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Can "Nudges" be Used to Guide Cancer Screening Decisions?

In a recent article published in the Journal of the American College of Radiology with collaborators at the Perelman School of Medicine and Leonard Davis Institute of Health Economics at University of Pennsylvania, VSSL member and Department of Medicine faculty Dr. Joshua Liao discussed the potential to use "nudges" -- interventions designed using principles from the discipline of behavioral economics -- to improve decision-making related to imaging-based cancer screening.

Dr. Liao and co-authors argue that suboptimal decision making and underutilization of imaging-based cancer screening tests arise from the fact that decisions to not occur in a vacuum, as well as the following factors:

1. Besides medical evidence, clinicians are heavily influenced by their practice environments, professional norms, and the design of electronic health records (EHRs).

2. Beyond personal preferences, patients are also impacted by social influences and heuristics used to ease decision making, leading to “predictably irrational behaviors” such as paying more attention to the short-term rather than longterm impact of their decisions or overweighting low probability events like harms from imaging tests or procedures.

Dr. Liao and colleagues suggest that "nudge interventions" -- subtle changes to the decision-making environment designed based on behavioral economics principles -- can impact medical decision making and may be particularly promising for improving choices related to imaging-based cancer screening. They note that there are multiple types of nudges, which can be conceptualized and organized as a “ladder of interventions” along a spectrum of intervention format and strength.

Nudges can span from light interventions based on providing or framing information about cancer screening (lower ladder rungs) to stronger interventions that attempt to directly influence decisions by planning or guiding choices about ordering and obtaining screening tests (higher ladder rungs). Specific types of nudges (eg, defaults) can be used alone, or in concert with other nudges (eg, informational feedback), to improve decision making and make the optimal choice the path of least resistance.

Learn more about Dr. Liao's work related to nudges and behavioral economics.


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