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PLoS One. 2018 Sep 19;13(9):e0202874. doi: 10.1371/journal.pone.0202874. eCollection 2018.

Perspectives on using decision-making nudges in physician-patient communications.

Fridman I1, Hart JL2,3,4,5,6,7, Yadav KN2,3,4,5, Higgins ET1,8.

Author information

1
Columbia Business School, Columbia University, New York, NY, United States of America.
2
Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania, Philadelphia, PA, United States of America.
3
Fostering Improvement in End-of-Life Decision Science (FIELDS) Program, University of Pennsylvania, Philadelphia, PA, United States of America.
4
Center of Health Incentives and Behavioral Economics (CHIBE), University of Pennsylvania, Philadelphia, PA, United States of America.
5
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States of America.
6
Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA, United States of America.
7
Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, PA, United States of America.
8
Department of Psychology, Columbia University, New York, NY, United States of America.

Abstract

Patients engaging in shared decision making must weigh the likelihood of positive and negative outcomes and deal with uncertainty and negative emotions in the situations where desirable options might not be available. The use of "nudges," or communication techniques that influence patients' choices in a predictable direction, may assist patients in making complex decisions. However, nudging patients may be perceived as inappropriate influence on patients' choices. We sought to determine whether key stakeholders, physicians, and laypersons without clinical training consider the use of nudges to be ethical and appropriate in medical decision making. Eighty-nine resident-physicians and 336 Mechanical-Turk workers (i.e., non-clinicians) evaluated two hypothetical preference-sensitive situations, in which a patient with advanced cancer chooses between chemotherapy and hospice care. We varied the following: (1) whether or not the patient's decision was influenced by a mistaken judgment (i.e., decision-making bias) and (2) whether or not the physician used a nudge. Each participant reported the extent to which the communication was ethical, appropriate, and desirable. Both physicians and non-clinicians considered using nudges more positively than not using them, regardless of an initial decision-making bias in patients' considerations. Decomposing this effect, we found that physicians viewed the nudge that endorsed hospice care more favorably than the nudge that endorsed chemotherapy, while non-clinicians viewed the nudge that endorsed chemotherapy more favorably than the nudge that endorsed hospice care. We discuss implications and propose exploring further physicians' and patients' differences in the perception of nudges; the differences may suggest limitations for using nudges in medical decisions.

PMID:
30231040
PMCID:
PMC6145510
DOI:
10.1371/journal.pone.0202874
[Indexed for MEDLINE]
Free PMC Article

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