This study introduces and evaluates a model of motivated health decision processing. In this model, threatening health decision information is thought to lead to two potentially incompatible motivations in decision makers: the desire to process information in an effortful manner, and the desire to defend against threat. The model proposes that these dual motivations lead to biased but effortful processing of decision options. The model was tested empirically by experimentally manipulating exposure to threatening information and measuring decision information processing and decision strategy selection. Participants (N = 100; age 40+) were randomly assigned to one of two groups and exposed to either threatening or non-threatening information about skin cancer. They were asked to read about and choose from five skin cancer treatments; a computerized process-tracing tool recorded their pattern of information acquisition as they perused the information. Results showed that compared to participants in the low threat condition, participants in the high threat condition were more likely to avoid information about death and to use an attribute-based decision strategy. Participants in the high threat condition and participants who used an attribute-based decision strategy were also more likely to make an accurate decision. Post hoc analyses showed that participants in the high threat condition were more likely than participants in the low threat condition to use an effective lexicographic decision strategy, and that anxiety and impulsivity moderated the relationship between condition and decision strategy. The results of this study suggest that exposure to perceived threats can lead to patients' avoidance of frightening, but important, information about treatments and to the use of heuristic decision strategies while making treatment decisions
