THIS IS A TEST

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Consumer Information Needs
Baruch Fischhoff Toxicology Forum Annual
Meeting July 11, 2005
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Consumer understanding of toxicology is shaped in
many encounters.
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Each communication affects both specific choices
and general beliefs.
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Communications Include
newspaper headlines advertisements consumer
reporters internet drug bills insurance
premiums personal experience
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Potentially Relevant to Many Choices
Self-diagnosis of problems Compliance Evaluating
improvement Monitoring/reporting side
effects Seeking/joining clinical trial Lifestyle
changes Buying/using insurance Political behavior
(voting, calling,)
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Communications Serve Recipients Needs If They
Are faithful to the underlying facts Focus on
facts critical to pending choices Present facts
comprehensibly and credibly Create a coherent
picture
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The Industry Needs a Communication Strategy
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The Industry Needs a Communication
Strategy and Technical Execution
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If the Strategy Involves Creating Communications
That
Are faithful to the underlying facts Focus on
facts critical to audience choices Present facts
comprehensibly and credibly Create a coherent
picture
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Then One Disciplined Approach to Execution
Is Behavioral Decision Research
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Behavioral Decision Research (aka Behavioral
Economics)
Interface of psychology and economics Combines
analytical and behavioral methods Suited to
decisions with technical content Draws
systematically on academic research
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Behavioral Decision Research (aka Behavioral
Economics)
Interface of psychology and economics Combines
analytical and behavioral methods Suited to
decisions with technical content Draws
systematically on academic research Involves
three integrated forms of research
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Normative analysis of decisions, identifying
optimal choices, given facts and
values Descriptive research, characterizing
behavior in terms comparable to normative
analysis Prescriptive interventions, closing
gaps between normative ideal and descriptive
reality
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An Example Informed Consent for 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, simulating the
optimal choices of typical patients, told about
different risks.
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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, not performed)
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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Similar Attention Required for Any Communications
That
Are faithful to the underlying facts Focus on
facts critical to audience choices Present facts
comprehensibly and credibly Create a coherent
picture
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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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Effective Execution
requires collaboration among domain specialists,
decision analysts, communicators, practitioners,
and patients (or their representatives).
Missing any ingredient undermines the
communication strategy.
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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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Reasons for Guarded Optimism
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Solid Scientific Base
For analyzing various classes of decisions,
assessing recipients goals, and conveying
specific kinds of facts.
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Solid Scientific Base
For analyzing various classes of decisions,
assessing recipients goals, and conveying
specific kinds of facts. Also, a disciplined
way to use medical and pharmaceutical knowledge.
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Many and Varied Worked Examples
Sexual assault prevention Teen STI risk Vaccines
(anthrax, MMR)Implants (breast, xeno-) Dietary
supplements Cancer (prevention, treatment,
concepts) Hazardous chemicals (home,
work) Homeland security
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People tend to 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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Some Sources

• Eggers, S.L., Fischhoff, B. (2004). A
  defensible claim? Behaviorally realistic
  evaluation standards. Journal of Public Policy
  and Marketing, 23, 14-27.
• 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.
• Fischhoff, B. (in press). Cognitive issues in
  stated preference methods. In K-G. Mäler J.
  Vincent (Eds.), Handbook of Environmental
  Economics. Amsterdam Elsevier.
• Fischhoff, B., Bostrom, A., Quadrel, M.J.
  (2002). Risk perception and communication. In
  R. Detels et al. (Eds.), Oxford textbook of
  public health. London Oxford University Press.
• Fischhoff, B., Wesseley, S. (2003). Managing
  patients with inexplicable health problems.
  British Medical Journal, 326, 595-597.
• Morgan, M.G., Fischhoff, B., Bostrom, A.,
  Atman, C. (2001). Risk communication The
  mental models approach. New York Cambridge
  University Press.
• Center for Risk Perception and Communication
  http//sds.hss.cmu.edu/risk/