THIS IS A TEST

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Risk Communication An Introduction
Baruch Fischhoff University Professor Carnegie
Mellon Department of Social Decision
Sciences Department of Engineering Public
Policy Adapted for the SuperCourse from a talk
to International Society for Pharmacoepidemiology
April 19-20, 2004
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Overview
Communication research strategies Two case
studies medical informed consent public health
information management Six brief
examples Communication research management
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Pressure for Lay Participation in Decisions
Involving Risks
health finance environment national security
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Poor Execution Can
undermine effective lay decision making create
feelings of helplessness erode public faith in
authorities erode authorities faith in the
public erode the social coordination produced by
sharing trusted information sources
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Research Strategy Choices
Begin with formal analysis? Persuasive or
non-persuasive? Optimality or mastery? Which
individual differences?
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Research Strategy Choices
Begin with formal analysis? Persuasive or
non-persuasive? Optimality or mastery? Which
individual differences? Also Do you consider
affect? social context? resources? (potentially
important, but outside present talk)
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Behavioral Decision Research
Normative analysis of decision situation Descripti
ve behavioral research, in terms comparable to
normative analysis Prescriptive interventions,
closing gaps between normative ideal
and descriptive reality
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Behavioral Decision Research Strategy Choices
Begin with formal analysis? yes Persuasive or
non-persuasive? Non (default) Optimality or
mastery? either Which individual differences?
circumstances, values, competence
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Three Classes of Information
Quantitative How big are the risks - and
benefits? Qualitative What determines risks -
and benefits? Communication process What is
social context of message?
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Uses of Quantitative Information

• calculating expected utility
• assessing the value of new information
• setting priorities
• applying a threshold for concern

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Uses of Qualitative Information

• making quantitative information credible
• reconciling competing claims
• generating options
• monitoring environment for changes
• feeling realistically empowered

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Uses of Process Information

• establishing source credibility
• (competence, honesty)
• assessing source expectations
• (audience competence, locus of control)
• identifying conversational context
• (interpretation, reading between the lines)

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A Quantitative Information Example Carotid
Endarterechtomy

• Surgery can extend life, but lots can go wrong.
• Patients face flood of information at
  a stressful time.
• Physicians face duty to inform.
• (with Jon Merz, Paul Fischbeck, Dennis Mazur)

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Normative Analysis
Value-of-information analysis, using risk
analyses of patient - relevant outcomes,
formalizing the materiality standard
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Many Possible Side Effects

• death
• stroke
• facial paralysis
• myocardial infarction
• lung damage
• headache
• resurgery
• tracheostomy
• gastrointestinal upset
• broken teeth
• .

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But knowledge of only a few would affect many
patients choices

• death
  15.0
• stroke 5.0
• facial paralysis 3.0
• myocardial infarction 1.1
• lung damage 0.9
• headache 0.8
• resurgery 0.4
• tracheostomy 0.2
• gastrointestinal upset 0.09
• broken teeth 0.01
• ( that would decline, if they knew of each risk)

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Descriptive Research (anticipated)
Patients dont know probabilities of top risks
death, stroke, facial nerve paralysis Patients
dont know event meaning for facial paralysis
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Prescriptive Design Issues (1) Identify
Communication Challenges

• verbal quantifiers (e.g., likely threat)
• experientially unfamiliar events
• value uncertainty (what do I really want?)
• but not
• very low probabilities
• cumulative risk (from repeated exposure)

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Prescriptive Design Issues (2) Choose Performance
Measures

• knowledge
• inferential ability
• appropriateness of confidence
• appropriateness of self-efficacy
• personally rational choices
• satisfaction (?)

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Conclusions
Systematically using clinical trial results can
drastically simplify task (for patient
physician) formalize materiality standard set
research priorities The adequacy of
non-persuasive communication is plausible, but
not proven
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Research Strategy
Begin with formal analysis?
yes Persuasive or non-persuasive?
non Optimality or mastery? ptimality Which
individual differences? health status,
values (assume competence)
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A Qualitative Information (and Communication
Process) Example Emergency
Notification for Waterborne Pathogens
Cryptosporidium intrusion in domestic water
supplies. Special vulnerability for
immunocompromised individuals. (Liz Casman,
Felicia Wu, Claire Palmgren, Mitch Small, Joan
Rose, Hadi Dowlatabadi)
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Normative Analysis Behaviorally realistic model
of system performance, including detection,
organizational coordination, and consumer response
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Descriptive Research
Mental models interviews (open-ended,
structured by model) with HIV
individuals knew a lot, could do
little residents of communities with past
intrusions knew little, mildly curious
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Conclusions
Abandon emergency communication for crypto
(perhaps OK for other contaminants, E. coli,
bioterror) Provide bottled water to those at
risk Reevaluate communications for other
immunocompromised individuals
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Research Strategy
Begin with formal analysis? yes Persuasive or
non-persuasive? persuasive Optimality or
mastery? mastery Which individual differences?
health status, values, competence
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Six Brief Examples
Sexual assault prevention advice Teen STI
risk Vaccines (anthrax, MMR) Dietary
supplements Hazardous chemicals Homeland security
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Sexual Assault
Problem confident, universal, contradictory
advice fosters confusion and guilt Normative
inventory of strategies, meta-analysis of
effectiveness studies, identification of
values Descriptive nuanced belief structure,
exaggerated effectiveness Prescriptive create
realistic expectations, promote research
evaluating effectiveness
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STIs (teens)
Problem flood of repetitious information creates
illusion of understanding. Normative influence
diagram summarizing decision-relevant
science Descriptive broad knowledge of HIV/AIDS,
with critical bugs little knowledge of other
STIs, limited feeling of control Prescriptive
targeted HIV/AIDS messages DVD on sexual
decision making
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Vaccination (anthrax, MMR)
Problem mistrust of officials affects trust in
medicine Normative comprehensive model of
factors determining health, trust Descriptive
critical issues outside official problem space,
terminological confusion Prescriptive provide
context, including irrelevant concerns
research as communication
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Dietary supplements
Problem commercial-freedom-of-speech policies
expanding direct-to-consumer communication Normat
ive analysis model sensitive to burden of
responsibility for consumer/market
failure Descriptive analysis court-mandated
labels may erode consumer rationality Prescriptive
analysis standardized, validated labels legal
standard for adequacy
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Hazardous Chemicals
Problem Can voluntary controls substitute for
regulatory controls? Normative diffusion/uptake
model, including effects of behavior Descriptive
ineffective measures intuitively appealing (e.g.,
gloves, in-room breaks) Prescriptive
standardized, validated labels legal standard
for adequacy
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Homeland Security
Problem Plans without behavioral
input Normative Behaviorally realistic
emergency response model Descriptive Simple
facts not transmitted unfounded belief in panic
specific fears decline, general anxiety
stable Prescriptive Communication to experts,
interdisciplinary teams, preemptive messages
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Also
BSE SARS HRT GMOs Xenotransplantation smallpox
(vaccination)
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General Conclusions
Effective risk communication requires continuing
collaboration among domain specialists, risk
analysts, risk communicators, practitioners,
and patients (or their representatives) -- with
each willing to have its assumptions challenged.
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Why doesnt everyone adopt behavioral decision
research?
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Possible Professional Reasons
need for specialization separation of research
worlds isolation of researchers from
practitioners predisposition to
persuasion predisposition to sweeping
generalizations
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Possible Management Reasons
focus on single outcome narrow reviewing of
proposals and products favor method application
over development mandate to persuade difficulty
of evaluating non-persuasive communications
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• Persuasive communication
• can inappropriately
• undermine credibility of public and experts
• alienate audience
• overlook critical audience goals constraints
• impose bureaucratic priorities

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• Non-persuasive communication
• can inappropriately
• assume nonexistent abilities
• deny people needed protections
• muddle value issues
• leave wrong priorities unchallenged

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Non-persuasive communication is needed when
No single, clear optimal choice multiple values,
situations large uncertainties No clear advisory
role experts distrusted shared decision-making
option desired
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The Empirical Question
How competent are lay people to participate?
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Many Strong Opinions, Drawn from
assertion selected research evidence anecdotal
observation small, unrepresentative
samples speculative interpretation ambiguity
regarding decision frame
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Common Rhetorical Answers
Political predisposition Behavioral
assumption
liberal
conservative
popular democracy
hyper-rational public
free markets
paternalistic regulation
technocratic control
irrational public
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The Empirical Question (reformulated)
How competent are lay people to participate? --
when facing specific decisions -- and given half
a chance
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A (Complex) Working Hypothesis

• People often do sensible things if
• They get relevant information in a concise,
  credible form with adequate context, and without
  distractions
• They have control over their environment and are
  judged by their own goals
• They have some minimal decision-making competence

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Collaborators
Lita Furby, Marcia Morgan, Julie Downs, Wändi
Bruine de Bruin, Sara Eggers, Matt Dombroski,
Donna Riley, Mitch Small, Steve Risotto, Dan
Kovacs, Paul Fischbeck, Claire Palmgren, Robyn
Dawes, Rebecca Parkin, Gordon Butte, Sarah
Thorne, Martha Embrey, Jenn Lerner, Roxana
Gonzalez, Deb Small, Gabriel Silverman, Lisa
Schwartz, Steve Woloshin
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Sources

• Eggers, S.L., Fischhoff, B. (in press). A
  defensible claim? Behaviorally realistic
  evaluation standards. Journal of Public Policy
  and Marketing.
• Fischhoff, B. (1992). Giving advice Decision
  theory perspectives on sexual assault. American
  Psychologist, 47, 577-588.
• Fischhoff, B. (1994). What forecasts (seem to)
  mean. Intl Journal of Forecasting, 10, 387-403.
• Fischhoff, B. (1995). Risk perception and
  communication unplugged Twenty years of
  process. Risk Analysis, 15, 137-145.
• Fischhoff, B. (1999). Why (cancer) risk
  communication can be hard. Journal of the
  National Cancer Institute Monographs, 25, 7-13.
• Fischhoff, B. (2000). Scientific management of
  science? Policy Sciences, 33, 73-87.