Can avoidance of complications lead to biased healthcare decisions?
Imagine that you have just received a colon cancer diagnosis and need to choose between two different surgical treatments. One surgery, the ``complicated surgery,'' has a lower mortality rate (16\% vs. 20\%) but compared to the other surgery, the ``uncomplicated surgery,'' also c...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Cambridge University Press
2006-07-01
|
| Series: | Judgment and Decision Making |
| Subjects: | |
| Online Access: | http://journal.sjdm.org/jdm06008.pdf |
| _version_ | 1797722992721002496 |
|---|---|
| author | Jennifer Amsterlaw Brian Zikmund-Fisher Angela Fagerlin Peter A. Ubel |
| author_facet | Jennifer Amsterlaw Brian Zikmund-Fisher Angela Fagerlin Peter A. Ubel |
| author_sort | Jennifer Amsterlaw |
| collection | DOAJ |
| description | Imagine that you have just received a colon cancer diagnosis and need to choose between two different surgical treatments. One surgery, the ``complicated surgery,'' has a lower mortality rate (16\% vs. 20\%) but compared to the other surgery, the ``uncomplicated surgery,'' also carries an additional 1\% risk of each of four serious complications: colostomy, chronic diarrhea, wound infection, or an intermittent bowel obstruction. The complicated surgery dominates the uncomplicated surgery as long as life with complications is In our first survey, 51\% of a sample (recruited from the cafeteria of a university medical center) selected the dominated alternative, the uncomplicated surgery, justifying this choice by saying that the death risks for the two surgeries were essentially the same and that the uncomplicated surgery avoided the risk of complications. In follow-up surveys, preference for the uncomplicated surgery remained relatively consistent (39\%--51\%) despite (a) presenting the risks in frequencies rather than percents, (b) grouping the 4 complications into a single category, or (c) giving the uncomplicated surgery a small chance of complications as well. Even when a pre-decision ``focusing exercise'' required people to state directly their preferences between life with each complication versus death, 49\% still chose the uncomplicated People's fear of complications leads them to ignore important differences between treatments. This tendency appears remarkably resistant to debiasing approaches and likely leads patients to make healthcare decisions that are inconsistent %Background: Imagine that you have just received a colon cancer diagnosis %and need to choose between two different surgical treatments. One %surgery, the ``complicated surgery,'' has a lower mortality rate (16\% %vs. 20\%) but compared to the other surgery, the ``uncomplicated %surgery,'' also carries an additional 1\% risk of each of four serious %complications: colostomy, chronic diarrhea, wound infection, or an %intermittent bowel obstruction. The complicated surgery dominates the %uncomplicated surgery as long as life with complications is preferred %over death. However, people's aversion to these %complications might make them choose the uncomplicated surgery, the %dominated alternative. %Methods: We presented the above scenario to a general population sample %recruited from the cafeteria of a university medical center. %Information about the probability of treatment outcomes was presented %both in text and in a summary table. Participants were then asked to %select which surgery they would choose. We varied the presentation %format in a series of follow-up surveys to examine effects on choice. %Results: In our first survey, 51\% of the sample (N=87, M age= 39 yrs., %65\% female) selected the dominated alternative, the uncomplicated %surgery. Participants justified this choice by saying that the death %risks for the two surgeries were essentially the same, and the %uncomplicated surgery avoided the risk of complications. In the %follow-up surveys, preference for the uncomplicated surgery remained %relatively consistent (39\%--51\%) despite (a) presenting the risks in %frequencies rather than percents, (b) grouping the 4 complications into %a single category, or (c) giving the uncomplicated surgery a small %chance of complications as well. Even when a pre-decision %``focusing exercise'' required people to %state directly their preferences between life with each complication %versus death (92\% preferred life with any of the complications listed %over death), 49\% of participants (N=77, M age= 39 yrs., 67\% female) %still chose the uncomplicated surgery. %Conclusions: People's fear of complications leads them %to ignore important differences between treatments. This tendency %appears remarkably resistant to debiasing approaches and likely leads %patients to make healthcare decisions that are inconsistent with their %own preferences. |
| first_indexed | 2024-03-12T09:56:47Z |
| format | Article |
| id | doaj.art-ca0be20cad9149908b5fc3a26f280b2c |
| institution | Directory Open Access Journal |
| issn | 1930-2975 |
| language | English |
| last_indexed | 2024-03-12T09:56:47Z |
| publishDate | 2006-07-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Judgment and Decision Making |
| spelling | doaj.art-ca0be20cad9149908b5fc3a26f280b2c2023-09-02T12:08:42ZengCambridge University PressJudgment and Decision Making1930-29752006-07-011NA6475Can avoidance of complications lead to biased healthcare decisions?Jennifer AmsterlawBrian Zikmund-FisherAngela FagerlinPeter A. UbelImagine that you have just received a colon cancer diagnosis and need to choose between two different surgical treatments. One surgery, the ``complicated surgery,'' has a lower mortality rate (16\% vs. 20\%) but compared to the other surgery, the ``uncomplicated surgery,'' also carries an additional 1\% risk of each of four serious complications: colostomy, chronic diarrhea, wound infection, or an intermittent bowel obstruction. The complicated surgery dominates the uncomplicated surgery as long as life with complications is In our first survey, 51\% of a sample (recruited from the cafeteria of a university medical center) selected the dominated alternative, the uncomplicated surgery, justifying this choice by saying that the death risks for the two surgeries were essentially the same and that the uncomplicated surgery avoided the risk of complications. In follow-up surveys, preference for the uncomplicated surgery remained relatively consistent (39\%--51\%) despite (a) presenting the risks in frequencies rather than percents, (b) grouping the 4 complications into a single category, or (c) giving the uncomplicated surgery a small chance of complications as well. Even when a pre-decision ``focusing exercise'' required people to state directly their preferences between life with each complication versus death, 49\% still chose the uncomplicated People's fear of complications leads them to ignore important differences between treatments. This tendency appears remarkably resistant to debiasing approaches and likely leads patients to make healthcare decisions that are inconsistent %Background: Imagine that you have just received a colon cancer diagnosis %and need to choose between two different surgical treatments. One %surgery, the ``complicated surgery,'' has a lower mortality rate (16\% %vs. 20\%) but compared to the other surgery, the ``uncomplicated %surgery,'' also carries an additional 1\% risk of each of four serious %complications: colostomy, chronic diarrhea, wound infection, or an %intermittent bowel obstruction. The complicated surgery dominates the %uncomplicated surgery as long as life with complications is preferred %over death. However, people's aversion to these %complications might make them choose the uncomplicated surgery, the %dominated alternative. %Methods: We presented the above scenario to a general population sample %recruited from the cafeteria of a university medical center. %Information about the probability of treatment outcomes was presented %both in text and in a summary table. Participants were then asked to %select which surgery they would choose. We varied the presentation %format in a series of follow-up surveys to examine effects on choice. %Results: In our first survey, 51\% of the sample (N=87, M age= 39 yrs., %65\% female) selected the dominated alternative, the uncomplicated %surgery. Participants justified this choice by saying that the death %risks for the two surgeries were essentially the same, and the %uncomplicated surgery avoided the risk of complications. In the %follow-up surveys, preference for the uncomplicated surgery remained %relatively consistent (39\%--51\%) despite (a) presenting the risks in %frequencies rather than percents, (b) grouping the 4 complications into %a single category, or (c) giving the uncomplicated surgery a small %chance of complications as well. Even when a pre-decision %``focusing exercise'' required people to %state directly their preferences between life with each complication %versus death (92\% preferred life with any of the complications listed %over death), 49\% of participants (N=77, M age= 39 yrs., 67\% female) %still chose the uncomplicated surgery. %Conclusions: People's fear of complications leads them %to ignore important differences between treatments. This tendency %appears remarkably resistant to debiasing approaches and likely leads %patients to make healthcare decisions that are inconsistent with their %own preferences.http://journal.sjdm.org/jdm06008.pdfrisk communicationmedical decisionscognitive biasesNAKeywords |
| spellingShingle | Jennifer Amsterlaw Brian Zikmund-Fisher Angela Fagerlin Peter A. Ubel Can avoidance of complications lead to biased healthcare decisions? Judgment and Decision Making risk communication medical decisions cognitive biasesNAKeywords |
| title | Can avoidance of complications lead to biased healthcare decisions? |
| title_full | Can avoidance of complications lead to biased healthcare decisions? |
| title_fullStr | Can avoidance of complications lead to biased healthcare decisions? |
| title_full_unstemmed | Can avoidance of complications lead to biased healthcare decisions? |
| title_short | Can avoidance of complications lead to biased healthcare decisions? |
| title_sort | can avoidance of complications lead to biased healthcare decisions |
| topic | risk communication medical decisions cognitive biasesNAKeywords |
| url | http://journal.sjdm.org/jdm06008.pdf |
| work_keys_str_mv | AT jenniferamsterlaw canavoidanceofcomplicationsleadtobiasedhealthcaredecisions AT brianzikmundfisher canavoidanceofcomplicationsleadtobiasedhealthcaredecisions AT angelafagerlin canavoidanceofcomplicationsleadtobiasedhealthcaredecisions AT peteraubel canavoidanceofcomplicationsleadtobiasedhealthcaredecisions |