Analyses
Between-Subjects Factor
- Memory test condition (3): Verbatim only , Gist only, Verbatim + Gist
Within-Subjects Factors
- Medication type (2): methotrexate, hydroxychloroquine
- Item type (4): True and verbatim, True and gist-consistent , False (gist-inconsistent and filler)
- True and verbatim (14 items): “For rheumatoid arthritis, one to three tablets are usually taken once a day. [Hydroxychloroquine]”
- True and gist-consistent (14 items): ”For rheumatoid arthritis treatment, hydroxychloroquine tablets are taken daily.”
- False (21 items):
- Gist-inconsistent (14 items): “For rheumatoid arthritis treatment, two tablets are usually taken once a week. [Hydroxychloroquine]”
- Filler (7 items): “Store it in the fridge below 40 degrees Fahrenheit. [Hydroxychloroquine]”
Fuzzy-Trace Theory
- Patients simultaneously encode verbatim representations of new information (e.g., “One to three tablets are taken once a day”) as well as qualitative interpretations of it (e.g., “Daily medication required”).1
- Gist memories are more enduring and easier to retrieve than verbatim memories.2
- Traditional dual-process theories of memory differentiate between familiarity and recollection. However, they cannot account for the high frequency of false alarms elicited by distractors that are semantically related to the studied information (gist-based distractors).
- Fuzzy-Trace Theory-based ‘Conjoint Recognition’ models differentiate between gist-based and verbatim-based memory processes.3
Sample
- N = 178 healthy adults (♀ = 137, ♂ = 41, Mage = 19.93, SDage = 2.12)
- Participants were naïve to the medication information
- 6% reported direct (self) and 6% reported indirect (e.g., family environment) experience with various arthritis medication types
- arthritis medication knowledge (16 items): M = 1.21, SD = 2.23, range: 0 - 11
| 3 Brainerd, C. J., Wright, R., Reyna, V. F. (2001). Conjoint recognition and phantom recollection. Journal of Experimental Psychology: Learning Memory and Cognition, 27 (2), 307-327. 4 For modeling instructions, visit: https://www.human.cornell.edu/hd/research/labs/memorylab/research | |
1 Reyna, V. F. (2008). A theory of medical decision making and health: fuzzy trace theory. Medical Decision Making, 28(6), 829–833. 2 Add reference. | This research was funded by a PCORI grant. |
Purpose
- Patient-centered informed decision-making requires that patients understand risk and safety information, e.g., about medications that can produce serious adverse outcomes.
- Arthritis medication is a prime example of a treatment that can involve severe side effects such as pneumonia and cancer.
- Medication safety guides are designed to inform patients about medication risks but modern memory theories have not been applied to assess what is encoded and retained from these guides.
Apply Fuzzy-Trace Theory to assess true and false memory for two widely distributed arthritis medication guides.
Conclusions - Healthy young adults primarily encode and retain gist representations of written medication information.
- Verbatim memory for some facts interfered with recognizing other facts.
- The studied memory processes generalize: results replicated across drugs.
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Discussion
- A model omitting erroneous recollection rejection (using verbatim memory of what was presented to erroneously reject other verbatim information) did not fit the data.
- A “sentence variant” Conjoint Recognition model with B1 = B2 fit the data well.
- Result revealed distinct verbatim and gist memories for medication information as well as phantom recollection - highly vivid false memories for gist-consistent information that was never presented.
Gist-Based False Memory for Risk and Safety Information
about Arthritis Medication
Valerie F. Reyna, Ph.D.*, Julia Nolte, M.Sc.*, & Susan J. Blalock, M.P.H., Ph.D.**
Research Fuzzy-Trace Theory suggests that effects of gist-based false memory should be even more pronounced for older adults. As a result, we are currently replicating the presented results in a sample of older arthritis patients. | Health Care Providers should anticipate that patients may falsely remember risk and safety information that is consistent with their gist representations, rather than precise facts, and may attribute that information to trusted sources such as medication guides. |
Limitations
- Participants were healthy young adults and thus not representative of typical arthritis patients (common age of disease onset: between 30 and 60 years).
- Both SafeMedicationTM guides require advanced literacy skills (Flesch-Kinkaid grade 11). Results may not generalize to other medication information.
Table 2: Conjoint Recognition Parameter Estimates for B1 = B2 |
| | | | |
| probability of accepting a distractor due to response bias in the verbatim condition | | | |
| probability of accepting a distractor due to response bias in the gist condition | | | |
| probability of accepting a distractor due to response bias in the mixed (verbatim + gist) condition | | | |
| erroneous recollection rejection (rejects target based on gist-cued verbatim traces of different target) | | | |
| identity judgment (accepts a target based on verbatim traces of that target) | | | |
| probability of rejecting a distractor based on gist-cued verbatim traces of a target | | | |
| probability of distractor acceptance due to phantom recollection | | | |
| similarity judgment for target | | | |
| similarity judgment for related distractor | | | |
Table 1: Conjoint Recognition Model Fit |
| | | |
| Log Likelihood = – 10,593.95 | | | | | | | | | | |
| | | | | | | | | | | |
| Log Likelihood = – 10,585.61 | | | | | | | | | | |
Study design
- Materials
- ASHP (American Society for Health System Pharmacists) SafeMedicationTM information about two commonly prescribed immunosuppressants: methotrexate and hydroxychloroquine
1) Knowledge test
2) 2 medication guides
- counterbalanced presentation order
3) Buffer tasks and demographic questions
4) Memory test
- randomized presentation order; sentence model variant4
Fit a Conjoint Recognition model to participants‘ memory data.