title: A matter of perspective: choosing for others differs from choosing for yourself in making treatment decisions.
abstract: BACKGROUND
  Many people display omission bias in medical decision making, accepting the risk of passive nonintervention rather than actively choosing interventions (such as vaccinations) that result in lower levels of risk.
  
  
  OBJECTIVE
  Testing whether people's preferences for active interventions would increase when deciding for others versus for themselves.
  
  
  METHODS
  Survey participants imagined themselves in 1 of 4 roles: patient, physician treating a single patient, medical director creating treatment guidelines, or parent deciding for a child. All read 2 short scenarios about vaccinations for a deadly flu and treatments for a slow-growing cancer.
  
  
  METHODS
  Two thousand three hundred and ninety-nine people drawn from a demographically stratified internet sample.
  
  
  METHODS
  Chosen or recommended treatments. We also measured participants' emotional response to our task.
  
  
  RESULTS
  Preferences for risk-reducing active treatments were significantly stronger for participants imagining themselves as medical professionals than for those imagining themselves as patients (vaccination: 73% [physician] & 63% [medical director] vs 48% [patient], Ps<.001; chemotherapy: 68% & 68% vs 60%, Ps<.012). Similar results were observed for the parental role (vaccination: 57% vs 48%, P=.003; chemotherapy: 72% vs 60%, P<.001). Reported emotional reactions were stronger in the responsible medical professional and parental roles yet were also independently associated with treatment choice, with higher scores associated with reduced omission tendencies (OR=1.15 for both regressions, Ps<.01).
  
  
  CONCLUSIONS
  Treatment preferences may be substantially influenced by a decision-making role. As certain roles appear to reinforce "big picture" thinking about difficult risk tradeoffs, physicians and patients should consider re-framing treatment decisions to gain new, and hopefully beneficial, perspectives.
authors.affiliation: VA Health Services Research & Development Center for Practice Management and Outcomes Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. bzikmund@med.umich.edu
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Zikmund-Fisher
authors.forename: Brianna
authors.initials: B
authors.lastname: Sarr
authors.forename: Angela
authors.initials: A
authors.lastname: Fagerlin
authors.forename: Peter A
authors.initials: PA
authors.lastname: Ubel
mesh_terms: D002755:Choice Behavior; D003657:Decision Making; D006801:Humans; D007252:Influenza Vaccines; D010358:Patient Participation; D017060:Patient Satisfaction; D010817:Physician-Patient Relations
chemical_list: D007252:Influenza Vaccines