Standard approaches to medical decision making, such as the Health Belief Model, focus mostly on the cognitive aspects of decisions, such as balancing perceived severity and perceived benefits. Our analysis shows that important affective variables, such as worry and appraisals, play an additional role in predicting actual medical choices, such as the choice to pursue genetic testing for breast cancer. These findings suggest the need to develop broader models of how people make decisions in health care domains.

Wang, C., Gonzalez, R., Janz, N., Milliron, K., & Merajver, S. (2007). The role of cognitive appraisal and worry in BRCA1/2 testing decisions among a clinic population.Psychology & Health, 22, 719-736. doi:10.1080/14768320600976216 (PDF)

Abstract

Previous studies examining decision making in the context of genetic testing for BRCA1/2 gene mutations have been limited in their reliance on cross-sectional designs, lack oftheoretical guidance, and focus on measures of intention rather than actual behavior. Informed by the Health Belief Model and other theories of self-regulation, the present study set out to examine the role of cognitive appraisal and worry in BRCA1/2 testing decisions. A total of 205 women completed baseline questionnaires prior to their genetic counselling appointment. Medical charts were audited to determine testing decisions.Bivariate analyses indicated that perceived severity of being a carrier and perceived benefits and barriers to testing were significantly associated with testing decisions. Perceived benefits remained significant in multivariate analyses. Moreover, multivariate analyses revealed a significant three-way interaction between perceived susceptibility, perceived severity, and worry about being a mutation carrier and testing decisions. Among women high in baseline worry, those high in perceived susceptibility but low in perceived severity were significantly more likely to undergo genetic testing than all other susceptibility/severity combinations (80% vs. 36.2–42.9% range; Wald test = 8.79,p < 0.01). These results support the need for researchers and practitioners to consider how interactions between cognition and worry may influence genetic testing decisions.