d'Ydewalle G, Evers-Kiebooms G
Birth Defects Orig Artic Ser. 1987;23(2):209-25.
In cognitive psychology, considerable attention has recently been given to studies on risk perception and decision making under uncertainty. The attempt to apply the cognitive frameworks to the genetic counseling setting is a major challenge. After reviewing the relevant literature in cognitive psychology, the aim of our first study was to understand how people process and memorize genetic information about Huntington's disease. Although we did not obtain clear-cut data about the mental representation of this genetic information in our subjects, the context in which the information was given was a surprisingly strong variable affecting its memorability. Pauker and Pauker (1979) developed a tree model helping the prospective parents to use the probabilities as well as the costs of different outcomes to decide on having an amniocentesis performed. Specific attention was paid to the estimation of the costs of the outcomes. While repeating the same experiment, the goal of our second study was to investigate whether the subjects agree with the advice given by the model and whether their final decision was affected by using the technique or not. In a third experiment, we scrutinized the joint decision process of two persons as compared with the decision process of people not discussing together. They all received genetic information, either about Hemophilia or about Down syndrome. The joint decision process was completely different for the two genetic diseases. As the two diseases have highly different risk probabilities, we had to unravel the influence of the importance of the risk and the burden of the disease on the ongoing decision of two persons. The set of findings at least suggests that the existing models in the literature have overlooked the importance of the context in providing the information and the complexities of the decision process when two people have to agree. Moreover, the serious problems in carrying out an experiment when a decision tree is imposed upon the subjects, reveal the potential inadequacy of the assumed total rationality of the decision maker.
在认知心理学中，最近人们对不确定性下的风险感知和决策研究给予了相当多的关注。将认知框架应用于遗传咨询环境是一项重大挑战。在回顾了认知心理学的相关文献后，我们第一项研究的目的是了解人们如何处理和记忆关于亨廷顿舞蹈症的遗传信息。尽管我们在受试者中没有获得关于这种遗传信息心理表征的明确数据，但信息给出的背景是影响其记忆性的一个惊人的强大变量。帕克和帕克（1979年）开发了一个树形模型，帮助准父母利用不同结果的概率以及成本来决定是否进行羊膜穿刺术。特别关注了结果成本的估计。在重复相同实验时，我们第二项研究的目标是调查受试者是否同意该模型给出的建议，以及他们的最终决定是否受到使用该技术的影响。在第三个实验中，我们仔细研究了两人的联合决策过程，并与未一起讨论的人的决策过程进行了比较。他们都收到了关于血友病或唐氏综合征的遗传信息。两种遗传疾病的联合决策过程完全不同。由于这两种疾病的风险概率差异很大,我们必须弄清楚风险的重要性和疾病负担对两人正在进行的决策的影响。这一系列研究结果至少表明，文献中现有的模型忽略了提供信息时背景的重要性以及两人必须达成一致时决策过程的复杂性。此外，当给受试者强加一个决策树来进行实验时所出现的严重问题，揭示了决策者假定的完全理性的潜在不足。
