MODELING THE GIST OF RISKS, BENEFITS, AND VALUES IN PATIENTS' WILLINGNESS TO START MEDICATIONS

Purpose:

    Patients have difficulty understanding medication risks and communication approaches to risk often lack theoretical motivation. Applying fuzzy-trace theory and empirical research, we examined how theoretically and empirically motivated enhancements of risk messages influence three outcome variables: ordinal risk perception, worry about experiencing side effects, and willingness (intentions) to start a new medication.

Methods:

   We contacted 1453 patients with a chronic inflammatory rheumatic disease. 465 patients (mean age 58.99 years, 79.7% female) completed and returned a mail survey. Patients considered the acceptability of a medication with a realistic type and level of risk (a 2% or 0.2% chance of developing a serious infection). We also varied factorially the presence/absence of an icon array (IA) and a balance image (BI). Thus, patients were randomly assigned to one of eight conditions. Benefit, cost and route of administration were held constant. Data were analyzed using structural equation modeling.

Results:                                            

   Neither quantitative level of risk nor the presence of IA or BI affected willingness to start medication by themselves. Instead, perceived gist of the acceptability of the medication's risks, perceived benefits relative to risks, and gist principles (values/beliefs applied to perceptions of options) such as “Better safe than sorry” influenced outcome variables: Judging the risks as unacceptable and as outweighing the benefits of taking the medication increased ordinal risk perception and feelings of worry, and decreased intentions to start treatment.  Gist principles supporting medication decreased feelings of worry and increased willingness to start. For outcome variables, higher ordinal risk perceptions heightened worry, and worry in turn lowered starting intentions. The resulting SEM model was robust to controlling for demographic variables and illustrated that willingness to start a new medication was mediated by the gist of risk acceptability, perceived benefits relative to risks, and gist principles (Figure 1). Alternative models were tested and ruled out.

Conclusions:

   Across different ways of communicating risk, the subjectively extracted overall gist of the options – and not the actual magnitude of risk – influenced ordinal risk perception, worry, and willingness to start a medication. Consistent with theory, models built on representations of gist (related to acceptability of risks, benefits relative to risks, and gist principles) performed better than models which include only affect (worry) and risk perception to predict medication intentions.