Helping patients make better decisions: how to apply behavioral economics in clinical practice

Figures & data

Table 1 Examples of behavioral economics used for common clinical questions

How can I best encourage my patients to get an influenza immunization?

Framing examples:

Instead of saying “It’s time to get a flu shot.”, use framing:

“Set a good example for your family and get peace of mind. Get your flu shot.” (gain frame) or “Your family needs you to be healthy, now and later, so get your flu shot.” (loss frame). In the context of flu shots, the desire to avoid regret is a powerful motivator.

Norms example:

“Last year, over xx% of my patients (or patients at this clinic) got a flu shot.” The more similar the comparison group to the patient, the better. Note: this assumes the number is quite high. What if the numbers are not so great? Tell a story about a patient who regretted not getting the shot or one who ended up being really grateful to have had it.

Is it better to explain the risks of a treatment first and then the expected benefits or vice versa? Does the explanation sequence matter?

Default example:

If a patient has no strong preference, the order of treatment options may matter, as they may choose the first option mentioned, especially if it is perceived as a recommendation.

How can I help my patient to understand their disease risk level? Are numbers or pictures better?

Framing example: Pictures can often better convey individual risk level, as many patients can relate to these more easily than to statistics. Picture tables of risk can be found at http://www.npc.nhs.uk/therapeutics/cardio/cd_lipids/resources/pda_Lipids.pdf,^Citation40 which can be used to explain someone’s personal risk of heart attack when using statins.

Table 2 Summary of major behavioral economics strategies*

Name of principle	Behaviors	Strategy with patients
Affect/emotion	Our emotional associations can powerfully affect our actions; we make decisions based on emotion or affect, not statistics	Use anecdotes and stories to emphasize a point
Loss aversion	Losing something causes us more mental anguish than gaining something of the same value (loss aversion)	Frame information as to what person may lose rather than what they may gain
Incentives	We respond to prizes or privileges. Responses to incentives are shaped by things such as strongly avoiding losses	Invent and offer incentives of some kind. Frame information as to what person may lose rather than what they may gain (strong loss aversion)
Messenger	We are heavily influenced by who communicates to us. We value information more from those we trust and respect	Use your personal power in a positive way with the patient. Try to earn their trust and respect
Salience	We pay more attention to information that seems relevant to us	Make information or recommendations personal and tailored
Framing	We are influenced by the way in which information is presented to us	Frame messages to patients when conveying important information about treatment choice
Commitments	We seek to be consistent with our public promises	Ask for commitment (sign pledge, tell family and friends)
Norms	We respond to social pressure and are strongly influenced by what we think other people are doing	Use examples of others who take action
Defaults	We tend to go with the flow of preset options	Make it easier to decide to act versus not act (eg, require opt-out)
Priming	Our acts are often influenced by subconscious cues	Plan positive cues to stimulate patient choices
Ego	We take actions that make us feel better about ourselves	Recognize and praise beneficial behaviors
Present bias/discounting	We have “present-bias” preferences, which means that present benefits and costs are valued more than future benefits and costs. In other words, we discount the future. Thus, an immediate reward of $10 is valued more than a future reward of the same amount, and an immediate cost of $10 feels larger than a future cost of $10	Help patient consider present benefit of behavior or cost rather than future benefit
Rule of thumb	We adopt rules of thumb to deal with limited information-processing capacity	Assess patient’s common approach to decision making. Try not to overwhelm patient with information at one sitting

Note:

* Selected behaviors are modeled after those by the Behavioural Insights Team. Data from: © Crown copyright 2010. Cabinet Office Behavioural Insights Team. Applying Behavioural Insight to Health. London, UK: Cabinet Office; 2010. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/60524/403936_BehaviouralInsight_acc.pdf. Accessed October 15, 2014. License details available from: http://www.nationalarchives.gov.uk/doc/open-government-licence/.²⁰

National Prescribing CentreStatins patient decision aidEnglandNational Prescribing Centre2009 Available from: http://www.npc.nhs.uk/therapeutics/cardio/cd_lipids/resources/pda_Lipids.pdfAccessed September 2, 2014

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Cabinet Office Behavioural Insights TeamApplying Behavioural Insight to HealthLondon, UKCabinet Office2010 Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/60524/403936_BehaviouralInsight_acc.pdfAccessed October 15, 2014

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