Jennifer M. Taber

The role of current affect, anticipated affect and spontaneous self-affirmation in decisions to receive self-threatening genetic risk information

One reason for not seeking personally threatening information may be negative current and anticipated affective responses. We examined whether current (e.g., worry) and anticipated negative affect predicted intentions to seek sequencing results in the context of an actual genomic sequencing trial (ClinSeq®; n = 545) and whether spontaneous self-affirmation mitigated any (negative) association between affect and intentions. Anticipated affective response negatively predicted intentions to obtain and share results pertaining to both medically actionable and non-actionable disease, whereas current affect was only a marginal predictor. The negative association between anticipated affect and intentions to obtain results pertaining to non-actionable disease was weaker in individuals who were higher in spontaneous self-affirmation. These results have implications for the understanding of current and anticipated affect, self-affirmation and consequential decision-making and contribute to a growing body of evidence on the role of affect in medical decisions.

Genetic testing for hereditary melanoma and pancreatic cancer: A longitudinal study of psychological outcome

CDKN2A/p16 mutations confer 76% lifetime risk of melanoma and up to 17% lifetime risk of pancreatic cancer. Our objective was to determine the short‐ and long‐term impact of CDKN2A/p16 genetic counseling and test reporting on psychological distress, cancer worry, and perceived costs and benefits of testing.

Parental preferences for CDKN2A/p16 testing of minors

Purpose: Genetic testing of minors is controversial, as ethical considerations depend on multiple aspects of the particular disease and familial context. For melanoma, there is a well-established and avoidable environmental influence and a documented benefit of early detection.Methods: We surveyed 61 CDKN2A/p16 mutation-tested adults from two kindreds about their attitudes toward genetic testing of minors immediately posttesting and 2 years later.Results: Overall, 86.9% expressed support of melanoma genetic testing of minors, with the importance of risk awareness (77.4%) and the likelihood of improved prevention and screening behaviors (69.8%) as the most frequently cited potential benefits. Among mutation carriers, 82.6% wanted genetic testing for their own children. These preferences remained stable over a 2-year period. Most respondents (62.3%) favored complete involvement of their children in genetic counseling and test reporting; 19.7% suggested that children be tested but not informed of the results. Concerns about inducing psychological distress or compromising childrens decision autonomy were infrequently cited. Testing preferences did not vary by respondent age, gender, or melanoma history.Conclusion: Respondents strongly supported melanoma genetic testing of minors, with most citing improved health behavior as a likely outcome. We discuss options for melanoma genetic counseling and testing of minors.

Information avoidance tendencies, threat management resources, and interest in genetic sequencing feedback.

BackgroundInformation avoidance is a defensive strategy that undermines receipt of potentially beneficial but threatening health information and may especially occur when threat management resources are unavailable.PurposeWe examined whether individual differences in information avoidance predicted intentions to receive genetic sequencing results for preventable and unpreventable (i.e., more threatening) disease and, secondarily, whether threat management resources of self-affirmation or optimism mitigated any effects.MethodsParticipants (N = 493) in an NIH study (ClinSeq®) piloting the use of genome sequencing reported intentions to receive (optional) sequencing results and completed individual difference measures of information avoidance, self-affirmation, and optimism.ResultsInformation avoidance tendencies corresponded with lower intentions to learn results, particularly for unpreventable diseases. The association was weaker among individuals higher in self-affirmation or optimism, but only for results regarding preventable diseases.ConclusionsInformation avoidance tendencies may influence decisions to receive threatening health information; threat management resources hold promise for mitigating this association.

Dispositional optimism and perceived risk interact to predict intentions to learn genome sequencing results.

OBJECTIVE Dispositional optimism and risk perceptions are each associated with health-related behaviors and decisions and other outcomes, but little research has examined how these constructs interact, particularly in consequential health contexts. The predictive validity of risk perceptions for health-related information seeking and intentions may be improved by examining dispositional optimism as a moderator, and by testing alternate types of risk perceptions, such as comparative and experiential risk. METHOD Participants (n = 496) had their genomes sequenced as part of a National Institutes of Health pilot cohort study (ClinSeq®). Participants completed a cross-sectional baseline survey of various types of risk perceptions and intentions to learn genome sequencing results for differing disease risks (e.g., medically actionable, nonmedically actionable, carrier status) and to use this information to change their lifestyle/health behaviors. RESULTS Risk perceptions (absolute, comparative, and experiential) were largely unassociated with intentions to learn sequencing results. Dispositional optimism and comparative risk perceptions interacted, however, such that individuals higher in optimism reported greater intentions to learn all 3 types of sequencing results when comparative risk was perceived to be higher than when it was perceived to be lower. This interaction was inconsistent for experiential risk and absent for absolute risk. Independent of perceived risk, participants high in dispositional optimism reported greater interest in learning risks for nonmedically actionable disease and carrier status, and greater intentions to use genome information to change their lifestyle/health behaviors. CONCLUSIONS The relationship between risk perceptions and intentions may depend on how risk perceptions are assessed and on degree of optimism.

Unaffected family members report improvements in daily routine sun-protection 2 years following melanoma genetic testing

Purpose:Reducing ultraviolet radiation exposure may decrease melanoma risk in the hereditary melanoma setting. It is unknown whether genetic counseling and test reporting of CDKN2A/p16 mutation status promote long-term compliance with photoprotection recommendations, especially in unaffected mutation carriers.Methods:This study evaluated changes 2 years following melanoma genetic testing in self-reported practice of sun protection (sunscreen, photoprotective clothing, and ultraviolet radiation avoidance) among 37 members of two CDKN2A/p16 kindreds (10 unaffected carriers, 11 affected carriers, and 16 unaffected noncarriers; response rate = 64.9% of eligible participants).Results:Multivariate profile analysis indicated that all three participant groups reported increased daily routine practice of sun protection 2 years following melanoma genetic testing (P < 0.02), with 96.9% reporting that at least one sun protection behavior was part of their daily routine, up from 78.1% at baseline (P < 0.015). Unaffected carriers (P < 0.024) and unaffected noncarriers (P < 0.027) reported significantly more frequent use of photoprotective clothing. Affected carriers maintained adherence to all sun protection behaviors. Reported sunburns in the past 6 months decreased significantly (P < 0.018).Conclusion:Members of high-risk families reported increased daily routine sun protection and decreased sunburns 2 years following melanoma genetic testing, with no net decline in sun protection following negative test results. Thus, genetic testing and counseling may motivate sustained improvements in prevention behaviors.Genet Med 16 11, 846–853.

Why do People Avoid Medical Care? A Qualitative Study Using National Data

BackgroundMany studies have examined barriers to health care utilization, with the majority conducted in the context of specific populations and diseases. Less research has focused on why people avoid seeking medical care, even when they suspect they should go.ObjectiveThe purpose of the study was to present a comprehensive description and conceptual categorization of reasons people avoid medical care.DesignData were collected as part of the 2008 Health Information National Trends Survey, a cross-sectional national survey.ParticipantsParticipant-generated reasons for avoiding medical care were provided by 1,369 participants (40% male; Mage=48.9; 75.1% non-Hispanic white, 7.4% non-Hispanic black, 8.5% Hispanic or Latino/a).Main MeasuresParticipants first indicated their level of agreement with three specific reasons for avoiding medical care; these data are reported elsewhere. We report responses to a follow-up question in which participants identified other reasons they avoid seeking medical care. Reasons were coded using a general inductive approach.Key ResultsThree main categories of reasons for avoiding medical care were identified. First, over one-third of participants (33.3% of 1,369) reported unfavorable evaluations of seeking medical care, such as factors related to physicians, health care organizations, and affective concerns. Second, a subset of participants reported low perceived need to seek medical care (12.2%), often because they expected their illness or symptoms to improve over time (4.0%). Third, many participants reported traditional barriers to medical care (58.4%), such as high cost (24.1%), no health insurance (8.3%), and time constraints (15.6%). We developed a conceptual model of medical care avoidance based on these results.ConclusionsReasons for avoiding medical care were nuanced and highly varied. Understanding why people do not make it through the clinic door is critical to extending the reach and effectiveness of patient care, and these data point to new directions for research and strategies to reduce avoidance.

Preferences for blood-based colon cancer screening differ by race/ethnicity.

OBJECTIVES To examine attitudes of a diverse community-based sample toward SEPT9, a simple, cost-effective colorectal cancer (CRC) blood test. METHODS One-hundred participants eligible for CRC screening (Mage =58.3; 44% unscreened; 38% white, 31% Hispanic, 31% black) completed cross-sectional surveys of their screening preferences following group discussions of colonoscopy, sigmoidoscopy, FOBT, and SEPT9. RESULTS Overall, 91% ranked SEPT9 first or second. Controlling for sociodemographic factors, unscreened Whites strongly preferred SEPT9, listing multiple advantages, whereas unscreened Blacks preferred colonoscopy. Only 19% of the sample listed negative aspects. CONCLUSION Blood-based screening for CRC was widely favored. Future research on medical decision-making should examine the basis for racial/ethnic differences in biomarker screening preferences.

Associations of spontaneous self-affirmation with health care experiences and health information seeking in a national survey of US adults

Objective: Self-affirming – such as by reflecting on one’s strengths and values – reduces defensiveness to threatening information, reduces negative effects of stereotype threat and promotes prosociality. These outcomes may promote physical health, highlighting a need to examine the role of self-affirmation in medical and health contexts. Design: Data were collected as part of the nationally representative, cross-sectional, 2013 Health Information National Trends Survey. Items were completed by 2731 respondents. Main Outcome Measures: Respondents answered questions about spontaneous self-affirmation tendencies, perceptions of providers and health care, involvement in medical appointments, health information seeking and engagement in medical research. Results: Spontaneous self-affirmation was associated with more positive perceptions of communication with one’s provider, better perceived quality of care, greater likelihood of asking questions in a medical appointment, greater information seeking for oneself and multiple indices of surrogate information seeking (i.e. seeking information for others). Four of eight significant associations remained significant when controlling for optimism. The associations of self-affirmation with aspects of the patient–provider relationship were not modified by factors likely to be associated with stereotype threat (e.g. race or BMI). Conclusion: Spontaneous self-affirmation was related to positive outcomes in health contexts. Experimental research is needed to further explore the causal nature of these associations.

Effectiveness of internet-based affect induction procedures: A systematic review and meta-analysis.

Procedures used to induce affect in a laboratory are effective and well-validated. Given recent methodological and technological advances in Internet research, it is important to determine whether affect can be effectively induced using Internet methodology. We conducted a meta-analysis and systematic review of prior research that has used Internet-based affect induction procedures, and examined potential moderators of the effectiveness of affect induction procedures. Twenty-six studies were included in final analyses, with 89 independent effect sizes. Affect induction procedures effectively induced general positive affect, general negative affect, fear, disgust, anger, sadness, and guilt, but did not significantly induce happiness. Contamination of other nontarget affect did not appear to be a major concern. Video inductions resulted in greater effect sizes. Overall, results indicate that affect can be effectively induced in Internet studies, suggesting an important venue for the acceleration of affective science. (PsycINFO Database Record