Cognitive Biases Influence Decision-Making Regarding Postacute Care in a Skilled Nursing Facility

Area of Science:

• Gerontology
• Health Services Research
• Cognitive Psychology

Background:

• Postacute care decisions are critical for an aging US population and are targeted by payment reforms.
• Improving patient and clinician decision-making in postacute care remains a challenge.

Purpose of the Study:

• To investigate the role of cognitive biases in patient and clinician decision-making for postacute care in skilled nursing facilities (SNFs).
• To identify the most influential cognitive biases affecting these decisions.

Main Methods:

• Secondary analysis of 105 semistructured interviews with patients, caregivers, and clinicians.
• Framework analysis of interview transcripts to identify cognitive biases, informed by prior reviews.

Main Results:

• Authority bias/halo effect and framing bias were the most prevalent and impactful cognitive biases identified.
• Default/status quo bias and anchoring bias were also observed in SNF decision-making.

Conclusions:

• Cognitive biases significantly impact postacute care decisions in SNFs.
• Authority bias and framing bias may jointly increase SNF acceptance.
• Understanding these biases is crucial for high-quality patient decisions amidst healthcare transformation.