A theory of medical decision making and health: fuzzy trace theory
Open accessAbstract
The tenets of fuzzy trace theory are summarized with respect to their relevance to health and medical decision making. Illustrations are given for HIV prevention, cardiovascular disease, surgical risk, genetic risk, and cancer prevention and control. A core idea of fuzzy trace theory is that people rely on the gist of information, its bottom-line meaning, as opposed to verbatim details in judgment and decision making. This idea explains why precise information (e.g., about risk) is not necessarily effective in encouraging prevention behaviors or in supporting medical decision making. People can get the facts right, and still not derive the proper meaning, which is key to informed decision making. Getting the gist is not sufficient, however. Retrieval (e.g., of health-related values) and processing interference brought on by thinking about nested or overlapping classes (e.g., in ratio concepts, such as probability) are also important. Theory-based interventions that work (and why they work) are presented, ranging from specific techniques aimed at enhancing representation, retrieval, and processing to a comprehensive intervention that integrates these components.
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Social and contextual cues can bias the way adolescents perceive the risk involved in certain behaviors.
“Social and contextual cues can bias the way adolescents perceive the risk involved in certain behaviors (Reyna 2008, Reyna & Adam 2003, Reyna & Farley 2006).”
From Is Adolescence a Sensitive Period for Sociocultural Processing? (2014) · cites this paper as Reyna 2008
The section “Interventions That Mainly Affect Representation and Retrieval” (page unavailable) says retrieval cues increase perceptions of STD risk in populations including high school students, and that contextual cues can signal risk. The paper also discusses adolescents’ perceptions of drug-use risk in “Why Precise Information Does Not Work” (page unavailable). These passages support the contextual-cue and adolescent-risk elements, but do not establish the claimed effect of social cues on adolescents’ risk perceptions. (LLM, conf=0.83)
Experimental — accuracy not yet measuredUntil now, all training procedures that yielded promising results in addiction did so in adult samples.
“Note that until now, all of these training-procedures, which yielded promising results in addiction, did so in adult samples (either students or adults with addiction problems; however, see Reyna, 2008, for training aimed at healthrelated decision-making in adolescents).”
From Addiction, adolescence, and the integration of control and motivation (2011) · cites this paper as Reyna, 2008
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Self-citationGaissmaier, W., Wegwarth, O., Skopec, D., Müller, A.-S., Broschinski, S., & Politi, M. C. (2011) · Health Psychology · doi:10.1037/a0024850 · Cited by 168 · see citing works
How Fuzzy-Trace Theory Predicts True and False Memories for Words, Sentences, and Narratives
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Self-citationRisk perception and communication in vaccination decisions: A fuzzy-trace theory approach
Reyna, V. F. (2011) · Vaccine · doi:10.1016/j.vaccine.2011.11.070 · Cited by 155 · see citing works
Self-citationFried, T. R., Tinetti, M. E., Towle, V. R., O’Leary, J. R., & Iannone, L. P. (2011) · Archives of Internal Medicine · doi:10.1001/archinternmed.2011.32 · Cited by 144 · see citing works
Developmental Reversals in Risky Decision Making
Reyna, V. F., Chick, C. F., Corbin, J. C., & Hsia, A. N. (2013) · Psychological Science · doi:10.1177/0956797613497022 · Cited by 136 · see citing works
Self-citationParental Decision-Making on Childhood Vaccination
Damnjanović, K., Graeber, J., Ilić, S., Lam, W. Y., Lep, Ž., Morales, S., Pulkkinen, T., & Vingerhoets, L. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.00735 · Cited by 135 · see citing works
Hoerger, M. P., Epstein, R. M., Winters, P., Fiscella, K. A., Duberstein, P. R., Gramling, R. E., Butow, P. N., Mohile, S. G., Kaesberg, P. R., Tang, W., et al. (2013) · BMC Cancer · doi:10.1186/1471-2407-13-188 · Cited by 127 · see citing works
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Review article: explaining risks of inflammatory bowel disease therapy to patients
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The case against economic values in the orbitofrontal cortex (or anywhere else in the brain).
Hayden, B. Y., & Niv, Y. (2021) · Behavioral Neuroscience · doi:10.1037/bne0000448 · Cited by 127 · see citing works
Eberhardt, W., de Bruin, W. B., & Strough, J. (2018) · Journal of Behavioral Decision Making · doi:10.1002/bdm.2097 · Cited by 116 · see citing works
Predictors of PrEP Uptake Among Patients with Equivalent Access
Golub, S. A., Fikslin, R. A., Goldberg, M. H., Peña, S. M., & Radix, A. E. (2019) · AIDS and Behavior · doi:10.1007/s10461-018-2376-y · Cited by 112 · see citing works
Efficacy of a Web-Based Intelligent Tutoring System for Communicating Genetic Risk of Breast Cancer
Wolfe, C. R., Reyna, V. F., Widmer, C. L., Cedillos, E. M., Fisher, C. R., Brust-Renck, P. G., & Weil, A. M. (2014) · Medical Decision Making · doi:10.1177/0272989x14535983 · Cited by 109 · see citing works
Self-citationReyna, V. F., & Mills, B. A. (2014) · Journal of Experimental Psychology General · doi:10.1037/a0036717 · Cited by 107 · see citing works
Self-citationBlalock, S. J., & Reyna, V. F. (2016) · Health Psychology · doi:10.1037/hea0000384 · Cited by 106 · see citing works
Self-citationDecision tool to improve the quality of care in rheumatoid arthritis
Fraenkel, L., Peters, E. M., Charpentier, P. A., Olsen, B., Errante, L., Schoen, R. T., & Reyna, V. F. (2012) · Arthritis Care & Research · doi:10.1002/acr.21657 · Cited by 105 · see citing works
Self-citationDecision-making under pressure: medical errors in uncertain and dynamic environments
Zavala-Calahorrano, A., Day, G. E., Plummer, D., & Bamford‐Wade, A. (2017) · Australian Health Review · doi:10.1071/ah16088 · Cited by 99 · see citing works
Exploring Patient Values in Medical Decision Making: A Qualitative Study
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Widman, L. M., Golin, C. E., Kamke, K., Burnette, J. L., & Prinstein, M. J. (2017) · American Journal of Public Health · doi:10.2105/ajph.2017.304106 · Cited by 86 · see citing works
Values-based shared decision-making in the antenatal period
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Providing information about options in patient decision aids
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Howard, A. F., Balneaves, L. G., & Bottorff, J. L. (2009) · Journal of Genetic Counseling · doi:10.1007/s10897-009-9245-9 · Cited by 82 · see citing works
Patzer, R. E., Basu, M., Larsen, C. P., Pastan, S. O., Mohan, S., Patzer, M., Konomos, M., McClellan, W. M., Lea, J. P., Howard, D. H., et al. (2015) · Transplantation · doi:10.1097/tp.0000000000001019 · Cited by 82 · see citing works
A formal model of fuzzy-trace theory: Variations on framing effects and the Allais Paradox.
Broniatowski, D. A., & Reyna, V. F. (2017) · Decision · doi:10.1037/dec0000083 · Cited by 82 · see citing works
Self-citationCorbin, J. C., Reyna, V. F., Weldon, R. B., & Brainerd, C. J. (2015) · Journal of Applied Research in Memory and Cognition · doi:10.1016/j.jarmac.2015.09.001 · Cited by 81 · see citing works
Self-citationTheories of Medical Decision Making and Health: An Evidence-Based Approach
Reyna, V. F. (2008) · Medical Decision Making · doi:10.1177/0272989x08327069 · Cited by 80 · see citing works
Self-citationPsychological foundations of explainability and interpretability in artificial intelligence
Broniatowski, D. A. (2021) · doi:10.6028/nist.ir.8367 · Cited by 76 · see citing works
On the Conceptual Ambiguity Surrounding Perceived Message Effectiveness
Yzer, M. C., LoRusso, S. M., & Nagler, R. H. (2014) · Health Communication · doi:10.1080/10410236.2014.974131 · Cited by 76 · see citing works
Advancing Visual Health Communication Research to Improve Infodemic Response
King, A. J., & Lazard, A. J. (2020) · Health Communication · doi:10.1080/10410236.2020.1838094 · Cited by 74 · see citing works
Effective vaccine communication during the disneyland measles outbreak
Broniatowski, D. A., Hilyard, K. M., & Dredze, M. H. (2016) · Vaccine · doi:10.1016/j.vaccine.2016.04.044 · Cited by 73 · see citing works
Gist reasoning training in cognitively normal seniors
Anand, R., Chapman, S. B., Rackley, A., Keebler, M. W., Zientz, J., & Hart, J. (2010) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.2633 · Cited by 70 · see citing works
Improving communication of breast cancer recurrence risk
Brewer, N. T., Richman, A. R., DeFrank, J. T., Reyna, V. F., & Carey, L. (2011) · Breast Cancer Research and Treatment · doi:10.1007/s10549-011-1791-9 · Cited by 69 · see citing works
Self-citationKumar, V., Kumar, A., & Darmstadt, G. L. (2010) · Seminars in Perinatology · doi:10.1053/j.semperi.2010.09.006 · Cited by 69 · see citing works
Pieterse, A. H., de Vries, M., Kunneman, M., Stiggelbout, A. M., & Feldman‐Stewart, D. (2012) · Social Science & Medicine · doi:10.1016/j.socscimed.2012.11.020 · Cited by 68 · see citing works
Brust-Renck, P. G., Royer, C. E., & Reyna, V. F. (2013) · Reviews of Human Factors and Ergonomics · doi:10.1177/1557234x13492980 · Cited by 68 · see citing works
Self-citationNumeracy, gist, literal thinking and the value of nothing in decision making
Reyna, V. F., & Brainerd, C. J. (2023) · Nature Reviews Psychology · doi:10.1038/s44159-023-00188-7 · Cited by 66 · see citing works
Self-citationCheung, J. M. Y., Bartlett, D. J., Armour, C. L., Laba, T., & Saini, B. (2016) · Behavioral Sleep Medicine · doi:10.1080/15402002.2016.1163702 · Cited by 66 · see citing works
Long, H. A., Brooks, J. M., Harvie, M., Maxwell, A., & French, D. (2019) · British Journal of Cancer · doi:10.1038/s41416-019-0524-4 · Cited by 65 · see citing works
Smith, S. G., Wolf, M. S., & von Wagner, C. (2010) · Journal of Health Communication · doi:10.1080/10810730.2010.522690 · Cited by 64 · see citing works
Gist Memory in the Unconscious-Thought Effect
Abadie, M., Waroquier, L., & Terrier, P. (2013) · Psychological Science · doi:10.1177/0956797612470958 · Cited by 63 · see citing works
Thoma, V., White, E. P., Panigrahi, A., Strowger, V., & Anderson, I. (2015) · PLoS ONE · doi:10.1371/journal.pone.0123202 · Cited by 62 · see citing works
Broniatowski, D. A., Klein, E. Y., & Reyna, V. F. (2014) · Medical Decision Making · doi:10.1177/0272989x14553472 · Cited by 62 · see citing works
Self-citationHealth Decision Making: Lynchpin of Evidence-Based Practice
Spring, B. (2008) · Medical Decision Making · doi:10.1177/0272989x08326146 · Cited by 61 · see citing works
Local Choices: Rationality and the Contextuality of Decision-Making
Vlaev, I. (2018) · Brain Sciences · doi:10.3390/brainsci8010008 · Cited by 60 · see citing works
Klein, E. Y., Martinez, E. M., May, L. S., Saheed, M. O., Reyna, V. F., & Broniatowski, D. A. (2017) · Journal of General Internal Medicine · doi:10.1007/s11606-017-4099-6 · Cited by 58 · see citing works
Self-citationWidman, L. M., Kamke, K., Evans-Paulson, R., Stewart, J., Choukas‐Bradley, S., & Golin, C. E. (2019) · The Journal of Sex Research · doi:10.1080/00224499.2019.1630800 · Cited by 58 · see citing works
Clinical Gist and Medical Education
Lloyd, F. J. (2009) · JAMA · doi:10.1001/jama.2009.1383 · Cited by 56 · see citing works
Questioning the Quantitative Imperative: Decision Aids, Prevention, and the Ethics of Disclosure
Schwartz, P. H. (2011) · The Hastings Center Report · doi:10.1353/hcr.2011.0029 · Cited by 55 · see citing works
A Quantum Probability Perspective on Borderline Vagueness
Blutner, R., Pothos, E. M., & Bruza, P. (2013) · Topics in Cognitive Science · doi:10.1111/tops.12041 · Cited by 55 · see citing works
Howard, A. F., Balneaves, L. G., Bottorff, J. L., & Rodney, P. (2010) · Qualitative Health Research · doi:10.1177/1049732310387798 · Cited by 55 · see citing works
Viruses, vaccines, and COVID-19: Explaining and improving risky decision-making.
Reyna, V. F., Broniatowski, D. A., & Edelson, S. M. (2021) · Journal of Applied Research in Memory and Cognition · doi:10.1016/j.jarmac.2021.08.004 · Cited by 55 · see citing works
Self-citationHaase, N., Betsch, C., & Renkewitz, F. (2015) · Journal of Health Communication · doi:10.1080/10810730.2015.1018605 · Cited by 54 · see citing works
Sobków, A., Olszewska, A., & Traczyk, J. (2020) · Intelligence · doi:10.1016/j.intell.2020.101452 · Cited by 54 · see citing works
My Lived Experiences Are More Important Than Your Probabilities
Holmberg, C., Waters, E. A., Whitehouse, K., Daly, M. B., & McCaskill‐Stevens, W. (2015) · Medical Decision Making · doi:10.1177/0272989x15594382 · Cited by 53 · see citing works
Offering informed choice about breast screening
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Fast or frugal, but not both: Decision heuristics under time pressure.
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Sometimes it does hurt to ask: The constructive role of articulating impressions
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Health and Illness Perceptions
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Pre-exposure Prophylaxis State of the Science: Empirical Analogies for Research and Implementation
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Risk Communication, Values Clarification, and Vaccination Decisions
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Supporting Shared Decision Making When Clinical Evidence Is Low
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- Authors
- Reyna, V. F.
- Affiliations
- Cornell University (US)
- Corresponding author
- Reyna, Valerie F.
- ORCID
- Reyna, Valerie F.
- Venue
- Medical Decision Making
- Publisher
- SAGE Publications
- Published
- 2008-11
- Volume
- 28
- Issue
- 6
- Pages
- 850-865
- ISSN
- 0272-989X (ISSN-L)
- 1552-681X
- PMC
- PMC2617718
- OpenAlex
- W2136995860
- Cited by
- 602
- References
- 79
- Citations by year
- 2026: 19 · 2025: 26 · 2024: 17 · 2023: 26 · 2022: 40 · 2021: 38 · 2020: 43 · 2019: 30 · 2018: 49 · 2017: 46 · 2016: 40 · 2015: 42 · 2014: 38 · 2013: 48 · 2012: 37
- FWCI
- 12.57
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Medical Decision Making (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Funders
- National Institute of Mental Health (R01MH061211, MH-061211)
- National Cancer Institute (R13CA126359)
- Topics
- Social Sciences › Decision Sciences › General Decision Sciences › Decision-Making and Behavioral Economics
- Health Sciences › Health Professions › General Health Professions › Patient-Provider Communication in Healthcare
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Keywords
- fuzzy-trace theory, health behavior, risk perception, HIV prevention, cardiovascular disease, surgical risk, genetic risk, cancer prevention, retrieval, ratio concept, probability judgment, theory-based intervention
- MeSH terms
- Cardiovascular Diseases, Decision Making, Humans, Health Knowledge, Attitudes, Practice, Models, Psychological, Neoplasms, Risk Factors, Surgical Procedures, Operative, Health Behavior, HIV Infections, Fuzzy Logic, Risk Assessment, Genetic Predisposition to Disease
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