The role of behavioural economics in medical decision-making for patients and providers

Hodges, Juliet (2024) The role of behavioural economics in medical decision-making for patients and providers. PhD thesis, London School of Economics and Political Science.

Text - Submitted Version Restricted to Repository staff only until 21 January 2027. Download (2MB)

Abstract

Finding ways to improve the quality of care delivered by clinicians, and the engagement of patients in decisions about their health, is a critical policy challenge. Behavioural economics has emerged in recent decades as a potential solution to help bridge the gap between people’s intentions and their actions. While it is a promising approach for influencing clinician behaviour, it has been underused in areas that prioritise patient autonomy, such as advance care planning (ACP) and shared decision-making (SDM). This thesis explores each of these themes, in three parts. In Part 1, a systematic review categorises, for the first time, the types of clinician behaviour that have been targeted with nudge interventions. This review finds that nudges to reduce undesirable behaviour, such as antibiotic prescribing, are both the most frequent and least successful, while very few interventions address patient engagement in decision-making. In Part 2, attention turns to ACP. In the UK, end-of-life wishes are commonly documented through an advance decision to refuse treatment (ADRT). The framing of comfort care as refusal of treatment was found in two online RCTs to significantly increase the likelihood of participants choosing life-prolonging care. However, this framing also led to more value-concordant decisions, which suggests there are benefits of positioning ACP in this way. In Part 3, measuring patients’ and clinicians’ perceptions of each other revealed an asymmetry between the level of SDM clinicians think they are providing and what patients report receiving. A final pilot study with orthopaedic surgeons tested a promising social norm message to increase their involvement of patients in decisions about treatment options. Taken together, this thesis demonstrates that behavioural economics is a potent tool for understanding patient barriers to ACP and influencing clinician behaviour, both in general and with regards to SDM.

Item Type:	Thesis (PhD)
Additional Information:	© 2024 Juliet Hodges
Library of Congress subject classification:	B Philosophy. Psychology. Religion > BF Psychology R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Sets:	Departments > Psychological and Behavioural Science
Supervisor:	Galizzi, Matteo M.
URI:	http://etheses.lse.ac.uk/id/eprint/4806

Actions (login required)

Record administration - authorised staff only