Uncertain futures: Individual risk and social context in decision-making in cancer screening

Abstract

A core logic of cancer control and prevention, like much in public health, turns on the notion of decision-making under conditions of uncertainty. Population-level data are increasingly used to develop risk profiles, or estimates, that clinicians and the consumer public may use to guide individual decisions about cancer screening. Individual risk perception forms a piece of a larger social economy of decision-making and choice that makes population screening possible. Individual decision-making depends on accessing and interpreting available clinical information, filtered through the lens of personal values and both cognitive and affective behavioural processes. That process is also mediated by changing social roles and interpersonal relationships. This paper begins to elucidate the influence of this ‘social context’ within the complexity of cancer screening. Reflecting on current work in risk and health, I consider how ethnographic narrative methods can enrich this model.

Keywords:

• risk
• risk perception
• cancer
• uncertainty
• screening

Notes

1. The author acknowledges extensive discussions with Dr. Paul Han and other study co-authors in conjunction with the research collaboration supported by the NCI Division of Cancer Control and Population Sciences through Dr. Andrew Freedman (see Han 2009, Han et al. 2009). The author is grateful for past individual support from the NCI Office of the Director, Cancer Prevention Fellowship Program (2004–08).

2. The author acknowledges on-going support, in part, from NIH/NCRR grant UL1RR024982-03 (Packer) that also sponsors the North and Central Texas Clinical and Translational Sciences pilot award to the author for fieldwork discussed here.

3. Ms. Angeline, Owen, Fred and Mike are pseudonyms of focus group participants and adapted for this paper. Off-set dialogue constitutes actual quotes from focus group data; character descriptions are comparable to the demographics of lay sample participants.