title: Decision-making strategies: ignored to the detriment of healthcare training and delivery?
abstract: Context: People do not always make health-related decisions which reflect their best interest - best interest being defined as the decision they would make if they carefully considered the options and fully understood the information available. A substantial literature has developed in behavioral economics and social psychology that seeks to elucidate the patterns in individual decision-making. While this is particularly relevant to healthcare, the insights from these fields have only been applied in a limited way. To address the health challenges of the twenty-first century, healthcare providers and healthcare systems designers need to more fully understand how individuals are making decisions.Methods: We provide an overview of the theories of behavioral economics and social psychology that relate to how individuals make health-related decisions. The concentration on health-related decisions leads to a focus on three topics: (1) mental shortcuts and motivated reasoning; (2) implications of time; and (3) implications of affect. The first topic is relevant because health-related decisions are often made in a hurry without a full appreciation of the implications and the deliberation they warrant. The second topic is included because the link between a decision and its health-related outcomes can involve a significant time lag. The final topic is included because health and affect are so often linked.Findings: The literature reviewed has implications for healthcare training and delivery. Selection for medical training must consider the skills necessary to understand and adapt to how patients make decisions. Training on the insights garnered from behavioral economics and social psychology would better prepare healthcare providers to effectively support their clients to lead healthy lives. Healthcare delivery should be structured to respond to the way in which decisions are made.Conclusions: These patterns in decision-making call into question basic assumptions our healthcare system makes about the best way to treat patients and deliver care. This literature has implications for the way we train physicians and deliver care.
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School , Boston , MA , USA ; Human and Social Development Research Programme, Human Sciences Research Council , Pretoria , South Africa.
authors.forename: Chris
authors.initials: C
authors.lastname: Desmond
authors.affiliation: Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital , Boston , MA , USA.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Brubaker
authors.affiliation: Department of Global Health and Social Medicine, Harvard Medical School , Boston , MA , USA ; Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital , Boston , MA , USA.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Ellner
keywords: choice behavior; decision theory; decision-making; health behavior