Perspectives on using decision-making nudges in physician-patient communications

Area of Science:

• Medical Ethics
• Health Communication
• Decision Science

Background:

• Shared decision-making involves patients weighing uncertain outcomes and emotions.
• Nudges, or choice-influencing techniques, can aid complex medical decisions but raise ethical concerns regarding influence.

Purpose of the Study:

• To assess the ethicality and appropriateness of using nudges in medical decision-making.
• To compare perceptions of nudges between physicians and non-clinicians.

Main Methods:

• Surveyed 89 resident physicians and 336 non-clinicians (Mechanical Turk workers).
• Participants evaluated hypothetical advanced cancer patient scenarios involving chemotherapy vs. hospice choices.
• Scenarios varied based on patient decision-making bias and physician use of nudges.

Main Results:

• Both physicians and non-clinicians viewed nudges more positively than their absence, regardless of patient bias.
• Physicians favored nudges endorsing hospice; non-clinicians favored nudges endorsing chemotherapy.
• Nudges were perceived as more ethical and appropriate when used compared to not using them.

Conclusions:

• Nudges may be considered ethical and appropriate in medical decision-making by both clinicians and the public.
• Differential preferences for nudges between physicians and patients highlight potential limitations for their application.
• Further research is needed to explore these perceptual differences and inform effective nudge implementation.