CAS PS 332 Lecture Notes - Lecture 15: Risk Perception, Cognitive Dissonance, Numeracy

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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
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
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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
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
Misunderstandings related to mismatched ethnic & cultural
backgrounds b/w patients & providers
o Improving PatientProvider 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
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