CAS PS 332 Lecture Notes - Lecture 15: Risk Perception, Cognitive Dissonance, Numeracy
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22 May 2019
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Lecture 15: 4/16/19
Mock Rounds Overview
• You will collect additional information about a hypothetical patient, summarize
their findings, and offer preliminary diagnoses and treatment
recommendations. The class will be broken into groups of ~7 students. Each
group will be assigned one patient. A case summary will be provided.
• Prior to class on 4/30/19: upload Part 1 of the assignment
o Preliminary case conceptualization and questions for the patient
• During class on 4/30/19
o Meet with a facilitator to narrow down questions to ask the patient
o Interview (as a group) the hypothetical patient/family >> collect additional
data and determine the relevance of your clinical hypotheses and
preliminary treatment plan
End of Life
• Explain how cognitive and emotional factors influence risk perception and
decision-making in the context of health behaviors (e.g., heuristics, numeracy,
motives, etc.)
o Psychosocial aspects of cancer
▪ E.g., optimism (helpful, perception has effect on treatment),
depression (unhelpful, nature of association = lower survival),
social support (psych effects aren’t limited to patients, also
parents and siblings)
▪ Cancer-related masculine threat
▪ Traumatic stress framework
o Intervention:
▪ Stepped model of care (psychosocial screening, level of risk and
care)
▪ Screening vs. assessment
▪ Targets & techniques
▪ Effect of psychotherapy on survival?
o Risk perception & decision-making
▪ Heuristics (e.g., representative, affective), cognitive dissonance,
conditional probabilities, loss- vs. gain-based messages,
ambiguous risk information, omission vs. commission
• Identify predictors of patient (dis)satisfaction
o Patient–provider communication = “Backbone” of all medical treatment
▪ Treatment decisions are often based on information that arises
from the medical consultation process
▪ Provider's communication skills (including nonverbal behaviors)
related to patient satisfaction
o Dissatisfaction after a medical appointment:
▪ Lack of information (provider says “i told them”)
▪ Poor understanding of medical advice (patient did not understand)
▪ Perception of being unable to adhere to treatment instructions
(adherence is not linear, not all patients have skills to adhere)
o “Too little time, too much to do”
▪ The more time physicians spend with patients, the more satisfied
patients are
o Understand development, and differences across lifespan and genders to
be able to present information in a way that is factually accurate, yet
understandable in simple terms
• Discuss factors that contribute to providers’ and patients’ less-than optimal
communication
o Provider Miscommunication
▪ Physicians may listen poorly or communicate at a level that is too
high or low:
• Variability re: social skills
• Variability in attitudes about the roles of provider and
patient during consultation
• (Often implicit) bias or discrimination based on differences
in culture, race/ethnicity, age, ability, gender, religion,
sexual orientation, et.
o Patient Communication Problems
▪ Patients are often unprepared to communicate about sensitive
health matters
• Different educational & social backgrounds
• Low health literacy influenced by low reading levels or
numeracy (understanding health statistics)
o Incomplete/inaccurate understanding of medical
conditions
• Misunderstandings related to mismatched ethnic & cultural
backgrounds b/w patients & providers
o Improving Patient–Provider Communication
▪ Goal = MUTUAL participation
▪ Communication skills training is now a component of medical and
nursing education
• Active listening skills
▪ Communication-enhancing interventions for patients
• Assertiveness coaching
▪ Motivational Interviewing (MI)
• Strengthens motivation & commitment to change a specific
health behavior
• Principles: Collaboration, Patient autonomy, Ambivalence
• Distinguish palliative care, end-of-life care, and hospice
o Palliative care = comprehensive care that improves QoL and reduces
suffering in individuals with a life-threatening condition and their families
(WHO, 2015)
▪ Early identification, prevention, & treatment of physical,
psychosocial, & spiritual distress
▪ When: Introduce at diagnosis (complement curative therapies)
▪ Increase palliative care as curative therapies become less
effective