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Experience and Evaluations
The manner by which individuals evaluate how good or bad it is to be in a health state is central to reaching an informed medical decision. Evidence has shown that personal experience with illness, such as being diagnosed with cancer, leads to a more positive evaluation of that health state than the general public's perception. This disparity has been attributed to a focusing bias on the part of the general public—the tendency to focus too narrowly on a single event, for example, cancer, while forgetting all the other aspects of life that will remain unaffected. One potential means for overcoming such a bias is to ask the public to imagine standing in the shoes of the patient. This perspective-taking exercise might be achieved through exposure to a vicarious illness experience, though further research is needed to test this hypothesis.
Personal Illness Experience
Researchers have consistently found that the general public gives lower evaluations of a particular health state, such as having chemotherapy to treat cancer, compared with individuals who have had personal experience with that health state. This has been described as the distinction between predicted utility, people's predictions about what they think chemotherapy would be like (i.e., unimaginably horrible), versus experienced utility, how the experience of chemotherapy actually is like for cancer patients (i.e., not as bad as they expected).
Discrepancy between Patients' and Public's Evaluations
In trying to understand how health state evaluations are affected by personal experience (or the lack thereof), researchers seem to have converged on a single explanation: focusing bias. This is the tendency for the general public to focus too much on a particular event (i.e., the cancer diagnosis) and not enough on the consequences of other new and ongoing future events that will compete for one's attention. For example, the general public may evaluate health states as worse than patients do because the general public focuses too narrowly on the (a) illness, forgetting that other facets of life will be unaffected; (b) immediate loss of health, forgetting patients' ability to adapt; (c) intense negative emotions aroused by the diagnosis, forgetting that extreme emotions tend to dissipate over time; and so on.
If the general public's inability to predict the effect of illness is due to focusing too narrowly, the question then becomes “What can broaden this narrow perspective individuals bring to the medical decision-making process when they have no personal experience?”
Vicarious Illness Experience
To broaden the general public's perceptions, they could be asked to imagine what it is like to live with a long-term, chronic illness. One means for achieving this perspective-taking task could be through exposure to a second type of illness experience: the vicarious experience (VE) of illness. For clarity, it is necessary to define the terminology used here. Firsthand personal experience is when A has been diagnosed with cancer; secondhand experience is when A tells B about his cancer diagnosis; and thirdhand experience is when B tells a third party, C, about A's cancer. Of course, one may have multiple types of experiences simultaneously, as when a man's father is diagnosed with cancer. The son has his own experience of being with his father while he is treated (firsthand) and also hears from his father what the experience of being diagnosed with and undergoing treatment for cancer was like for him (secondhand). Here, VE is defined as secondhand, being directly told about another's experience.
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