title: Being Kind to Your Future Self: Probability Discounting of Health Decision-Making.
abstract: BACKGROUND
  Nearly 50 % of patients with chronic medical illness exhibit poor treatment adherence. When making treatment decisions, these patients must balance the probability of current side effects against the probability of long-term benefits. This study examines if the behavioral economic construct of probability discounting can be used to explain treatment decisions in chronic disease.
  
  
  METHODS
  Thirty-eight nonadherent and 39 adherent patients with multiple sclerosis (MS) completed a series of hypothetical treatment scenarios with varied risk and benefit probabilities.
  
  
  RESULTS
  As described by a hyperbolic probability discounting model, all patients reported decreased medication initiation as the probability of treatment efficacy decreased and the probability of treatment side effects increased. When compared to adherent patients, nonadherent patients significantly devalued treatment efficacy and inflated treatment risk.
  
  
  CONCLUSIONS
  The methods in this study can be used to identify optimal risk/benefit ratios for treatment development and inform the process by which patients make treatment decisions.
authors.affiliation: University of Missouri-Kansas City, Kansas City, MO, USA.
authors.forename: Jared M
authors.initials: JM
authors.lastname: Bruce
authors.affiliation: Department of Pediatrics, University of Kansas Medical Center, 3901 Rainbow Blvd Mail Stop 4004, Kansas City, KS, 66160, USA. abruce@kumc.edu.|Children's Mercy Hospital, Kansas City, MO, USA. abruce@kumc.edu.
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Bruce
authors.affiliation: University of Missouri-Kansas City, Kansas City, MO, USA.
authors.forename: Delwyn
authors.initials: D
authors.lastname: Catley
authors.affiliation: Department of Neurology, University of Kansas Medical Center, Kansas City, KS, 66160, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Lynch
authors.affiliation: Children's Mercy Hospital, Kansas City, MO, USA.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Goggin
authors.affiliation: University of Kansas, Lawrence, KS, USA.
authors.forename: Derek
authors.initials: D
authors.lastname: Reed
authors.affiliation: University of Missouri-Kansas City, Kansas City, MO, USA.
authors.forename: Seung-Lark
authors.initials: SL
authors.lastname: Lim
authors.affiliation: Kessler Foundation, West Orange, NJ, USA.
authors.forename: Lauren
authors.initials: L
authors.lastname: Strober
authors.affiliation: University of Missouri-Kansas City, Kansas City, MO, USA.
authors.forename: Morgan
authors.initials: M
authors.lastname: Glusman
authors.affiliation: University of Missouri-Kansas City, Kansas City, MO, USA.
authors.forename: Abigail R
authors.initials: AR
authors.lastname: Ness
authors.affiliation: University of Kansas, Lawrence, KS, USA.
authors.forename: David P
authors.initials: DP
authors.lastname: Jarmolowicz
mesh_terms: D000328:Adult; D003657:Decision Making / Q000502:physiology*; D065786:Delay Discounting; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000188:drug therapy / Q000523:psychology*; D010349:Patient Compliance / Q000523:psychology*; D012201:Reward; D016896:Treatment Outcome
keywords: Behavioral economics; Compliance; Medical decision-making; Multiple sclerosis; Probability discounting; Temporal discounting; Treatment adherence