title: Testing whether decision aids introduce cognitive biases: results of a randomized trial.
abstract: OBJECTIVE
  Women at high risk of breast cancer face a difficult decision whether to take medications like tamoxifen to prevent a first breast cancer diagnosis. Decision aids (DAs) offer a promising method of helping them make this decision. But concern lingers that DAs might introduce cognitive biases.
  
  
  METHODS
  We recruited 663 women at high risk of breast cancer and presented them with a DA designed to experimentally test potential methods of identifying and reducing cognitive biases that could influence this decision, by varying specific aspects of the DA across participants in a factorial design.
  
  
  RESULTS
  Participants were susceptible to a cognitive bias - an order effect - such that those who learned first about the risks of tamoxifen thought more favorably of the drug than women who learned first about the benefits. This order effect was eliminated among women who received additional information about competing health risks.
  
  
  CONCLUSIONS
  We discovered that the order of risk/benefit information influenced women's perceptions of tamoxifen. This bias was eliminated by providing contextual information about competing health risks.
  
  
  CONCLUSIONS
  We have demonstrated the feasibility of using factorial experimental designs to test whether DAs introduce cognitive biases, and whether specific elements of DAs can reduce such biases.
authors.affiliation: VA Health Services Research and Development Center of Excellence, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. paubel@med.umich.edu
authors.forename: Peter A
authors.initials: PA
authors.lastname: Ubel
authors.forename: Dylan M
authors.initials: DM
authors.lastname: Smith
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Zikmund-Fisher
authors.forename: Holly A
authors.initials: HA
authors.lastname: Derry
authors.forename: Jennifer
authors.initials: J
authors.lastname: McClure
authors.forename: Azadeh
authors.initials: A
authors.lastname: Stark
authors.forename: Cheryl
authors.initials: C
authors.lastname: Wiese
authors.forename: Sarah
authors.initials: S
authors.lastname: Greene
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Jankovic
authors.forename: Angela
authors.initials: A
authors.lastname: Fagerlin
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000517:prevention & control*; D003071:Cognition; D032882:Comprehension; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods; D018570:Risk Assessment; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use*; D013629:Tamoxifen / Q000627:therapeutic use*
chemical_list: D020845:Selective Estrogen Receptor Modulators; D013629:Tamoxifen