Priscila G. Brust-Renck

Efficacy of a Web-based Intelligent Tutoring System for Communicating Genetic Risk of Breast Cancer: A Fuzzy-Trace Theory Approach

Background. Many healthy women consider genetic testing for breast cancer risk, yet BRCA testing issues are complex. Objective. To determine whether an intelligent tutor, BRCA Gist, grounded in fuzzy-trace theory (FTT), increases gist comprehension and knowledge about genetic testing for breast cancer risk, improving decision making. Design. In 2 experiments, 410 healthy undergraduate women were randomly assigned to 1 of 3 groups: an online module using a Web-based tutoring system (BRCA Gist) that uses artificial intelligence technology, a second group read highly similar content from the National Cancer Institute (NCI) Web site, and a third that completed an unrelated tutorial. Intervention. BRCA Gist applied FTT and was designed to help participants develop gist comprehension of topics relevant to decisions about BRCA genetic testing, including how breast cancer spreads, inherited genetic mutations, and base rates. Measures. We measured content knowledge, gist comprehension of decision-relevant information, interest in testing, and genetic risk and testing judgments. Results. Control knowledge scores ranged from 54% to 56%, NCI improved significantly to 65% and 70%, and BRCA Gist improved significantly more to 75% and 77%, P < 0.0001. BRCA Gist scored higher on gist comprehension than NCI and control, P < 0.0001. Control genetic risk-assessment mean was 48% correct; BRCA Gist (61%) and NCI (56%) were significantly higher, P < 0.0001. BRCA Gist participants recommended less testing for women without risk factors (not good candidates; 24% and 19%) than controls (50%, both experiments) and NCI (32%), experiment 2, P < 0.0001. BRCA Gist testing interest was lower than in controls, P < 0.0001. Limitations. BRCA Gist has not been tested with older women from diverse groups. Conclusions. Intelligent tutors, such as BRCA Gist, are scalable, cost-effective ways of helping people understand complex issues, improving decision making.

Communicating Numerical Risk Human Factors That Aid Understanding in Health Care

In this chapter, we review evidence from the human factors literature that verbal and visual formats can help increase the understanding of numerical risk information in health care. These visual representations of risk are grounded in empirically supported theory. As background, we first review research showing that people often have difficulty understanding numerical risks and benefits in health information. In particular, we discuss how understanding the meanings of numbers results in healthier decisions. Then, we discuss the processes that determine how communication of numerical risks can enhance (or degrade) health judgments and decisions. Specifically, we examine two different approaches to risk communication: a traditional approach and fuzzy-trace theory. Applying research on the complications of understanding and communicating risks, we then highlight how different visual representations are best suited to communicating different risk messages (i.e., their gist). In particular, we review verbal and visual messages that highlight gist representations that can better communicate health information and improve informed decision making. This discussion is informed by human factors theories and methods, which involve the study of how to maximize the interaction between humans and the tools they use. Finally, we present implications and recommendations for future research on human factors in health care.

Tutorial dialogues and gist explanations of genetic breast cancer risk

The intelligent tutoring system (ITS) BRCA Gist is a Web-based tutor developed using the Shareable Knowledge Objects (SKO) platform that uses latent semantic analysis to engage women in natural-language dialogues to teach about breast cancer risk. BRCA Gist appears to be the first ITS designed to assist patients’ health decision making. Two studies provide fine-grained analyses of the verbal interactions between BRCA Gist and women responding to five questions pertaining to breast cancer and genetic risk. We examined how “gist explanations” generated by participants during natural-language dialogues related to outcomes. Using reliable rubrics, scripts of the participants’ verbal interactions with BRCA Gist were rated for content and for the appropriateness of the tutor’s responses. Human researchers’ scores for the content covered by the participants were strongly correlated with the coverage scores generated by BRCA Gist, indicating that BRCA Gist accurately assesses the extent to which people respond appropriately. In Study 1, participants’ performance during the dialogues was consistently associated with learning outcomes about breast cancer risk. Study 2 was a field study with a more diverse population. Participants with an undergraduate degree or less education who were randomly assigned to BRCA Gist scored higher on tests of knowledge than those assigned to the National Cancer Institute website or than a control group. We replicated findings that the more expected content that participants included in their gist explanations, the better they performed on outcome measures. As fuzzy-trace theory suggests, encouraging people to develop and elaborate upon gist explanations appears to improve learning, comprehension, and decision making.

Understanding genetic breast cancer risk: Processing loci of the BRCA Gist Intelligent Tutoring System

The BRCA Gist Intelligent Tutoring System helps women understand and make decisions about genetic testing for breast cancer risk. BRCA Gist is guided by Fuzzy-Trace Theory, (FTT) and built using AutoTutor Lite. It responds differently to participants depending on what they say. Seven tutorial dialogues requiring explanation and argumentation are guided by three FTT concepts: forming gist explanations in ones own words, emphasizing decision-relevant information, and deliberating the consequences of decision alternatives. Participants were randomly assigned to BRCA Gist, a control, or impoverished BRCA Gist conditions removing gist explanation dialogues, argumentation dialogues, or FTT images. All BRCA Gist conditions performed significantly better than controls on knowledge, comprehension, and risk assessment. Significant differences in knowledge, comprehension, and fine-grained dialogue analyses demonstrate the efficacy of gist explanation dialogues. FTT images significantly increased knowledge. Providing more elements in arguments against testing correlated with increased knowledge and comprehension.

A Fuzzy-Trace Theory of Judgment and Decision-Making in Health Care: Explanation, Prediction, and Application

We discuss how an evidence-based theory of human behavior and decision-making—Fuzzy-Trace Theory (FTT)—can be used to better understand and improve public health and medicine. We present an overview of the theory, describing its core principles as well as illustrative evidence. Applications are discussed in the areas of risk perception, prevention, detection and diagnosis of disease, and decision-making regarding treatment. We then review findings from interventions designed to improve health judgments and medical decision-making by effectively communicating risks and benefits. The theory provides guidelines for development of such interventions because it predicts reactions to health messages and explains the causal mechanisms of judgment and decision-making. We also present recommendations for future research.

Pumps and Prompts for Gist Explanations in Tutorial Dialogues About Breast Cancer

Fuzzy-Trace Theory (FTT) generalizes research on discourse to predict how health messages can be better understood and remembered, thereby influencing decision making. Applying FTT, BRCA Gist delivers messages interactively through tutorial dialogues and is the first Intelligent Tutoring System designed to help laypeople make sound medical decisions. Previous research indicates that BRCA Gist helps people form useful “gist explanations,” which leads to improved knowledge, comprehension, and risk assessment. The present research examined the effectiveness of different BRCA Gist dialogue moves, including general pumps for information and prompts for specific information. Participants were randomly assigned to a control group or one of four BRCA Gist conditions evoking gist or verbatim representations crossed with general pumps or specific information prompts. Gist-evoking pumps by themselves produced significant gains in knowledge and risk assessment. Specific verbatim prompts increased knowledge without affecting risk assessment. Results are explained in light of memory research and FTT principles.

False memories in social anxiety disorder

False memories are memories of events that never occurred or that occurred, but not exactly as we recall. Events with emotional content are subject to false memories production similar to neutral events. However, individual differences, such as the level of maladjustment and emotional instability characteristics of Social Anxiety Disorder (SAD), may interfere in the production of false memories. Objectives This study aimed to assess the effect of emotion in memory performance for an event witnessed by participants with and without SAD. Methods Participants were 61 young adults with SAD and 76 without any symptoms of SAD who were randomly assigned to watch a story with or without emotional arousal. Participants answered a subjective scale of emotion about the story and a recognition memory test. Results Participants with SAD recovered more true memories and more false memories for the non-emotional version compared to the emotional version of the story. Overall, participants with SAD produced fewer false memories compared to those without SAD. Discussion This finding suggests that social anxiety may have a significant impact on emotional memory accuracy, which may assist in the development and improvement of techniques for therapeutic intervention

Active engagement in a web-based tutorial to prevent obesity grounded in Fuzzy-Trace Theory predicts higher knowledge and gist comprehension

We used Sharable Knowledge Objects (SKOs) to create an Intelligent Tutoring System (ITS) grounded in Fuzzy-Trace Theory to teach women about obesity prevention: GistFit, getting the gist of healthy eating and exercise. The theory predicts that reliance on gist mental representations (as opposed to verbatim) is more effective in reducing health risks and improving decision making. Technical information was translated into decision-relevant gist representations and gist principles (i.e., healthy values). The SKO was hypothesized to facilitate extracting these gist representations and principles by engaging women in dialogue, “understanding” their responses, and replying appropriately to prompt additional engagement. Participants were randomly assigned to either the obesity prevention tutorial (GistFit) or a control tutorial containing different content using the same technology. Participants were administered assessments of knowledge about nutrition and exercise, gist comprehension, gist principles, behavioral intentions and self-reported behavior. An analysis of engagement in tutorial dialogues and responses to multiple-choice questions to check understanding throughout the tutorial revealed significant correlations between these conversations and scores on subsequent knowledge tests and gist comprehension. Knowledge and comprehension measures correlated with healthier behavior and greater intentions to perform healthy behavior. Differences between GistFit and control tutorials were greater for participants who engaged more fully. Thus, results are consistent with the hypothesis that active engagement with a new gist-based ITS, rather than a passive memorization of verbatim details, was associated with an array of known psychosocial mediators of preventive health decisions, such as knowledge acquisition, and gist comprehension.

O impacto das crenças metacognitivas na memória de adultos jovens e idosos

The present study aims to understand the processes related to how good one’s memory is (along with its self-efficacy) and the actual memory performance throughout human development, as well as false memories’ production (i.e., remembering events that did not actually occur). The experiment was conducted with 82 young adult participants, with ages ranging from 30 to 35 years, and 79 old adult participants, with ages ranging from 65 and 70 years. We used the Brazilian version of the word associate procedure (with neutral and emotional words) followed by a recognition test to assess memory performance and the metacognitive beliefs questionnaire to evaluate memory beliefs for the words of the test. Results indicate that the more young adults believe in their memory, the fewer false memories were produced for neutral information.

O efeito do alerta emocional na qualidade da memória

This study extends scientific evidence on the susceptibility of distorted memories by assessing false memories (remembering events that did not actually occur) in emotionally arousing complex events. The experiment was conducted with 380 participants, aged between 17 and 45 years. The South Brazilian version of Cahill and McGaughs Slideshow Procedure adapted by Neufeld, Brust and Stein on the evaluation of the effect of emotion on memory and false memories was used. The procedure entailed showing the participant 11 slides, followed by asking the participant to read one of the two possible versions of a narrative (either the emotionally arousing or neutral narrative). Memory performance was investigated using a recognition memory test. Results suggest that introducing emotional information into the arousing narrative may lead to the enhancement of true memory as well as to the enhancement of the production of false memories.