title: Behavioral economic insights into physician tobacco treatment decision-making.
abstract: BACKGROUND
  Physicians self-report high adherence rates for Ask and Advise behaviors of tobacco dependence treatment but are much less likely to engage in "next steps" consistent with sophisticated management of chronic illness. A variety of potential explanations have been offered, yet each lacks face validity in light of experience with other challenging medical conditions.
  
  
  OBJECTIVE
  Conduct a preliminary exploration of the behavioral economics of tobacco treatment decision-making in the face of uncertain outcomes, seeking evidence that behaviors may be explained within the framework of Prospect Theory.
  
  
  METHODS
  Four physician cohorts were polled regarding their impressions of the utility of tobacco use treatment and their estimations of "success" probabilities. Contingent valuation was estimated by asking respondents to make monetary tradeoffs relative to three common chronic conditions.
  
  
  RESULTS
  Responses from all four cohorts showed a similar pattern of high utility of tobacco use treatment but low success probability when compared with the other chronic medical conditions. Following instructional methods aimed at controverting cognitive biases related to tobacco, this pattern was reversed, with success probabilities attaining higher valuation than for diabetes.
  
  
  CONCLUSIONS
  Important presuppositions regarding the potential "success" of tobacco-related patient interactions are likely limiting physician engagement by favoring the most secure visit outcome despite the limited potential for health gains. Under these conditions, low engagement rates would be consistent with Prospect Theory predictions. Interventions aimed at counteracting the cognitive biases limiting estimations of success probabilities seem to effectively reverse this pattern and provide clues to improving the adoption of target clinical behaviors.
authors: 1 Division of Pulmonary and Critical Care Medicine, Leonard Davis Institute of Health Economics.
authors: Frank T
authors: FT
authors: Leone
authors: Sarah
authors: S
authors: Evers-Casey
authors: Sarah
authors: S
authors: Graden
authors: Robert
authors: R
authors: Schnoll
mesh_terms: D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000191:economics / Q000379:methods*; D003657:Decision Making; D060909:Economics, Behavioral; D005260:Female; D006801:Humans; D008297:Male; D010817:Physician-Patient Relations; D014029:Tobacco Use Disorder / Q000191:economics / Q000523:psychology / Q000628:therapy*
keywords: behavioral economics; cognitive bias; physician education; prospect theory; tobacco dependence treatment