For prostate cancer, there was an optimistic bias for all HBM variables: risk and severity of prostate cancer and barriers to and benefits of screening. Women had an optimistic bias in relation to breast cancer risk and severity and barriers to having a screening mammogram but not in relation to the benefits of screening. In the first study 164 women aged 50 to 70 years responded to questions about breast cancer and screening mammography, while in the second study 200 men aged 45 to 60 years responded to questions about prostate cancer and screening using the prostate specific antigen test. Data were collected using telephone interviews, dialing numbers randomly selected from the telephone directory. To overcome this compartmentalization, two studies of cancer screening behavior assessed the extent to which unrealistic optimism occurred in relation to each of the elements of the HBM: severity and curability of cancer and the benefits of, and barriers to, having a screening test. It will require us to pay more attention to how patient-subjects apply information to themselves and to become more aware of the social-psychological factors that might impair decision-making in this context.Why do people fail to engage in positive behaviors which will promote their health and well-being? Researchers addressing this question adopt primarily one of two perspectives, drawing either on theories of health behavior, such as the Health Belief Model (HBM), or on theories of risk perception, such as unrealistic optimism. The authors said that unrealistic optimism has the potential to compromise informed consent "by interfering with the ability to apply information realistically." They concluded: "Improving the consent process in oncology research will require us to do more than address deficits in understanding.
Misunderstanding the purpose was not significantly related to unrealistic optimism, the study found. However, a substantial majority of the respondents – 72 percent – accurately understood that the purpose of the trials was to advance knowledge with the potential to benefit future patients and not necessarily to benefit them. Study respondents exhibited unrealistic optimism in response to three of five questions about the likelihood of particular events happening to them compared with other trial participants: having their cancer controlled by drugs administered in the trials, experiencing a health benefit from the drugs in the trials, and not experiencing a health problem from the drugs in the trials. Individuals can have one form of optimism without the other. Unrealistic optimism, which social psychologists define as being specific to a situation and consider a form of bias, is distinct from "dispositional optimism," which is a general outlook on life and is neither realistic nor unrealistic. Questionnaires assessed signs of unrealistic optimism, as well as participants' understanding of the trials' purpose.
The study included 72 patients with cancer who were enrolled in early-phase oncology trials in the New York metropolitan area between August 2008 and October 2009. "Others have claimed that unrealistic expectations for benefit are a result of misunderstanding and that the proper response to them is to provide patient-subjects with more information…" But the study cast doubt on both assumptions. Many cancer researchers and ethicists assume that hope and optimism in the research context are "always ethically benign, without considering the possibility that they reflect a bias," write the authors of the study, which appears in IRB: Ethics & Human Research.
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