Supporting effective shared decision-making in surgical context: Why framing of choices matters for high-risk patients and clinicians.

AIM: In the context of high-risk surgery, shared decision-making (SDM) is important. However, the effectiveness of SDM can be hindered by misalignment between patients and clinicians in their expectations of postoperative outcomes. This study investigated the extent and the effects of this misalignment, as well as its amenability to interventions that encourage perspective-taking. METHOD: Lay participants with a Charlson Comorbidity Index of ≥4 (representing patients) and surgeons and anaesthetists (representing doctors) were recruited. During an online experiment, subjects in both groups forecast their expectations regarding short-term (0, 1 and 3 months after treatment) and long-term (6, 9 and 12 months after treatment) outcomes of different treatment options for one of three hypothetical clinical scenarios - ischaemic heart disease, colorectal cancer or osteoarthritis of the hip - and then chose between surgical or non-surgical treatment. Subjects in both groups were asked to consider the scenarios from their own perspective (Estimation task), and then to adopt the perspective of subjects in the other study group (Perspective task). The decisions of all participants (surgery vs. non-surgical alternative) were analysed using binomial generalized linear mixed models. RESULTS: In total, 55 lay participants and 54 doctors completed the online experiment. Systematic misalignment in expectations between high-risk patients and doctors was observed, with patients expecting better surgical outcomes than clinicians. Patients forecast a significantly higher likelihood of engaging in normal activities in the long term (ß = -1.09, standard error [SE] = 0.20, t = -5.38, p < 0.001), a lower likelihood of experiencing complications in the long term (ß = 0.92, SE = 0.21, t = 4.45, p < 0.001) and a lower likelihood of experiencing depression in both the short term and the long term (ß = 1.01, SE = 0.19, t = 5.38, p < 0.001), than did doctors. Compared with doctors, patients forecast higher estimates of experiencing complications in the short term when a non-surgical alternative was selected (ß = -0.91, SE = 0.26, t = -3.50, p = 0.003). Despite this misalignment, in both groups surgical treatment was strongly preferred (estimation task: 88.7% of doctors and 80% of patients; perspective task: 82.2% of doctors and 90.1% of patients). CONCLUSION: When high-risk surgery is discussed, a non-surgical option may be viewed as 'doing nothing', hence reducing the sense of agency and control. This biases the decision-making process, regardless of the expectations that doctors and patients might have about the outcomes of surgery. Therefore, to improve SDM and to increase the agency and control of patients regarding decisions about their care, we advocate framing the non-surgical treatment options in a way that emphasizes action, agency and change.

Using the study of reasoning to address the age of unreason.

If we accept that societally, politically, and even culturally enlightenment face some serious challenges, can we use this rethinking of theories of reasoning to address them? The aim here is to make a case for building on the work presented by De Neys as an opportunity to advance an applied reasoning research programme.

Misdiagnosing the problem of why behavioural change interventions fail.

Routes to achieving any sort of meaningful success in the enterprise of behavioural change requires an understanding of the rate of failure, and why failures occur. This commentary shows that there is more to diagnosis of failures than fixating on micro- rather than the macro-level behaviours.

Impact of disease characteristics and knowledge on public risk perception of zoonoses.

Zoonoses represent a global public health threat. Understanding lay perceptions of risk associated with these diseases can better inform proportionate policy interventions that mitigate their current and future impacts. While individual zoonoses (e.g. bovine spongiform encephalopathy) have received scientific and public attention, we know little about how multiple zoonotic diseases vary relative to each other in lay risk perceptions. To this end, we examined public perceptions of 11 zoonoses across 12 qualitative attributes of risk among the UK public (n = 727, volunteer sample), using an online survey. We found that attribute ratings were predominantly explained via two basic dimensions of risk related to public knowledge and dread. We also show that, despite participants reporting low familiarity with most of the diseases presented, zoonoses were perceived as essentially avoidable. These findings imply that infection is viewed as dependent upon actions under personal control which has significant implications for policy development.

Identifying criminals: No biasing effect of criminal context on recalled threat.

To date, it is still unclear whether there is a systematic pattern in the errors made in eyewitness recall and whether certain features of a person are more likely to lead to false identification. Moreover, we also do not know the extent of systematic errors impacting identification of a person from their body rather than solely their face. To address this, based on the contextual model of eyewitness identification (CMEI; Osborne & Davies, 2014, Applied Cognitive Psychology, 28[3], 392-402), we hypothesized that having framed a target as a perpetrator of a violent crime, participants would recall that target person as appearing more like a stereotypical criminal (i.e., more threatening). In three separate experiments, participants were first presented with either no frame, a neutral frame, or a criminal frame (perpetrators of a violent crime) accompanying a target (either a face or body). Participants were then asked to identify the original target from a selection of people that varied in facial threat or body musculature. Contrary to our hypotheses, we found no evidence of bias. However, identification accuracy was highest for the most threatening target bodies high in musculature, as well as bodies paired with detailed neutral contextual information. Overall, these findings suggest that while no systematic bias exists in the recall of criminal bodies, the nature of the body itself and the context in which it is presented can significantly impact identification accuracy.

Talking to multi-morbid patients about critical illness: an evolving conversation.

Conversations around critical illness outcomes and benefits from intensive care unit (ICU) treatment have begun to shift away from binary discussions on living versus dying. Increasingly, the reality of survival with functional impairment versus survival with a late death is being recognised as relevant to patients. Most ICU admissions are associated with new functional and cognitive disabilities that are significant and long lasting. When discussing outcomes, clinicians rightly focus on patients' wishes and the quality of life (QoL) that they would find acceptable. However, patients' views may encompass differing views on acceptable QoL post-critical illness, not necessarily reflected in standard conversations. Maintaining independence is a greater priority to patients than simple survival. QoL post-critical illness determines judgments on the benefits of ICU support but translating this into clinical practice risks potential conflation of health outcomes and QoL. This article discusses the concept of response shift and the implication for trade-offs between number/length of invasive treatments and change in physical function or death. Conversations need to delineate how health outcomes (e.g. tracheostomy, muscle wasting, etc.) may affect individual outcomes most relevant to the patient and hence impact overall QoL. The research strategy taken to explore decision-making for critically ill patients might benefit from gathering qualitative data, as a complement to quantitative data. Patients, families and doctors are motivated by far wider considerations, and a consultation process should relate to more than the simple likelihood of mortality in a shared decision-making context.

Why people follow a gluten-free diet? An application of health behaviour models.

PURPOSE: To understand factors affecting adherence to GFD by celiac and non-celiac people through the application of behavioural theories, Integrative Model (IM) and Multi Theory Model (MTM). METHODS: Analyses were conducted for a sample of 308 subjects, majority females, celiac and non-celiac. Adherence to GFD was measured considering two scales, self-declared adherence and scored adherence, in order to discern possible inconsistencies between what subjects believe and what they really do. Subsequently, adherence to GFD was modelled by considering constructs of MTM and IM. Moreover, the constructs were designed based on literature review. Ordered logit (OL) model was used to test the IM and MTM theoretical models. RESULTS: The findings show that adherence to GFD is affected mainly by attitudes towards GFD, self-efficacy, injunctive norms, knowledge about GFD and health conditions. Between the two models, IM and MTM, results show that all constructs of IM explain the behaviour. Contrary, for MTM, results indicate only some constructs of the MTM explain adherence to GFD. CONCLUSIONS: Results of this study should be considered for improving the adherence to GFD for celiac people. Furthermore, it is important to consider the non-celiac people's perceptions for GFD and GF products. In other words an accurate information about the diet and products it is relevant for supporting people to make healthier food choices. Finally, as the results show, IM explain adherence to GFD better than MTM.

On the uses and abuses of narcissism as a public health issue.

Psychiatry understands narcissism as a pathological condition associated with poor social outcomes and difficulty relating to others. Millennials have been depicted by psychological research as 'narcissistic', and the term has lost accurate meaning. We underline the intellectual laxity of conflating social changes with narcissism and suggest ways forward.

Coincidence judgment in causal reasoning: How coincidental is this?

Given the important conceptual connections between cause and coincidence as well as the extensive prior research on causality asking, "how causal is this?", the present research proposes and evaluated a psychological construction of coincidentality as the answer to the question, "how coincidental is this?" Four experiments measured the judgment properties of a reasonably large set of real coincidences from an initial diary study. These judgements included coincidentality and an array of other judgments about event uncertainty, hypothesis belief and surprise as predictors of coincidentality consistent with and supporting our prior definition of coincidence (Johansen & Osman, 2015): "coincidences are surprising pattern repetitions that are observed to be unlikely by chance but are nonetheless ascribed to chance since the search for causal mechanisms has not produced anything more plausible than mere chance." In particular, we evaluated formal models based on judgements of uncertainty, belief and surprise as predictors to develop a model of coincidentality. Ultimately, we argue that coincidentality is a marker for causal suspicion/discovery in terms of a flag that a new, unknown causal mechanism may be operating.

Overstepping the boundaries of free choice: Folk beliefs on free will and determinism in real world contexts.

We know little about the commonality of folk beliefs around applications of psychological research on the unconscious control of behaviours. To address this, in Experiment 1 (N = 399) participants volunteered examples of where research on the unconscious has been applied to influence their behaviours. A subset of these were presented in Experiment 2 (N = 198) and Experiment 3 (N = 100). Participants rated the extent to which the behaviour being influenced in these contexts was: (1) via the unconscious, (2) free, (3) the result of prior conscious intentions, (4) under conscious control. Relative to judgements about the extent to which behaviour was influenced via the unconscious, the remaining judgements regarding conscious control of behaviours were either higher (e.g., political contexts) or lower (e.g., therapy). This study is the first to show, using ecologically valid examples, the folk beliefs people share on psychological constructs concerning free will and determinism.

Traffic light labelling of meals to promote sustainable consumption and healthy eating.

The focus of the present study is to examine the impact of behavioral interventions designed to encourage consumer change around food choices in line with more sustainable consumption as well as healthy eating. More specifically, as a potential method of persuasion, we test the effect of the provision of information using traffic light labelling attached to different meal options signalling their impact on the environment (e.g. carbon emission levels) as well as on their health (e.g., calorific content). While traffic light labelling has shown some success in encouraging both healthy and sustainable food consumption, there is still limited work demonstrating the impact on choice behavior. The present study includes two experiments (Experiment 1, N = 120 [approximately 40 per condition], Experiment 2, N = 297 [approximately 95 per condition]). They examined the impact of the presentation of single (traffic light labelling of calorific content, traffic light labelling of carbon emission levels) and dual (both calorific content and carbon emission levels) traffic light labels in a hypothetical simulated canteen environment. For some participants, the traffic light labels were supplemented with additional information which either contained general information regarding calorific content and carbon emissions, or specific reference values regarding the relationship between particular calorific or carbon emission levels to other activities (i.e. walking, driving). The Results from both experiments show that, compared to baseline, the presence of traffic light labels led to positive shifts towards lower carbon emission and lower calorific content meals. Both general and specific information supported positive behavioral change towards healthier and sustainable meal choices. The findings are discussed in relation to existing work examining the impact of behavioral interventions designed to support positive change in consumer behavior.

Arts-based interventions in healthcare education.

Healthcare education institutions are increasingly including arts-based interventions in their programmes. We analysed 62 studies of arts-based interventions to understand how these interventions may be beneficial, and why providing evidence continues to be a challenge for the field.Our analysis highlighted two issues. We found that 79% of the included studies reported that their interventions were successful, but without always defining this success or how it was measured. This lack of clarity was apparent in descriptions of both what arts-based interventions aimed to do, and in descriptions of how they might do this. We also found that only 34% of studies involved a collaboration with artists or arts educators, raising questions over who had the necessary experience and specialism in the arts to design and deliver such interventions.Our analysis revealed that arts-based interventions are failing to acknowledge, and subsequently capture through assessment, the process of learning in the moment. This is particularly important because arts-based pedagogies typically use embodied, practical, physical methods, in which what is being learnt cannot be separated from the process of learning. Involving artists and arts educators throughout the process of designing and delivering these interventions may help to bring clarity over what arts-based interventions are aiming to do and how they may do this, and ensure that appropriate evaluation methods are used. We suggest that close observation with feedback, and the use of reflective portfolios are two ways of assessing the process of learning in arts-based interventions.

The Bitter Truth About Sugar and Willpower: The Limited Evidential Value of the Glucose Model of Ego Depletion.

The idea behind ego depletion is that willpower draws on a limited mental resource, so that engaging in an act of self-control impairs self-control in subsequent tasks. To present ego depletion as more than a convenient metaphor, some researchers have proposed that glucose is the limited resource that becomes depleted with self-control. However, there have been theoretical challenges to the proposed glucose mechanism, and the experiments that have tested it have found mixed results. We used a new meta-analytic tool, p-curve analysis, to examine the reliability of the evidence from these experiments. We found that the effect sizes reported in this literature are possibly influenced by publication or reporting bias and that, even within studies yielding significant results, the evidential value of this research is weak. In light of these results, and pending further evidence, researchers and policymakers should refrain from drawing any conclusions about the role of glucose in self-control.

An integrative framework for mapping the psychological landscape of risk perception.

We vary greatly in our perception of risk, not just because of differences between risks themselves, but also because of individual, contextual and cultural differences too. To better understand and predict responses to risk, we need to (a) integrate these components, combining approaches from different psychological disciplines and (b) also consider risk tolerance - how individuals trade-off between risks and benefits. We therefore developed an ICONS (individual, contextual, cognitive, social) framework; using it across two empirical studies (n = 4228) to examine how individuals perceive and respond to the quotidian risks associated with consumer products. Three dimensions underlined risk perceptions: benefits, dread and individual responsibility. Risk tolerance was typically predicted by interactions between individual (demographic, cultural worldview, personality) and contextual (product type/category, harm information) factors. In turn, perceived dread, benefits and individual differences shaped how likely participants were to communicate risk information. Our results demonstrate for the first time how the interaction between individual, cognitive (risk tolerance, intensity), contextual, and social (risk communication) factors is key to understanding and predicting risk perceptions. Together, our findings help explain why societal responses to risks are often difficult to predict and have implications for the spread, and amplification, of risk information.

(Why) Is Misinformation a Problem?

In the last decade there has been a proliferation of research on misinformation. One important aspect of this work that receives less attention than it should is exactly why misinformation is a problem. To adequately address this question, we must first look to its speculated causes and effects. We examined different disciplines (computer science, economics, history, information science, journalism, law, media, politics, philosophy, psychology, sociology) that investigate misinformation. The consensus view points to advancements in information technology (e.g., the Internet, social media) as a main cause of the proliferation and increasing impact of misinformation, with a variety of illustrations of the effects. We critically analyzed both issues. As to the effects, misbehaviors are not yet reliably demonstrated empirically to be the outcome of misinformation; correlation as causation may have a hand in that perception. As to the cause, advancements in information technologies enable, as well as reveal, multitudes of interactions that represent significant deviations from ground truths through people's new way of knowing (intersubjectivity). This, we argue, is illusionary when understood in light of historical epistemology. Both doubts we raise are used to consider the cost to established norms of liberal democracy that come from efforts to target the problem of misinformation.

Self-reported Side-effects of Ultraviolet-C Disinfection Devices.

The COVID-19 pandemic increased sales of portable UV-C devices as a means of inactivating the SARS-CoV-2 virus. Research suggests that excessive UV-C exposure to the eyes and skin can lead to side-effects, primarily photokeratitis and erythema, but these findings are limited to case studies. This study explores self-reported side-effects of UV-C devices by collating five waves of UK consumer survey data from April 2020-December 2021 (N = 26 864). 30%-46% of owners report a side-effect after using a device claiming to emit UV-C. However, detailed analysis of Wave 4 data (N = 309) highlights inconsistencies between reported and plausible side-effect(s) associated with skin or eye exposure from UV-C devices. Alternative explanations are considered, namely that the reported side-effect(s) were psychosomatic or misattributed to direct exposure of UV-C radiation. Data regarding awareness of warnings about device side-effect(s) supports the misattribution explanation. For risk assessment purposes, limited reliable information about specific irritation or injury to the eye and skin was found from self-reporting surveys. To optimize future data collection, we recommend addressing recall errors by: reducing the period under investigation, supplementing responses with empirical measures, and incentivizing respondents to provide accurate information about the make and model of the UV-C device.

Finding patterns in policy questions.

To help advance exchanges between science and policy, a useful first step is to examine the questions which policymakers pose to scientists. The style of a question indicates what the asker is motivated to know, and how they might use that knowledge. Therefore, the aggregate pattern of typical policy inquires can help scientists anticipate what types of information policy audiences desire. A dataset (n = 2972) of questions from policymakers collected over 10 years (2011-2021)-by the Centre for Science and Policy at the University of Cambridge-was classified into one of seven classes. In the main, the most popular questions posed by policymakers-within the public and private sectors-were those whose answers inform how to achieve specific outcomes-whether directly, or by providing a causal analysis which is instrumental to this process. Moreover, this seems to be a general aspect of policymakers' inquiries, given that it is preserved regardless of the policy issue considered (e.g., Artificial Intelligence, Economy, or Health). Thus, maximizing the usefulness of the information that policymakers receive when engaging with scientists requires informing how to achieve specific outcomes-directly, or by providing a useful causal analysis.

Actions Do Not Always Speak Louder Than Words.

Financial (dis)incentives (e.g., bonuses, taxes) and social incentives (e.g., public praise) have typically been proposed as methods to encourage greater cooperation for the benefit of all. However, when cooperation requires exertion of effort, such interventions might not always be effective. While incentives tend to be highly motivating when choosing to exert effort, evidence suggests that they have less of an effect on behavior during effort execution. The aim of this exploratory study was to incorporate these insights into empirical investigation of the effects of social incentives on cooperative effort. To this end, we modified a public goods game task to require effort contributions to a common good. Crucial manipulation involved incorporating social incentives into this task and linking them to (a) choices that people made or (b) effortful actions they exerted. Our findings suggest, in line with recent effort-based decision-making models, that social incentives have a stronger effect on cooperative effort when they are linked to choices that people make, rather than the actual effort they exert. This study demonstrates potential benefits of eliciting a priori declarations of cooperative effort tied to social incentives to encourage greater effort for the benefit of all.

Perceiving threat in others: The role of body morphology.

People make judgments of others based on appearance, and these inferences can affect social interactions. Although the importance of facial appearance in these judgments is well established, the impact of the body morphology remains unclear. Specifically, it is unknown whether experimentally varied body morphology has an impact on perception of threat in others. In two preregistered experiments (N = 250), participants made judgments of perceived threat of body stimuli of varying morphology, both in the absence (Experiment 1) and presence (Experiment 2) of facial information. Bodies were perceived as more threatening as they increased in mass with added musculature and portliness, and less threatening as they increased in emaciation. The impact of musculature endured even in the presence of faces, although faces contributed more to the overall threat judgment. The relative contributions of the faces and bodies seemed to be driven by discordance, such that threatening faces exerted the most influence when paired with non-threatening bodies, and vice versa. This suggests that the faces and bodies were not perceived as entirely independent and separate components. Overall, these findings suggest that body morphology plays an important role in perceived threat and may bias real-world judgments.

Unconscious task application.

The nature of unconscious information processing is a heavily debated issue in cognitive science (e.g., Kouider & Dehaene, 2007), and neuroscience (e.g., Crick & Koch, 1998). Traditionally, it has been thought that unconscious cognitive processing is restricted to knowledge that is strongly prepared by conscious processes (e.g., Dehaene et al., 1998). In three experiments, we show that the task that is performed consciously can also be applied unconsciously to items outside the current task set. We found that a same-different judgment of two target stimuli was also performed on two subliminally presented prime stimuli. This was true for target and prime stimuli from entirely different categories, as well as for prime and target stimuli at different levels of abstraction. These results reveal that unconscious processing can generalize more widely than previously accepted.