered motorcycles. METHODS: We investigated population-wide motor vehicle driver and motorcyclist casualties (excluding passengers) recorded in Britain between 2002 and 2009. To adjust for exposure and measure individual risk, we used the estimated number of trips of motorcyclists and drivers, which had been collected as part of a national travel survey. RESULTS: Motorcyclists were 76 times more likely to be killed than were drivers for every trip. Older motorcyclist age-strongly linked to experience, skill set, and riding behavior-did not abate the risks of high-powered motorcycles. Older motorcyclists made more trips on high-powered motorcycles. CONCLUSIONS: Tighter engine size restrictions would help reduce the use of high-powered motorcycles. Policymakers should introduce health warnings on the risks of high-powered motorcycles and the benefits of safety equipment.

Subjective numeracy scale as a tool for assessing statistical numeracy in older adult populations.

BACKGROUND: Statistical numeracy, necessary for making informed medical decisions, is reduced among older adults who make more decisions about their medical care and treatment than at any other stage of life. Objective numeracy scales are a source of anxiety among patients, heightened among older adults. OBJECTIVE: We investigate the subjective numeracy scale as an alternative tool for measuring statistical numeracy with older adult samples. METHODS: Numeracy was assessed using objective measures for 526 adults ranging in age from 18 to 93 years, and all participants provided subjective numeracy ratings. RESULTS: Subjective numeracy correlated highly with objective measurements among oldest adults (70+ years; r = 0.51, 95% CI 0.32, 0.66), and for younger age groups. Subjective numeracy explained 33.2% of age differences in objective numeracy. CONCLUSION: The subjective numeracy scale provides an effective tool for assessing statistical numeracy for broad age ranges and circumvents problems associated with objective numeracy measures.

When opportunity matters: comparing the risk-taking attitudes of prisoners and recently released ex-prisoners.

Risk-taking tendencies and environmental opportunities to commit crime are two key features in understanding criminal behavior. Upon release from prison, ex-prisoners have a much greater opportunity to engage in risky activity and to commit criminal acts. We hypothesized that ex-prisoners would exhibit greater risk-taking tendencies compared to prisoners who have fewer opportunities to engage in risky activity and who are monitored constantly by prison authorities. Using cumulative prospect theory to compare the risky choices of prisoners and ex-prisoners our study revealed that ex-prisoners who were within 16 weeks of their prison release made riskier choices than prisoners. Our data indicate that previous studies comparing prisoners behind bars with nonoffenders may have underestimated the risk-taking tendencies of offenders. The present findings emphasize the central role played by risk-taking attitudes in criminal offending and highlight a need to examine offenders after release from prison.

The psychological drivers of self-reported risk preference.

Why are some people more willing than others to take risks? While behavioral tasks (e.g., monetary lotteries) are often regarded as a gold standard for capturing a person's risk preference, recent studies have found stated preferences (e.g., responses to hypothetical scenarios) to exhibit higher reliability, convergent validity, and test-retest stability. Yet, little is known about the psychological drivers of stated preferences. Central to the stated preference approach, the psychological risk-return model conceptualizes a person's propensity to engage in an activity or behavior as a tradeoff between their risk perceptions and expected benefits. To cast a light on the psychological drivers of risk preference within the psychological risk-return framework, in a series of studies participants reported how they evaluated the risks and benefits of activities and their propensity to engage. Individual differences in analytic and intuitive thinking dispositions were also measured. Some participants referred explicitly to risks and rewards of activities when deriving their risk propensity, which was associated with sensitivity to their risk perception and expected benefit ratings. Associations with thinking dispositions indicated that participants who considered risks and rewards were more disposed to analytic thinking. Participants' reports also revealed a broad repertoire of psychological drivers (e.g., intuition, imagination, and feeling) of their evaluations of activities. These were stable over time, associated with thinking dispositions, and influenced their risk preference. The findings provide support for the psychological risk-return model of risk preference. A multifaceted model of preference is urged by the findings to acknowledge the multiple co-occurring psychological drivers of risk preference. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Who tugs at our heart strings? The effect of avatar images on player generosity in the dictator game.

The present research was motivated by a prior study, where several wallets, each containing a photo of either a baby, a puppy, a family, or an elderly couple, were scattered across a city in the United Kingdom. Most of the wallets containing a photo of a baby were returned compared with less than one-third of the wallets containing a photo of an elderly couple. To investigate further, in a series of three studies we examined, using a pseudo online version of the dictator game, possible subtle cues supporting prosocial behaviour by manipulating the type of avatar used by the recipient of the donation made by the "dictator." Overall, it emerged that participants showed significantly higher levels of generosity towards babies and older people, supporting the notion that perceptions of vulnerability and need drive prosocial behaviour.

Implementation of personalised medicine policies in mental healthcare: results from a stated preference study in the UK.

BACKGROUND: Public support for the implementation of personalised medicine policies (PMPs) within routine care is important owing to the high financial costs involved and the potential for redirection of resources from other services. AIMS: We aimed to determine the attributes of a PMP most likely to elicit public support for implementation. We also aimed to determine whether such support differed between a depression PMP and one for cystic fibrosis. METHOD: In a discrete-choice experiment, paired vignettes illustrating both the current model of care (CMoC) and a hypothetical PMP for either depression or cystic fibrosis were presented to a representative sample of the UK public (n = 2804). Each vignette integrated varying attributes, including anticipated therapeutic benefit over CMoC, and the annual cost to the taxpayer. Respondents were invited to express their preference for either the PMP or CMoC within each pair. RESULTS: The financial cost was the most important attribute influencing public support for PMPs. Respondents favoured PMP implementation where it benefited a higher proportion of patients or was anticipated to be more effective than CMoC. A reduction in services for non-eligible patients reduced the likelihood of support for PMPs. Respondents were more willing to fund PMPs for cystic fibrosis than for depression. CONCLUSIONS: Cost is a significant factor in the public's support for PMPs, but essential caveats, such as protection for services available to PMP-ineligible patients, may also apply. Further research should explore the factors contributing to condition-specific nuances in public support for PMPs.