Choice architecture is a better strategy than engaging patients to spur behavior change

Patient engagement is increasingly seen as a potentially effective way to improve quality and lower costs in health care. We review and synthesize current research, including our work with patients' use of prescription medications, to explore whether and in what settings patient engagement may not be realistic or even necessary. Our commentary argues that a more tempered assessment of patient engagement is warranted for the following three reasons: Evidence of the effectiveness of interventions to increase patient engagement on health outcomes is not definitive; ongoing and sustained patient engagement conflicts with cognitive limitations that are the hallmark of basic human nature; and, in some settings, choice architecture and associated strategies provide a clear alternative for improving behavior and decisions without relying on ongoing engagement. We recommend the use of such strategies when possible, including the marriage of patient engagement strategies with choice architecture solutions.