Risk communication in dementia care: family perspectives

Family carers are often involved in decisions concerning the health and social care needs of people with dementia. These decisions frequently involve considering risks inherent in daily living situations and discussing these with care recipients and professionals. The purpose of this study is to understand the risks that present most concern to family carers; explore attitudes and approaches of this group towards risk; and examine how information about risks is shared between familial carers, care recipients and professionals working in dementia care. Five focus groups were held across Northern Ireland between April and July 2015 involving 22 carers. Risks of most concern were driving, falls, financial risks, getting lost and using electrical appliances. Concepts of ‘risk’ related to terms such as danger, harm and vulnerability with emphasis on consequences rather than likelihoods. The psychosocial benefits of taking risk were recognised by some participants. Discussion of risks with family members with dementia primarily involved bringing risk matters to the attention of the individual. Family carers talked with a wide range of professionals about risks. Divergences in perspectives were noted, particularly in relation to matters of health and safety. A model of risk communication is developed illustrating how this can play a key role in informed, shared decision-making where a family member has dementia, serving an important role in risk management processes in informal community dementia care.     

The Spillover effect of compulsory insurance

The assumption usually made in the insurance literature that risks are always insurable at the desired level does not hold in the real world: some risks are not—or are only partially—insurable, while others, such as civil liability or health and workers' injuries, must be fully insured or at least covered for a specific amount. We examine in this paper conditions under which a reduction in the constrained level of insurance for one risk increases the demand of insurance for another independent risk. We show that it is necessary to sign the fourth derivative of the utility function to obtain an unambiguous spillover effect. Three different sufficient conditions are derived if the expected value of the exogenous risk is zero. The first condition is that risk aversion be standard—that is, that absolute risk aversion and absolute prudence be decreasing. The second condition is that absolute risk aversion be decreasing and convex. The third condition is that both the third and the fourth derivatives of the utility function be negative. If the expected value of the exogenous risk is positive, a wealth effect is added to the picture, which goes in the opposite direction if absolute risk aversion is decreasing.     

Chancen und Herausforderungen der Rückversicherung in der gesetzlichen Krankenversicherung

In 2009 a so-called morbidity orientated risk structure equalization scheme was installed for the German statutory health insurance in order to minimize structural differences between different providers with respect to revenue and expenditures. Even with this mechanism some risks to the individual health insurance providers remain. Reinsurance could be a way to mitigate these risks, but so far only very few contracts have been signed. Moreover the existing reinsurance contracts only focus on the periphery of the statutory health insurance system such as travel health insurance. In this article we therefore analyse existing risks for individual health insurance providers and evaluate their (re-)insurability. Hereafter the potential for reinsurance solutions in the German statutory health insurance itself as well as in newer forms of healthcare provision (e.g. integrated health care and managed care) is discussed. We find that reinsurance may be a reasonable solution for many of the risks in the statutory health insurance scheme. But as research in this area is very young further analysis of the nature of risks is necessary.     

Unrecognized,concealed, or forgotten – the case of absent information in risk communication

There are differing and partially incompatible views about what kind of issues should be included into risk discussions and what kinds of risks should be emphasized and dealt with. While the emergence of new risks has been extensively studied, relatively little attention has been paid to the roles that the absence of information can play in risk debates. Potentially relevant information may be downplayed or omitted and less relevant overemphasized when actors with varying interests, knowledge bases, and risk frames interact. Multiple and cumulative environmental and health risks caused by chemicals and other stressors pose particular challenges for risk communication. We identify and discuss different forms of unrecognized, hidden, and forgotten information by using chemical risks as a case. A widely applicable typology of absent information in risk communication is outlined.     

Risk Management—the Revealing Hand

Many believe that the recent emphasis on enterprise risk management function is misguided, especially after the failure of sophisticated quantitative risk models during the global financial crisis. One concern is that top‐down risk management will inhibit innovation and entrepreneurial activities. The authors disagree and argue that risk management should function as a “revealing hand” that identifies, assesses, and mitigates risks in a cost‐efficient way. In so doing, risk management can add value by allowing companies to take on riskier projects and strategies. But to avoid problems encountered in the past, particularly during the recent crisis, risk managers must overcome deep‐seated individual and organizational biases that prevent managers and employees from thinking clearly and analytically about their risk exposures. In this paper, the authors draw lessons from seven case studies about the ways that a corporate risk management function can foster highly interactive dialogues to identify and prioritize risks, help to allocate resources to mitigate such risks, and bring clarity to the value trade‐offs and moral dilemmas that often must be addressed in decisions to manage risks. Developing an effective risk management system requires, first, an agreement about a company's objectives, values, and priorities; second, a clear formulation and communication of the firm's “risk appetite”; and, third, continuous monitoring of a firm's risk‐taking behavior against its declared risk limits. Quantitative risk models should not be the sole—or even the most important—basis for decision‐making. They cannot replace management judgment and are best used to trigger in‐depth discussions among managers and employees about the most important risks faced by the firm and the best ways to respond to them.     

Implementing Evidence-Based Practice in Health Care

This article summarizes recent research on the effectiveness of efforts to implement evidence-based health care. The authors conclude that the evidence in support of single interventions being effective in bringing about practitioner change is weak at best. The authors give examples and evaluative comments on more complex organizational and systemic interventions that are aimed at changing clinical practice, and discuss some of the barriers to their application.     

Perceived health risks and perceptions of expert consensus in modern food society

The article deals with perceptions of food and health risks. Relevant questions are: (1) To what degree do consumers associate specific negative health consequences with food additives and genetically modified food, and do their perceptions differ from the experts’ views? (2) How do consumers perceive experts’ evaluations of health risks connected to food additives and genetically modified food? The results are based on a survey of Norwegian residents in 1999/2000, and of a selected sample of Norwegian experts on food and risks. There were great differences between consumers and experts in their assessments of health risks. To varying extents, consumers associate various health consequences with the risk factors. Consumers seem to perceive experts as more united about the risk factors as health risks than experts do themselves. The findings are discussed with reference to the stigma concept and to a social constructionist perspective. The results contribute to the understanding of consumer perception of risks and their understanding of expert agreement about health risks. They also point to the importance of the interplay between consumers and experts in the public debate and communication process about food and risks.     

Shifting reactions to risks: a case study

Social science research in the field of risk analysis has emphasised evaluating the magnitude of individuals’ reactions to risks (e.g. strength and salience of concerns, frequency and forcefulness of behaviours that respond to risks). Fewer studies assess the factors that contribute to risk reactions or the types of risks to which reactions are directed (e.g. human health, wildlife health or ecosystem health risks; economic or aesthetic concerns). Theoretical and empirical research on amplification and attenuation of risk (e.g. the Social Amplification of Risk Framework) reveals that the strength of people’s reaction to risks can change markedly over time, as a function of new stimuli. We expand on this foundation to consider here how the types of risks members of the public react to may also shift over the course of their exposure to a hazard, particularly as more information about the hazard becomes available. This case study of risk reactions related to an outbreak of type E botulism in north-western Michigan, USA, demonstrates that the types of risks people react to can change substantially over time. We identify factors that contributed to changes in types of risk reactions, and then consider how these factors potentially distinguish the botulism outbreak from other outbreaks. This case study suggests that, under certain conditions, risk communication can meaningfully alter the types of risks that people react to in response to an environmental hazard. We discuss implications of these findings for risk research, risk communication and environmental conservation.     

Genetic risk information

Risk information and communication of health risks play a large role in medicine. With the growing importance of genetics and genomics in medicine, the importance of risk communication will even increase in the future. This paper starts with a discussion on the concept of medical risk information and then focusses on genetic risk information. Three examples of genetic risk information are discussed (carrier testing, susceptibility testing and pharmacogenomics testing) in order to exemplify the broad variety of types of risk information and their specific challenges for medical counselling.     

Risk Communication and the Social Amplification of Public Sector Risk

Concerns exist within the public sector about the ability of organizations to communicate issues of risk. These concerns include: the nature and magnitude of risks; the vulnerability of those who may bear the consequences associated with an event; and the sense of helplessness felt by victim groups. Apart from the public sector's role as risk generator, regulator and communicator, it also has some responsibility for dealing with the consequences of a major catastrophic event through agencies such as health care and the emergency services. Under certain conditions, it is apparent that concerns over risk issues can escalate beyond a level expected by those charged with the management of that risk. Within this framework, the effective communication of risk and uncertainty is an integral, but often neglected, part of public sector activities. This article explores the process of risk communication and risk amplification and suggests a number of perspectives on policy development.     

Critical factors and pathways influencing genetically modified food risk perceptions

This study aims to identify the critical factors and paths that affect the Chinese public’s risk perceptions of genetically modified (GM) foods from an emotional appraisal perspective. Using an experiment conducted with university undergraduate business students in China, we examined the evaluative pathways of the Chinese public by manipulating fairness and controllability appraisals in scenarios constructed about GM foods risk. The experiment was designed around two evaluative pathways – consequentialist and deontological perspectives – focusing on controllability and fairness. This led to a distinct set of emotional responses. It was found that both consequence-based and morality-based emotions caused stronger perceived risks toward GM foods. Understanding these responses provides new insight into how scientists and experts in China might best frame their communications about GM foods.     

Consequences,morality, and time in environmental risk evaluation

Environmental risks pose a serious problem to individual and societal decision‐making, and the public debate is often characterized by a conflict between morally‐principled and technically oriented points of view. Drawing on previous work of Böhm and Pfister (), we propose a model on how environmental risks are cognitively represented and how risks are evaluated. The model suggests two evaluative pathways, evaluations of consequences and evaluation of moral considerations, each leading to a distinct set of emotions and action tendencies. Either one of these pathways may become dominant depending on the evaluative focus of the person, which, in turn, depends on the causal structure of the risk. An experimental study yields confirming evidence for this model. Furthermore, the influence of time perspective, that is, the delay of negative consequences caused by an environmental risk, is investigated. Contrary to the common assumption, only weak evidence for temporal discounting effects is found. It is concluded that environmental risks, due to their strong moral component, are partly immune to time perspective.     

Optimum Allocations to Health Care Flexible Spending Accounts

Abstract

Models used to derive optimal contributions to health care flexible spending accounts (FSAs) typically assume an employee’s household annual out-of-pocket health care expenses are an absolutely continuously random variable. This assumption, however, ignores the fact that some employees may be able to accurately predict a portion of their household annual out-of-pocket health care expenses and often actually incur only those expenses during the plan year, implying that a mixed random variable may be more appropriate. In addition, data have shown that employees are setting contributions at lower levels than existing absolutely continuous models would suggest is optimal. Using a mixed model of household annual out-of-pocket health care expenses we prove that it is often optimal for employees to contribute an amount equal to their household annual predictable out-of-pocket expenses, thus avoiding the risk of forfeiture. We also propose a practical rule of thumb that employees may use for setting their FSA contributions. Overall, we recommend that employees use their FSAs to cover only their highly predictable out-of-pocket health care expenses rather than use their FSAs as a contingency fund to pay for unlikely or unexpected outof-pocket health care expenses.     

Engaging employees in health care can contain costs and improve quality

Employers need to do much more to change some of the deep-seated employee attitudes and behaviors that are driving health care costs. This article debunks common employer misconceptions about employees' attitudes and behaviors with regard to health care. It then discusses the results employers can obtain by taking specific initiatives that provide employees with the motivation and resources they need to effectively manage health risks and make informed health care decisions.     

Risk,responsibility and negative responses: a qualitative study of parental trust in childhood vaccinations

Abstract

Childhood vaccination programmes have benefits that far outweigh risks, in public health terms. However, some parents decide not to immunise their children. This paper explores the ways in which such parents talk about the perceived risks and benefits incurred by vaccinating (or not vaccinating) their children. Between 2013 and 2016, we undertook 29 in-depth interviews with non-vaccinating and/or ‘vaccine hesitant’ parents in Fremantle, Western Australia and Adelaide, South Australia. Our analysis of the interviews identified particular constructions of risk and responsibility. All interviews were transcribed and analysed using both inductive and deductive processes. Our analysis mirrors the chronological process through which parents navigate risk. We start with the concept of ‘responsibilisation’, which underpins parental engagement with decision-making and praxis. We then explore how responsiblisation takes the form of detailed and time-consuming ‘research’. Parents then attempt to navigate multiple and conflicting ‘risks’: the risk of vaccine-preventable diseases, risks associated with vaccination and risks associated with their own perceived lack of understanding. After engaging with risk, parents justify the decision and accept the associated ‘responsibility’. Parents use this sense of responsibility to navigate through the ‘responses’ of others, which we conceptualise as the risk of unwelcome consequences. In conclusion, parents have a reflexive understanding of the physical, psychological and socio-economic risks they incur as a consequence of their choice to either partially vaccinate, delay vaccination or reject vaccination for their children. They construct these risks with reference to particular discourses, engagement with expert opinion and lifestyle choices emblematic of late modernity. The risks they are willing to accept and the subsequent responsibility and blame they assume when choosing to abstain, or partially abstain, from vaccinating their children are, to the parents, coherent with their interpretation of best parenting practice.     

Optimism and the perceptions of new risks

While many risks, especially new ones, are not objectively quantifiable, individuals still form perceptions of risks using incomplete or unclear evidence about the true nature of those risks. In the case of well known risks, such as smoking, individuals perceive risks to be smaller for themselves than others, exhibiting ‘optimism bias’. Although existing evidence supports optimism bias occurring in the case of risks about which individuals are familiar, evidence does not yet exist to suggest that optimism bias applies for new risks. This paper addresses this question by examining the gap in perceptions of risks individuals have for themselves versus society and the environment, conceptualised as social and/or environmental optimism biases. We draw upon the 2002 UEA‐MORI Risk Survey to examine the existence of optimism bias and its effects on risk perceptions and acceptance regarding five science and technology‐related topics: climate change, mobile phones, radioactive waste, GM food and genetic testing. Our findings provide evidence of social and environmental optimism bias following similar patterns and optimism bias appearing greater for those risks bringing sizeable benefit to individuals (e.g. mobile phone radiation) rather than those more acutely affecting society or the environment (e.g. GM food or climate change). Social optimism bias is found to reduce risk perceptions for risks that have received large amounts of media attention, namely, climate change and GM food. On the other hand, optimism bias appears to increase risk perceptions about genetic testing.     

Prior health expenditures and risk sharing with insurers competing on quality

Insurers can exploit the heterogeneity within risk-adjustment classes to select the good risks because they have more information than the regulator on the expected expenditures of individual insurees. To counteract this cream skimming, mixed systems combining capitation and cost-based payments have been adopted that do not, however, generally use the past expenditures of insurees as a risk adjuster. In this article, two symmetric insurers compete for clients by differentiating the quality of service offered to them according to some private information about their risk. In our setting it is always welfare improving to use prior expenditures as a risk adjuster.     

The ‘Plateau‐ing’ of the European Better Regulation Agenda: An Analysis of Activities Carried out by the Barroso Commission

In this paper we examine cases commonly characterised as risk‐risk tradeoffs (i.e., creating new risks while solving existing ones), in an attempt to learn lessons that can be valuable for future regulatory decision‐making. A broad range of environmental and health literature was reviewed and numerous cases of proclaimed risk‐risk tradeoffs were analysed in order to determine: 1) why regulatory measures were initially taken, 2) why these measures caused a countervailing risk to emerge, 3) how tradeoffs could have been avoided, and 4) whether the case is a good example of a risk‐risk tradeoff. The analysis reveals that only a small number of these cases can actually be considered risk‐risk tradeoffs. In a large number of cases safer alternatives are and were available at the time decisions were made. In some cases the proclaimed risk‐risk tradeoff simply did not exist or occur, and in some cases countervailing risks were ignored for reasons unknown. In many cases, the countervailing risks could have been anticipated and avoided by proactively seeking safer alternatives, completing a tradeoff and impact assessment, or increasing stakeholder input in the decision‐making process. We conclude that concerns about risk‐risk tradeoffs are not a reasonable argument against future application of the precautionary principle. Indeed, sound decision‐making processes in the face of uncertainty should always consider and attempt to mitigate reasonable risk‐risk tradeoffs.     

What do friends and the media tell us? How different information channels affect women’s risk perceptions of age‐related female infertility

This paper investigates through which channels women receive information about the general risk levels of age‐related female infertility and how the different channels affect women’s perceptions of the risk. We find that the media reaches women of all ages, while only about one woman in four has received information from the health care system. We also find that friends and relatives are an important source of information that affects women’s risk perceptions. However, the information from friends and relatives seems to generally make female recipients more likely to overestimate the risks. We conclude that the information sources have different, sometimes even opposite, impacts on the risk perceptions, possibly making it harder for a woman to be aware of the true general risks of age‐related infertility.     

Commonplaces in Risk Talk: Face Threats and Forms of Interaction

Talk about risk is problematic for interaction; it can involve the speaker or hearer saying things that threaten participants' ‘face’, the ways they want themselves to be seen by others. One way of dealing with these threats to face, and to keep the conversation going, is the use of commonplaces. Commonplaces, generally applicable and generally known arguments, play an important role in interaction, invoking shared, taken‐for‐granted perspectives embedded in familiar roles and everyday practices. They are similar to some of the frames discussed in risk communication, but they focus our attention on rhetoric and interaction rather than cognition. In this paper, I show how commonplaces are used in focus group discussions of public choices involving dangers to life or health. They tend to be used in response to dilemmas, when a speaker is put on the spot, and they tend to lead to other commonplaces. Analysis of commonplaces supports those who argue that studies of public perception of risks and programmes of communication about risks need to be sensitive to the personal interactions, rhetorical strategies, and cultural embeddedness of any risk talk.