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A critical review of clinician-directed nudges

Briana S Last1, Rinad S Beidas2, Katelin Hoskins3

  • 1Department of Psychology, Psychology Building B, Room 358, Stony Brook University, Stony Brook, NY, 11794, USA.

Current Opinion in Psychology
|August 13, 2024
PubMed

Insights

Nudges, or subtle choice architecture changes, show limited clinical decision improvements and can backfire. Healthcare systems should focus on structural interventions over these light-touch approaches.

Area of Science:

  • Health policy
  • Behavioral economics
  • Clinical decision-making

Background:

  • Nudges, subtle changes to choice presentation, have grown popular in policy.
  • Healthcare systems widely adopted nudges for clinical decision improvement.
  • Recent research highlights significant limitations and potential harms of nudges.

Purpose of the Study:

  • To evaluate the effectiveness and unintended consequences of nudges in healthcare.
  • To advocate for a shift from nudges to more comprehensive interventions.

Main Methods:

  • Review of recent research on nudge interventions in clinical settings.
  • Analysis of potential backfire effects and crowd-out phenomena.
  • Examination of structural factors influencing health outcomes.

Main Results:

  • Nudges offer modest benefits in some clinical decision contexts.
  • Nudges, especially electronic health record alerts, can backfire with unintended consequences.
  • Nudges may divert attention from crucial structural determinants of health.

Conclusions:

  • The limitations and risks of nudges necessitate a reevaluation of their use in healthcare.
  • Future interventions should prioritize multi-level, structurally focused strategies over light-touch nudges.
  • Addressing root causes of poor health requires moving beyond behavioral nudges.
Keywords:
Alarm fatigueBehavioral economicsCrowd-out effectsFraming effectsNudges

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