Skeptical Reactions to Breast Cancer Screening Benefits and Harms: Antecedents, Consequences, and Implications for Screening Communication

Objective: When people receive information about the benefits and harms of mammography screening, they do not always accept it at face value and instead express skepticism. The purpose of this research was to identify the psychological drivers of this skepticism. Two theory-driven hypotheses were considered: One hypothesis proposes that skeptical reactions reflect a psychological defense against information that is emotionally aversive. Another proposes that skeptical reactions reflect a normative probabilistic inference that information that conflicts with prior beliefs is unlikely to be true. This work also identified the potential consequences of skepticism for people's screening preferences. Method: A nationally representative sample of female participants ages 39-49 received information about the benefits and harms of mammography screening. Skepticism toward information about screening benefits and harms was measured, as well as hypothesis-relevant predictors of that skepticism. Participants' preferred age to have regular mammograms was also assessed. Results: The results did not support the hypothesis that skepticism reflects an emotional defense. Instead, skepticism was associated with experiencing the information as conflicting with beliefs and past screening messages. Expressing more skepticism toward screening harms was associated with preferring to start screening at a younger age. Conclusions: These data suggest that people express skepticism toward mammography evidence not because it is aversive information, but instead because it conflicts with other things they believe and have been told. Consistent, coordinated messages from health experts about mammography evidence may therefore help to reduce skepticism, and help promote an informed patient population. Objetivo: Cuando las personas reciben informaci & oacute;n sobre los beneficios y da & ntilde;os de la mamograf & iacute;a, no siempre la aceptan al pie de la letra y, en cambio, expresan escepticismo. El prop & oacute;sito de esta investigaci & oacute;n fue identificar los impulsores psicol & oacute;gicos de este escepticismo. Se consideraron dos hip & oacute;tesis basadas en teor & iacute;as: una hip & oacute;tesis propone que las reacciones esc & eacute;pticas reflejan una defensa psicol & oacute;gica contra la informaci & oacute;n que es emocionalmente aversiva. La otra propone que las reacciones esc & eacute;pticas reflejan una inferencia probabil & iacute;stica normativa de que es poco probable que la informaci & oacute;n que entre en conflicto con creencias previas sea cierta. Este trabajo tambi & eacute;n identific & oacute; las posibles consecuencias del escepticismo en las preferencias de detecci & oacute;n de las personas. M & eacute;todos: Una muestra representativa a nivel nacional de mujeres participantes de entre 39 y 49 a & ntilde;os recibi & oacute; informaci & oacute;n sobre los beneficios y da & ntilde;os de la mamograf & iacute;a. Se midi & oacute; el escepticismo hacia la informaci & oacute;n sobre los beneficios y da & ntilde;os de la detecci & oacute;n, as & iacute; como los predictores de ese escepticismo relevantes para las hip & oacute;tesis. Tambi & eacute;n se evalu & oacute; la edad preferida de las participantes para realizarse mamograf & iacute;as peri & oacute;dicas. Resultados: Los resultados no apoyaron la hip & oacute;tesis de que el escepticismo refleja una defensa emocional. En cambio, el escepticismo se asoci & oacute; con experimentar la informaci & oacute;n como algo que conflige con creencias y mensajes de detecci & oacute;n anteriores. Expresar m & aacute;s escepticismo hacia los da & ntilde;os de las pruebas de detecci & oacute;n se asoci & oacute; con la preferencia de comenzar las pruebas a una edad m & aacute;s temprana. Conclusiones: Estos datos sugieren que las personas expresan escepticismo hacia la evidencia de la mamograf & iacute;a no porque sean aversivos a la informaci & oacute;n, sino porque entra en conflicto con otras cosas que creen y les han dicho. Por lo tanto, los mensajes coherentes y coordinados de los expertos en salud sobre la evidencia de la mamograf & iacute;a pueden ayudar a reducir el escepticismo y ayudar a promover una poblaci & oacute;n de pacientes informada.