Clinicians who engage patients and family members in shared decision-making know that people don't always make healthcare decisions based on what is rational. The irrationality of healthcare decisions was a major topic of discussion at the International Society for Pharmacoeconomics and Outcomes Research's 21st Annual International Meeting.
Douglas E. Hough, PhD, associate scientist in the Department of Health Policy and Management at the Johns Hopkins University Bloomberg School of Public Health in Baltimore, was one of the experts who spoke at the ISPOR meeting.
Dr. Hough explained how mainstream economics assumes all participants are rational, but behavioral economics acknowledges participants are not always rational — which is frequently the case in healthcare.
He also outlined the following four key concepts of behavioral economics that clinicians may want to consider when making decisions about care with patients and their families.
- Loss aversion. This describes when a person dislikes the "loss" of something they possess considerably more than he or she would like to gain something new.
- Framing. When a clinician provides a patient with the same information, but focuses on a different aspect. For instance, a clinician can present the number of patients who lived post-treatment instead of the number of patients who died.
- The power of defaults. This describes when proactively consenting or opting in to one decision requires someone to opt out of an alternative decision.
- Hyperbolic discounting. A model where people make choices based much more strongly on the present than the future.
According to Dr. Hough, framing and the power of defaults can be the most persuasive models when dealing with an individual who doesn't have a strong preference either way regarding a decision related to their healthcare.
Although behavioral economics does not provide a "magic bullet" when it comes to decision-making, it may help guide decisions and improve outcomes, he concluded.