Ellen Peters

The affect heuristic

This paper introduces a theoretical framework that describes the importance of affect in guiding judgments and decisions. As used here, ‘‘affect’’ means the specific quality of ‘‘goodness’’ or ‘‘badness’’ (i) experienced as a feeling state (with or without consciousness) and (ii) demarcating a positive or negative quality of a stimulus. Affective responses occur rapidly and automatically—note how quickly you sense the feelings associated with the stimulus word ‘‘treasure’’ or the word ‘‘hate’’. We argue that reliance on such feelings can be characterized as ‘‘the affect heuristic’’. In this paper we trace the development of the affect heuristic across a variety of research paths followed by ourselves and many others. We also discuss some of the important practical implications resulting from ways that this heuristic impacts our daily lives. 2002 Cambridge University Press. Published by Elsevier B.V.

Numeracy and Decision Making

A series of four studies explored how the ability to comprehend and transform probability numbers relates to performance on judgment and decision tasks. On the surface, the tasks in the four studies appear to be widely different; at a conceptual level, however, they all involve processing numbers and the potential to show an influence of affect. Findings were consistent with highly numerate individuals being more likely to retrieve and use appropriate numerical principles, thus making themselves less susceptible to framing effects, compared with less numerate individuals. In addition, the highly numerate tended to draw different (generally stronger or more precise) affective meaning from numbers and numerical comparisons, and their affective responses were more precise. Although generally helpful, this tendency may sometimes lead to worse decisions. The less numerate were influenced more by competing, irrelevant affective considerations. Analyses showed that the effect of numeracy was not due to general intelligence. Numerical ability appears to matter to judgments and decisions in important ways.

Heuristics and Biases: The Affect Heuristic

Abstract This paper introduces a theoretical framework that describes the importance of affect in guiding judgments and decisions. As used here, “affect” means the specific quality of “goodness” or “badness” (i) experienced as a feeling state (with or without consciousness) and (ii) demarcating a positive or negative quality of a stimulus. Affective responses occur rapidly and automatically—note how quickly you sense the feelings associated with the stimulus word “treasure” or the word “hate”. We argue that reliance on such feelings can be characterized as “the affect heuristic”. In this paper we trace the development of the affect heuristic across a variety of research paths followed by ourselves and many others. We also discuss some of the important practical implications resulting from ways that this heuristic impacts our daily lives.

Less Is More in Presenting Quality Information to Consumers

Much effort has been put into improving measures of health care quality. Although early research suggested that consumers made little use of quality reports, most reports were based on nonstandardized measures and were not user friendly. Information presentation approaches, however, will have a significant influence on what information is attended and used. The present research examines whether information presentation methods differentially influence consumers who differ in numeric skills. Results of three studies support the idea that “less is more” when presenting consumers with comparative performance information to make hospital choices. Results were particularly strong for those lower in numeracy, who had higher comprehension and made better choices when the information-presentation format was designed to ease the cognitive burden and highlight the meaning of important information. These findings have important implications for the sponsors of comparative quality reports designed to inform consumer decision making in health care.

Rational actors or rational fools: implications of the affect heuristic for behavioral economics ☆

Abstract This paper describes two fundamental modes of thinking. The experiential mode, is intuitive, automatic, natural, and based upon images to which positive and negative affective feelings have been attached through learning and experience. The other mode is analytic, deliberative, and reason based. I describe recent empirical research illuminating “the affect heuristic” wherein people rapidly consult their affective feelings, when making judgments and decisions. This heuristic enables us to be rational actors in many situations. It works beautifully when experience enables us to anticipate accurately how we will like or dislike the consequences of our decisions. However, it fails miserably when the consequences turn out to be much different than we anticipated. In the latter circumstances, the rational actor may well become the rational fool.

Adult Age Differences in Dual Information Processes Implications for the Role of Affective and Deliberative Processes in Older Adults' Decision Making

Age differences in affective/experiential and deliberative processes have important theoretical implications for judgment and decision theory and important pragmatic implications for older-adult decision making. Age-related declines in the efficiency of deliberative processes predict poorer-quality decisions as we age. However, age-related adaptive processes, including motivated selectivity in the use of deliberative capacity, an increased focus on emotional goals, and greater experience, predict better or worse decisions for older adults depending on the situation. The aim of the current review is to examine adult age differences in affective and deliberative information processes in order to understand their potential impact on judgments and decisions. We review evidence for the role of these dual processes in judgment and decision making and then review two representative life-span perspectives (based on aging-related changes to cognitive or motivational processes) on the interplay between these processes. We present relevant predictions for older-adult decisions and make note of contradictions and gaps that currently exist in the literature. Finally, we review the sparse evidence about age differences in decision making and how theories and findings regarding dual processes could be applied to decision theory and decision aiding. In particular, we focus on prospect theory (Kahneman & Tversky, 1979) and how prospect theory and theories regarding age differences in information processing can inform one another.

The Springs of Action: Affective and Analytical Information Processing in Choice

Affective processes were predicted to play a critical role in choices among complex stimuli. As hypothesized, self-report measures of individual differences in affective information processing were associated with choices in a task designed by Bechara, Damasio, Damasio, and Anderson (1994) to mimic the gains, losses, and uncertainties of real life decisions. The results were stronger when the processing of losses was considered separately from the processing of gains. Greater negative affectivity was associated with more avoidance of high-loss options; greater positive affectivity was associated with more choices from high-gain options. Both measures of affectivity added unique explanatory power to the prediction of choices among the decks over and above conscious knowledge about the decks. Affect appears to play an important role in guiding decisions and judgments.

Clinical Implications of Numeracy: Theory and Practice

BackgroundLow numeracy is pervasive and constrains informed patient choice, reduces medication compliance, limits access to treatments, impairs risk communication, and affects medical outcomes; therefore, it is incumbent upon providers to minimize its adverse effects.PurposeWe provide an overview of research on health numeracy and discuss its implications in clinical contexts.ConclusionsLow numeracy cannot be reliably inferred on the basis of patients’ education, intelligence, or other observable characteristics. Objective and subjective assessments of numeracy are available in short forms and could be used to tailor health communication. Low scorers on these assessments are subject to cognitive biases, irrelevant cues (e.g., mood), and sharper temporal discounting. Because prevention of the leading causes of death (e.g., cancer and cardiovascular disease) depends on taking action now to prevent serious consequences later, those low in numeracy are likely to require more explanation of risk to engage in prevention behaviors. Visual displays can be used to make numerical relations more transparent, and different types of displays have different effects (e.g., greater risk avoidance). Ironically, superior quantitative processing seems to be achieved by focusing on qualitative gist and affective meaning, which has important implications for empowering patients to take advantage of the evidence in evidence-based medicine.

Beyond Information: Exploring Patients' Preferences

quired not only to produce the same level of health as the current ones but also to be substantially less expensive. Showingtheprivatesectorthatcomparativeeffectivenessfunds will be used in this way could change the entire research and development process in the US health care industry. It could also help the current administration achieve its goal of making health care more affordable for all US citizens. To adopt these 2 criteria for funding comparative effectiveness research, the agencies that release funds must make tough decisions. The agencies will be accused of sponsoring rationing. A strong case can be made that this does not represent rationing but rather uses research dollars to produce therapies that are better and substantially less expensive. After all, when a computer is purchased today at a small percentage of the cost of computers produced years ago, it is not believed that the private sector has rationed computer chips. Instead, the research and development model in the computer industry has been to make better machines and to make them at increasingly lower costs, thereby making computers affordable to many more individuals. It is time to use public funding and comparative effectiveness research toaccomplish the same thing inmedicine. If this opportunity is missed, another one is unlikely to come along. Thenrationingmayactuallybecometheonlywaybywhichreductions in health care expenditures can be achieved.

Presenting quantitative information about decision outcomes: a risk communication primer for patient decision aid developers

BackgroundMaking evidence-based decisions often requires comparison of two or more options. Research-based evidence may exist which quantifies how likely the outcomes are for each option. Understanding these numeric estimates improves patients’ risk perception and leads to better informed decision making. This paper summarises current “best practices” in communication of evidence-based numeric outcomes for developers of patient decision aids (PtDAs) and other health communication tools.MethodAn expert consensus group of fourteen researchers from North America, Europe, and Australasia identified eleven main issues in risk communication. Two experts for each issue wrote a “state of the art” summary of best evidence, drawing on the PtDA, health, psychological, and broader scientific literature. In addition, commonly used terms were defined and a set of guiding principles and key messages derived from the results.ResultsThe eleven key components of risk communication were: 1) Presenting the chance an event will occur; 2) Presenting changes in numeric outcomes; 3) Outcome estimates for test and screening decisions; 4) Numeric estimates in context and with evaluative labels; 5) Conveying uncertainty; 6) Visual formats; 7) Tailoring estimates; 8) Formats for understanding outcomes over time; 9) Narrative methods for conveying the chance of an event; 10) Important skills for understanding numerical estimates; and 11) Interactive web-based formats. Guiding principles from the evidence summaries advise that risk communication formats should reflect the task required of the user, should always define a relevant reference class (i.e., denominator) over time, should aim to use a consistent format throughout documents, should avoid “1 in x” formats and variable denominators, consider the magnitude of numbers used and the possibility of format bias, and should take into account the numeracy and graph literacy of the audience.ConclusionA substantial and rapidly expanding evidence base exists for risk communication. Developers of tools to facilitate evidence-based decision making should apply these principles to improve the quality of risk communication in practice.