Department of Psychology, University of Florida, Gainesville, GL, USA.
Max Plank Institute for Human Development, Berlin, Germany.
Med Decis Making. 2018 Jul;38(5):562-572. doi: 10.1177/0272989X18759933. Epub 2018 Apr 9.
Medical decisions made on behalf of another person-particularly those made by adult caregivers for their minor children-are often informed by the decision maker's beliefs about the treatment's risks and benefits. However, we know little about the cognitive and affective mechanisms influencing such "proxy" risk perceptions and about how proxy risk perceptions are related to prominent judgment phenomena.
Adult caregivers of minor children with asthma ( N = 132) completed an online, cross-sectional survey assessing 1) cognitions and affects that form the basis of the availability, representativeness, and affect heuristics; 2) endorsement of the absent-exempt and the better-than-average effect; and 3) proxy perceived risk and unrealistic comparative optimism of an asthma exacerbation. We used the Pediatric Asthma Control and Communication Instrument (PACCI) to assess asthma severity.
Respondents with higher scores on availability, representativeness, and negative affect indicated higher proxy risk perceptions and (for representativeness only) lower unrealistic optimism, irrespective of asthma severity. Conversely, respondents who showed a stronger display of the better-than-average effect indicated lower proxy risk perceptions but did not differ in unrealistic optimism. The absent-exempt effect was unrelated to proxy risk perceptions and unrealistic optimism.
Heuristic judgment processes appear to contribute to caregivers' proxy risk perceptions of their child's asthma exacerbation risk. Moreover, the display of other, possibly erroneous, judgment phenomena is associated with lower caregiver risk perceptions. Designing interventions that target these mechanisms may help caregivers work with their children to reduce exacerbation risk.
代表他人做出的医疗决策——尤其是成年照顾者为其未成年子女做出的决策——通常基于决策者对治疗风险和收益的信念。然而，我们对影响此类“代理”风险感知的认知和情感机制知之甚少，也不清楚代理风险感知与突出的判断现象有何关系。
132 名患有哮喘的未成年儿童的成年照顾者完成了一项在线横断面调查，评估了 1）构成可得性、代表性和情感启发式的认知和情感；2）对无例外和优于平均效应的认可；以及 3）哮喘恶化的代理感知风险和不切实际的比较乐观。我们使用儿科哮喘控制和沟通工具（PACCI）来评估哮喘的严重程度。
在可得性、代表性和负性情绪方面得分较高的受访者表示代理风险感知更高，并且（仅在代表性方面）不切实际的乐观情绪更低，而不论哮喘严重程度如何。相反，表现出更强的优于平均效应的受访者表示代理风险感知较低，但不切实际的乐观情绪没有差异。无例外效应与代理风险感知和不切实际的乐观情绪无关。
启发式判断过程似乎有助于照顾者对其子女哮喘恶化风险的代理风险感知。此外，其他可能错误的判断现象的表现与照顾者较低的风险感知相关。设计针对这些机制的干预措施可能有助于照顾者与子女一起降低恶化风险。
