Looking at Patients' Choices through the Lens of Expected Utility: A Critique and Research Agenda
ABSTRACT The expected utility framework underlies much research in medical decision making. Because the framework requires decisions to be decomposed into probabilities of states and the values of those states, researchers have investigated the two components separately from each other and from patients' actual decisions. The authors propose that it would be productive to focus more research on the relationships among risk perceptions, outcome valuations, and choices in the same decision makers. They outline exploratory analyses based on two existing national surveys, the Medical Expenditure Panel Survey and the Joint Canada/United States Survey of Health.
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ABSTRACT: To introduce a new online generic decision support system based on multicriteria decision analysis (MCDA), implemented in practical and user-friendly software (Annalisa©). All parties in health care lack a simple and generic way to picture and process the decisions to be made in pursuit of improved decision making and more informed choice within an overall philosophy of person- and patient-centred care. The MCDA-based system generates patient-specific clinical guidance in the form of an opinion as to the merits of the alternative options in a decision, which are all scored and ranked. The scores for each option combine, in a simple expected value calculation, the best estimates available now for the performance of those options on patient-determined criteria, with the individual patient's preferences, expressed as importance weightings for those criteria. The survey software within which the Annalisa file is embedded (Elicia©) customizes and personalizes the presentation and inputs. Principles relevant to the development of such decision-specific MCDA-based aids are noted and comparisons with alternative implementations presented. The necessity to trade-off practicality (including resource constraints) with normative rigour and empirical complexity, in both their development and delivery, is emphasized. The MCDA-/Annalisa-based decision support system represents a prescriptive addition to the portfolio of decision-aiding tools available online to individuals and clinicians interested in pursuing shared decision making and informed choice within a commitment to transparency in relation to both the evidence and preference bases of decisions. Some empirical data establishing its usability are provided.Health expectations: an international journal of public participation in health care and health policy 08/2013; DOI:10.1111/hex.12111 · 2.85 Impact Factor
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ABSTRACT: The quality and safety of health care are under increasing scrutiny. Recent studies suggest that medical errors, practice variability, and guideline noncompliance are common, and that cognitive error contributes significantly to delayed or incorrect diagnoses. These observations have increased interest in understanding decision-making psychology.Many nonrational (i.e., not purely based in statistics) cognitive factors influence medical decisions and may lead to error. The most well-studied include heuristics, preferences for certainty, overconfidence, affective (emotional) influences, memory distortions, bias, and social forces such as fairness or blame.Although the extent to which such cognitive processes play a role in anesthesia practice is unknown, anesthesia care frequently requires rapid, complex decisions that are most susceptible to decision errors. This review will examine current theories of human decision behavior, identify effects of nonrational cognitive processes on decision-making, describe characteristic anesthesia decisions in this context, and suggest strategies to improve decision-making.Anesthesiology 11/2013; DOI:10.1097/ALN.0000000000000073 · 6.17 Impact Factor
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ABSTRACT: Objective To examine the effect of ordering information in a patient decision aid (PtDA) about treatments for obstructive sleep apnea (OSA). Methods We recruited 643 individuals to imagine that they had been diagnosed with OSA and to choose between treatment options. A value clarification exercise was used to determine which attributes of treatment mattered most to each individual. Before deciding on their preferred treatment option, we randomly assigned participants to view information with attributes in: a pre-specified order (Group 1), order of what mattered most last (Group 2), and first (Group 3). Results Of the 510 participants who provided usable results, viewing information that mattered most first was associated with choosing the treatment option most concordant with their informed values. The order effect was most pronounced in younger individuals. Conclusions In this study of hypothetical patients, order effects were found to improve the information patients focussed on, potentially improving the quality of their decisions. Practice implications The order of information presented in a PtDA can inadvertently influence patients’ choices. By tailoring information order for each patient, developers can not only overcome this dilemma, but also make it simpler for patients to choose the option that is best for them.Patient Education and Counseling 08/2014; 96(2). DOI:10.1016/j.pec.2014.05.021 · 2.60 Impact Factor