Han Paul K J, Williams Andrew E, Haskins Amy, Gutheil Caitlin, Lucas F Lee, Klein William M P, Mazor Kathleen M
Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, Maine.
Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland.
Cancer Epidemiol Biomarkers Prev. 2014 Dec;23(12):2916-23. doi: 10.1158/1055-9965.EPI-14-0872. Epub 2014 Sep 25.
Aversion to "ambiguity"-uncertainty about the reliability, credibility, or adequacy of information-about medical tests and treatments is an important psychological response that varies among individuals, but little is known about its nature and extent. The purpose of this study was to examine how individual-level ambiguity aversion relates to important health cognitions related to different cancer screening tests.
A survey of 1,074 adults, ages 40 to 70 years, was conducted in four integrated U.S. healthcare systems. The Ambiguity Aversion in Medicine (AA-Med) scale, a measure of individual differences in aversion to ambiguity (AA) about medical tests and treatments, was administered along with measures of several cancer screening-related cognitions: perceived benefits and harms of colonoscopy, mammography, and PSA screening, and ambivalence and future intentions regarding these tests. Multivariable analyses were conducted to assess the associations between AA-Med scores and cancer screening cognitions.
Individual-level AA as assessed by the AA-Med scale was significantly associated (P < 0.05) with lower perceived benefits, greater perceived harms, and greater ambivalence about all three screening tests, and lower intentions for colonoscopy but not mammography or PSA screening.
Individual-level AA is broadly and simultaneously associated with various pessimistic cognitive appraisals of multiple cancer screening tests. The breadth of these associations suggests that the influence of individual-level AA is insensitive to the degree and nonspecific with respect to the causes of ambiguity.
Individual-level AA constitutes a measurable, wide-ranging cognitive bias against medical intervention, and more research is needed to elucidate its mechanisms and effects.
对医学检查和治疗中“模糊性”——关于信息的可靠性、可信度或充分性的不确定性——的厌恶是一种重要的心理反应，个体之间存在差异，但对其本质和程度知之甚少。本研究的目的是探讨个体层面的模糊性厌恶如何与不同癌症筛查测试相关的重要健康认知相关联。
在美国四个综合医疗系统中对1074名40至70岁的成年人进行了一项调查。使用医学模糊性厌恶（AA-Med）量表来衡量个体对医学检查和治疗中模糊性（AA）的厌恶差异，并同时测量了几种与癌症筛查相关的认知：结肠镜检查、乳房X线摄影和前列腺特异性抗原（PSA）筛查的感知益处和危害，以及对这些检查的矛盾心理和未来意图。进行多变量分析以评估AA-Med得分与癌症筛查认知之间的关联。
通过AA-Med量表评估的个体层面的AA与所有三种筛查测试的较低感知益处、较高感知危害和较大矛盾心理显著相关（P < 0.05），并且与结肠镜检查的较低意愿相关，但与乳房X线摄影或PSA筛查无关。
个体层面的AA与多种癌症筛查测试的各种悲观认知评估广泛且同时相关。这些关联的广度表明，个体层面AA的影响对模糊性的程度不敏感且在原因方面是非特异性的。
个体层面的AA构成了一种针对医学干预的可测量的、广泛的认知偏差，需要更多研究来阐明其机制和影响。
