© 1999 by Oxford University Press
Journal of the National Cancer Institute Monographs, No. 25, 14-15,
1999
© 1999 Oxford University Press
Improving Cancer Risk Communication: a Discussion of Fischhoff
Correspondence to: Edward Maibach, Ph.D., M.P.H., Porter Novelli, 1120 Connecticut Ave., N.W., Suite 1100, Washington, DC 20036 (e-mail: emaibach{at}porternovelli.com).
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INTRODUCTION |
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 Top Introduction Operational ImplicationsConceptual ImplicationsNotesReferences |
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The implications of Fischhoff's observations (1) about why cancer risk communication can be hard, and the steps risk communicators can take to be more effective, are rich at both the operational level as well as the conceptual level.
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OPERATIONAL IMPLICATIONS |
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TopIntroductionOperational ImplicationsConceptual ImplicationsNotesReferences |
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Fischhoff's recommendations are clear and extremely promising. Following his recommendations will not be easy, however, as they represent a considerable challenge to the field of risk communication. Fischhoff recommends a formal set of procedures for capturing and comparing expert conceptions (an "expert model") and target audience conceptions (a "mental model") of the risk at issue. After these conceptions have been formalized, an iterative research-based process is used to determine which elements of the expert model most effectively improve target audience understanding of the risk. Whereas the skills to conduct these procedures may be stock in trade for risk and decision scientists, they are unknown to the majority of health and risk communication planners.
Accelerating the adoption of Fischhoff's formalized approach will require a considerable investment in research and development (R&D) and training, although if made, the dividends are likely to be considerable. R&D is needed to create simple yet robust means for developing expert and mental models, as well as empirical procedures by which to determine which information from the expert model is most useful. Health and risk communication professionals, students, and the people who teach and advise them will require training, at a minimum, to understand the rationale underlying this formalized approach. Until such time that risk communication professionals have a full understanding of the process, risk or decision scientists or both should be integral members of the communication planning team.
There are budgetary and timeline implications at the operational level as well. When properly conducted, communication planning requires an investment of time and money in audience or formative research. Fischhoff's formalized approach to risk communication planning, however, may pose even greater time and financial demands, at least initially. These demands may be lessened in the long run as expert models and audience mental models become available in the published literature and elsewhere.
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CONCEPTUAL IMPLICATIONS |
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TopIntroductionOperational ImplicationsConceptual ImplicationsNotesReferences |
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There are two distinct objectives for communicating cancer risk information: enabling audience members to make informed decisions (e.g., cancer patients who have a choice among treatment options) and persuading audience members to adopt a specific belief or behavior [e.g., increasing daily consumption of fruit and vegetables (2)]. Each of these objectives has a different underlying assumption. In the case of enabling people to make informed decisions, the communicator's assumption is that no one decision or course of action is right for all people, but rather each individual's unique values and situation must be weighed against the options. In the case of using risk information to persuade audience members to embrace a given option, the communicator's assumption is that there is an acceptably high degree of consensus among experts to warrant the assertion that the recommended option is the "right" option. Without a high degree of consensus that the recommended behavior is, in fact, in the best interest of the individual (or possibly, in certain instances, in the best interest of society), the ethics of providing risk information for purposes of persuasion are questionable (3,4).
The criteria for judging effectiveness must, therefore, vary according to the objective of the risk communication program. Risk communication that seeks to enable people to make informed or "better" decisions should be judged on its ability to
- Impart an accurate (albeit perhaps limited) understanding of the
risk, particularly (as Fischhoff points out) information that is
"worth knowing";
- Facilitate a good decision-making process (5);1 and
- Impart confidence that a good decision has been reached. Without
such confidence, decision-makers are likely to be plagued by
unproductive anxiety (6).
Conversely, risk communication that seeks to persuade should be judged by its ability to
- Impart an accurate understanding of the risk, particularly
information that is motivational;
- Modify or reinforce cognitive antecedents to the recommended
option; and
- Encourage positive self-evaluations on the basis of enactment of
the recommended option (7).
Fischhoff's formalized approach to assessment and communication planning have the potential to improve the practice and evaluation of both forms of risk communication. Risk communication planners should, however, be clear about which of the two objectives they are pursuing to apply the formalisms appropriately.
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NOTES |
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1 A good "decision-making process" is distinct from a good "decision." A good decision-making process interprets risk information accurately, in the context of personal values and the situational considerations, to select the most highly valued option. The quality of a decision is more difficult to assess.
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REFERENCES |
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TopIntroductionOperational ImplicationsConceptual ImplicationsNotesReferences |
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1 Fischhoff B. Why (cancer) risk communication can be hard. J Natl Cancer Inst Monogr 1999;25:7-13.
2 Maibach E, Holtgrave DR. Advances in public health communication. Ann Rev Public Health 1995;16:219-38.[CrossRef][ISI][Medline]
3 Rothschild ML. Carrots, sticks & promises: a conceptual framework for the management of public health and social issue behaviors. J Marketing. In press 1999.
4 Smith C, Dunfee T, Ross W. Social contracts and marketing ethics. J Marketing. In press 1999.
5 Mowen JC. Judgment calls. New York (NY): Simon & Schuster; 1993. p 161-85.
6 Bandura A. Self-efficacy: the exercise of control. New York (NY): WH Freeman; 1997.
7 Bandura A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs (NJ): Prentice-Hall; 1986.
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