VA Health Services Research and Development Center of Excellence, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
Patient Educ Couns. 2010 Aug;80(2):158-63. doi: 10.1016/j.pec.2009.10.021. Epub 2009 Dec 9.
Women at high risk of breast cancer face a difficult decision whether to take medications like tamoxifen to prevent a first breast cancer diagnosis. Decision aids (DAs) offer a promising method of helping them make this decision. But concern lingers that DAs might introduce cognitive biases.
We recruited 663 women at high risk of breast cancer and presented them with a DA designed to experimentally test potential methods of identifying and reducing cognitive biases that could influence this decision, by varying specific aspects of the DA across participants in a factorial design.
Participants were susceptible to a cognitive bias - an order effect - such that those who learned first about the risks of tamoxifen thought more favorably of the drug than women who learned first about the benefits. This order effect was eliminated among women who received additional information about competing health risks.
We discovered that the order of risk/benefit information influenced women's perceptions of tamoxifen. This bias was eliminated by providing contextual information about competing health risks.
We have demonstrated the feasibility of using factorial experimental designs to test whether DAs introduce cognitive biases, and whether specific elements of DAs can reduce such biases.
患有乳腺癌高风险的女性面临着一个艰难的决策，即是否服用他莫昔芬等药物来预防首次乳腺癌诊断。决策辅助工具（DA）为帮助她们做出这一决策提供了一种很有前途的方法。但人们仍然担心 DA 可能会引入认知偏差。
我们招募了 663 名患有乳腺癌高风险的女性，并向她们展示了一种 DA，旨在通过在参与者中采用因子设计来实验性地测试潜在的识别和减少可能影响这一决策的认知偏差的方法，具体方法是改变 DA 的特定方面。
参与者易受认知偏差的影响，即顺序效应，即那些首先了解他莫昔芬风险的人比首先了解其益处的人对该药物的评价更高。对于那些收到关于竞争健康风险的额外信息的女性，这种顺序效应被消除了。
我们发现风险/收益信息的顺序会影响女性对他莫昔芬的看法。通过提供关于竞争健康风险的背景信息，可以消除这种偏见。
我们已经证明了使用因子实验设计来测试 DA 是否会引入认知偏差，以及 DA 的特定元素是否可以减少这种偏差的可行性。
