Critical Care Physicians' Perspectives on Nudging in Communication

Area of Science:

• Behavioral Economics
• Medical Ethics
• Qualitative Research

Background:

• Behavioral economics reveals human susceptibility to cognitive biases and heuristics.
• The conscious use of nudges by physicians to influence patient decisions remains unclear.
• Ethical implications and physician perceptions of nudging in medicine require further investigation.

Purpose of the Study:

• To explore critical care physicians' perspectives on using nudges in patient clinical decision-making.

Main Methods:

• Qualitative study utilizing semistructured interviews with 54 critical care physicians across 3 Boston tertiary care hospitals.
• Physicians were randomly selected from adult, pediatric, and neonatal critical care attending specialties.
• Thematic analysis of interview transcripts was conducted between October 2024 and February 2025.

Main Results:

• Nudging is generally perceived as a positive and essential aspect of medical communication.
• Physicians expressed ethical concerns, particularly regarding patient autonomy.
• Nudging effectiveness and appropriateness varied by clinical situation, physician specialty, sex, and experience level.
• Differences observed in nudging strategies: adult intensivists used more direct/transparent nudges, while pediatric/neonatal intensivists favored subtle nudges for shared decision-making. Female physicians focused on emotional well-being, males on efficiency/outcomes. Junior physicians were more hesitant than senior counterparts.

Conclusions:

• Physicians recognize the importance of nudging in patient communication but acknowledge ethical uncertainties.
• The findings suggest that nudging can be an effective and appropriate communication technique when tailored to specific contexts.
• Understanding physician perspectives is crucial for the ethical and effective implementation of nudging in healthcare settings.