ated with communicating benefit and risk information; when faced with a benefit–risk decision, people tend to behave more intuitively, by sensing the qualities of whatever it is we are deciding and then integrating those qualities very quickly and automatically; patient perception of benefit and risk is just one of many factors at play when a decision is made about drug usage; when forced to confront trade-offs, people become uncomfortable and may use a simple rule to determine the decision or avoid making the decision altogether; and lastly, people must acquire and comprehend benefit–risk information before they can process it.

Dr. Slovic raised the question, Assuming that a patient acquires and comprehends this information, how does he or she make decisions involving benefit and risk? He argued that rarely do ordinary individuals explicitly calculate benefit–risk trade-offs when making a decision. Patients make on-the-spot, experiential decisions that are influenced by a complicated set of interacting factors, such as physician decision (the physician is making the decision about what is best), patient perception of benefit and risk (e.g., associating high benefit with low or zero risk), and innumeracy. Patients rely on their own knowledge, feelings, and memories when constructing preferences, and the way that information is presented or framed can readily alter their decisions. There are no neutral frames, so this poses a tremendous challenge to communicating benefit–risk information. Every presentation of information creates a bias one way or another, and whoever frames the decision inevitably manipulates the choice.

Dr. Slovic discussed affect, one of the many powerful elements of preference construction. He defined affect as a valenced feeling (e.g., goodness or badness) associated with a stimulus. It involves the processing of feelings associated with stimuli in what is known as the “experiential mode” of thinking, in contrast to the “analytic mode.”2 These two types of thinking—experiential and analytic—reside side-by-side in our brains and play off each other in “the dance of affect and reason.” Researchers are currently trying to understand how these two ways of thinking interact and have demonstrated thus far that experiential decision making increases with innumeracy, cognitive load (e.g., the complexity of the task and information), stress (e.g., time pressure), age, and the accompaniment of affect-rich images with the information. Studies have also demonstrated that although, in reality, risk and benefit are generally positively correlated, in people’s minds they tend to be strongly negatively correlated. This is because people judge benefits and risks based on feelings, with beneficial activities typically associated with lower risk.3

2

See Epstein S. 1994. Integration of the cognitive and the psychodynamic unconscious. American Psychologist 49:709–724.

3

See Alhakami AS, Slovic P. 1994. A psychological study of the inverse relationship between perceived risk and perceived benefit. Risk Analysis 14:1085–1096.



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