Dafina Petrova

Understanding the harms and benefits of cancer screening: A model of factors that shape informed decision making

Objective. Decisions about cancer screenings often involve the consideration of complex and counterintuitive evidence. We investigated psychological factors that promote the comprehension of benefits and harms associated with common cancer screenings and their influence on shared decision making. Methods. In experiment 1, 256 men received information about PSA-based prostate cancer screening. In experiment 2, 355 women received information about mammography-based breast cancer screening. In both studies, information about potential screening outcomes was provided in 1 of 3 formats: text, a fact box, or a visual aid (e.g., mortality with and without screening and rate of overdiagnosis). We modeled the interplay of comprehension, perceived risks and benefits, intention to participate in screening, and desire for shared decision making. Results. Generally, visual aids were the most effective format, increasing comprehension by up to 18%. Improved comprehension was associated with 1) superior decision making (e.g., fewer intentions to participate in screening when it offered no benefit) and 2) more desire to share in decision making. However, comprehension of the evidence had a limited effect on experienced emotions, risk perceptions, and decision making among those participants who felt that the consequences of cancer were extremely severe. Conclusions. Even when information is counterintuitive and requires the integration of complex harms and benefits, user-friendly risk communications can facilitate comprehension, improve high-stakes decisions, and promote shared decision making. However, previous beliefs about the effectiveness of screening or strong fears about specific cancers may interfere with comprehension and informed decision making.

Neural mechanisms underlying urgent and evaluative behaviors: An fMRI study on the interaction of automatic and controlled processes

Dual‐process theories have dominated the study of risk perception and risk‐taking over the last two decades. However, there is a lack of objective brain‐level evidence supporting the two systems of processing in every‐day risky behavior. To address this issue, we propose the dissociation between evaluative and urgent behaviors as evidence of dual processing in risky driving situations. Our findings show a dissociation of evaluative and urgent behavior both at the behavioral and neural level. fMRI data showed an increase of activation in areas implicated in motor programming, emotional processing, and visuomotor integration in urgent behavior compared to evaluative behavior. These results support a more automatic processing of risk in urgent tasks, relying mainly on heuristics and experiential appraisal. The urgent task, which is characterized by strong time pressure and the possibility for negative consequences among others factors, creates a suitable context for the experiential‐affective system to guide the decision‐making process. Moreover, we observed greater frontal activation in the urgent task, suggesting the participation of cognitive control in safe behaviors. The findings of this research are relevant for the study of the neural mechanisms underlying dual process models in risky perception and decision‐making, especially because of their proximity to everyday activities. Hum Brain Mapp 36:2853–2864, 2015.

Lonely hearts don't get checked: On the role of social support in screening for cardiovascular risk.

OBJECTIVE Regular cardiovascular risk screening can prevent cardiovascular disease through timely implementation of lifestyle changes or medication. However, few studies have investigated what factors promote regular screening for risk factors like hypertension and high blood cholesterol. The aim of this study was to investigate the relationship between social support and adherence to cardiovascular risk screening. METHODS We analyzed data from the Spanish National Health Survey-a cross-sectional representative survey conducted by the Spanish Ministry of Health in 2012 (N=21,007). Participants reported whether they had their blood pressure and cholesterol levels measured by a health professional in the previous 12 months. Social support (i.e., the perception that emotional and practical support was available when needed) was measured with a validated scale. Multiple logistic regressions were conducted adjusted for demographic and health-related factors. RESULTS Compared to individuals who reported a lack of social support, individuals who perceived sufficient social support were on average twice more likely to report participation in blood pressure screening, OR=2.06, 95% CI [1.60, 2.66] and cholesterol screening, OR=2.85, 95% CI [1.99, 4.09]. These effects were uniform across different demographics and were replicated in a previous wave of the survey. Factors associated with worse screening adherence were low social class, being single or widowed, smoking, alcohol consumption, and no history of cardiovascular risk. DISCUSSION Perceptions of social support are positively related to cardiovascular risk screening adherence. Future research should investigate what type of social support most effectively increases screening participation among high risk populations.

To screen or not to screen: What factors influence complex screening decisions?

Contrary to peoples intuitions, many screenings can have both benefits (e.g., lives saved) and harms (e.g., unnecessary treatments). Statistical information is often provided to ensure informed decision making. However, few theoretical models have addressed the role of comprehension of such information in screening decisions. In an experiment, we studied how cognitive skills, emotions, and a priori beliefs about screening affect comprehension of the evidence of benefits and harms from screening and intentions to get screened. Young adults (N = 347) received information about a disease for which a screening test was available and numerical information about the benefits and harms from screening. Results showed that comprehension and perceptions of benefits are central to decisions; however, lay perceptions of harms along the screening cascade require further study. Numeracy, science literacy, and emotions can promote informed decision making by facilitating comprehension of the evidence. At the same time emotions and beliefs resulting from persuasive campaigns can have strong effects on screening intentions beyond the available evidence. To apply to screening procedures where informed decision making is recommended, theoretical models of screening decisions need to include comprehension of benefits and harms, and account for how cognitive skills, emotions, and beliefs influence comprehension and decisions. (PsycINFO Database Record

Language and motor skills in siblings of children with autism spectrum disorder: A meta‐analytic review

Children with autism spectrum disorder (ASD) show significant linguistic and motor impairments compared to children with typical development (TD). Findings from studies of siblings of children with ASD show similarities to conclusions from studies of children with ASD. The current meta‐analysis reviewed studies reporting linguistic and/or motor skills in siblings of children with ASD compared to siblings of children with TD. Thirty‐four studies published between 1994 and 2016 met all inclusion criteria. We compared three different age groups (12 months or younger, 13 to 24 months, and 25 to 36 months). At 12 months, compared to siblings of children with TD, siblings of children with ASD had worse receptive language (d = −.43, 95% CI [−.53, −.33]) and expressive language skills (d = −.40, 95% CI [−.57, −.23]), and these effects were sustained at 24 and 36 months. Similar, albeit smaller differences in fine motor skills were detected at 12 months (d = −.22, 95% CI [−.39, −.04]), and these differences were larger at 36 months (d = −.36, 95% CI [−.54, −.17]). There were differences in gross motor skills at 12 months (d = −.22, 95% CI [−.40, −.04]), but only a few studies were available at later ages. Compared to siblings of children with TD, infants who have siblings with ASD have worse linguistic and motor skills. These differences are detectable as early as when infants are 12 months old and seem to be sustained until they are 3 years old. Differences in language skills are larger than those in motor skills, especially during the first year. Autism Res 2017, 10: 1737–1750.

Neuroanatomical variations as a function of experience in a complex daily task: A VBM and DTI study on driving experience

Complex tasks require the learning and integration of multiple cognitive, sensory, and psychomotor skills for correct execution. Driving-related skills are developed step by step through the increase of mileage driven and the accumulation of practice in different traffic situations. The acquisition of these skills should be reflected in the brain structure. However, no previous studies have explored brain structural variations associated with driving experience. The aim of the present study was to investigate whether driving frequency, defined as average annual driving mileage, is related to neuroanatomical variations in gray matter (GM) volume and white matter (WM) integrity using voxel-based morphometry (VBM) and DTI-based fractional anisotropy (FA), respectively. We recruited 83 drivers with variable range of annual driving mileage and controlled for age, sex, handedness, IQ, time since the acquisition of driving license, use of motorcycles/mopeds and bicycles, perceived driving skills, and subjective probability of having an accident. Our results showed variations in white matter FA as a function of mileage driven. Driving experience was related to a significant increase of FA in parts of the right hemisphere superior and inferior longitudinal fasciculus, anterior thalamic radiation, forceps majors, inferior fronto-occipital fasciculus, and corticospinal tract. No significant differences were observed in gray matter volumes. FA variations were found in brain regions that have been associated with cognitive, visual, and motor processes necessary for skilled performance in driving. These results suggest that variations in white matter diffusivity can underlie the development of driving skills and safer driving.

Global Health Policy and Access to Care: Investigating Patient Choice on an International Level Using Social Media.

Background Increased access to transportation and information has led to the emergence of more diverse patient choice and new forms of health care consumption, such as medical travel. In order for health care providers to effectively attract patients, more knowledge is needed on the mechanisms underlying decision-making of potential travelers from different countries. A particularly promising method of studying the travelers’ motives is collecting data on social media. Objectives The aim of this study was to test what factors influence decision-making of potential medical travelers and how these factors interact. Based on existing literature, the factors analyzed included quality, cost, and waiting time for 2 procedures varying in invasiveness across 12 different destination countries. Methods Decision-making patterns were examined using a pilot questionnaire that generated a large amount of data from over 800 participants in 40 countries. Participants indicated their willingness to travel given different scenarios. Each scenario consisted of a combination of several factors. Additionally, participants were asked to indicate the reasons for their choice. Results Individuals display high willingness to travel for medical care when combining all participants and scenarios, travel for care was chosen 66.9% of the time. Among the factors influencing their decisions, quality of the medical procedure abroad was considered most important, and cost was least important as shown by chi-square tests and corresponding odds ratios. Log-linear analyses revealed an interaction between time waiting in the local health care system and type of procedure, whereby time pressure increased the odds of agreeing to travel for the more invasive procedure. The odds of traveling to Europe and the USA were by far the highest, although participants indicated that under certain conditions they might be willing to travel to other medical destinations, such as Asia. Conclusion Our measurements yielded several reliable insights into the factors driving medical decision-making. An essential next step would be to expand these findings with a more encompassing sample and more elaborate statistical modeling.

Еffects of fortified milk on cognitive abilities in school-aged children: results from a randomized-controlled trial

BackgroundMicronutrients such as vitamins and minerals and long-chain polyunsaturated omega-3 fatty acids (PUFAs) are essential for children’s brain development and cognitive functions. The current study investigated whether milk fortified with micronutrients and PUFA can result in improved cognitive function in mainstream school children.MethodsOne-hundred-and-nineteen children (age 8–14, 58 boys) were randomly allocated to a fortified milk group or a regular full milk control group. Participants consumed 0.6L/day of the milk for 5 months. We recorded relevant biochemical, anthropometric, and cognitive measures (working memory and processing speed) at the start of the study and at follow-up after 5 months.ResultsThe fortified milk significantly increased docosahexaenoic acid (DHA) (change from baseline of 28% [95% CI 17–39%] vs. −6% [95% CI − 13 to 0%] in the control group) and serum 25OH-vitamin D concentrations (41% [95% CI 30–52%] vs. 21% [95% CI 11–30%] in the control group). The fortified milk improved working memory on one of two tests (32% [95% CI 17–47%] vs. 13% [95% CI 6–19%] in the control group). The fortified milk also indirectly increased processing speed on one of two tests; this effect was small and completely mediated by increases in 25OH-vitamin D concentrations.ConclusionsThese results suggest that fortifying milk with micronutrients and PUFA could be an effective and practical way to aid children’s cognitive development.

Can we improve risk communication about non‐invasive prenatal testing?

Diagnostic information from prenatal screening for Down syndrome can help families prepare for the birth of a child with special needs or help them decide whether they want to continue with the pregnancy. Currently in the UK women are offered the combined screening test (a blood test and an ultrasound) that categorizes them into “higher risk” or “lower risk” groups (see www.nhs.uk). Women at higher risk are offered a diagnostic test, such as amniocentesis or chorionic villus sampling (CVS). These diagnostic tests are invasive and carry a 0.5 to 1% risk of miscarriage. This article is protected by copyright. All rights reserved

Strengths and Gaps in Physicians’ Risk Communication: A Scenario Study of the Influence of Numeracy on Cancer Screening Communication:

Objective. Many patients have low numeracy, which impedes their understanding of important information about health (e.g., benefits and harms of screening). We investigated whether physicians adapt their risk communication to accommodate the needs of patients with low numeracy, and how physicians’ own numeracy influences their understanding and communication of screening statistics. Methods. UK family physicians (N = 151) read a description of a patient seeking advice on cancer screening. We manipulated the level of numeracy of the patient (low v. high v. unspecified) and measured physicians’ risk communication, recommendation to the patient, understanding of screening statistics, and numeracy. Results. Consistent with best practices, family physicians generally preferred to use visual aids rather than numbers when communicating information to a patient with low (v. high) numeracy. A substantial proportion of physicians (44%) offered high quality (i.e., complete and meaningful) risk communication to the patient. This was more often the case for physicians with higher (v. lower) numeracy who were more likely to mention mortality rates, OR=1.43 [1.10, 1.86], and harms from overdiagnosis, OR=1.44 [1.05, 1.98]. Physicians with higher numeracy were also more likely to understand that increased detection or survival rates do not demonstrate screening effectiveness, OR=1.61 [1.26, 2.06]. Conclusions. Most physicians know how to appropriately tailor risk communication for patients with low numeracy (i.e., with visual aids). However, physicians who themselves have low numeracy are likely to misunderstand the risks and unintentionally mislead patients by communicating incomplete information. High-quality risk communication and shared decision making can depend critically on factors that improve the risk literacy of physicians.