Nudgingdecision making

Choice architecture, or the way in which information is framed, is part of everyday medical decision making. Simple changes such as defaults and framing can be effective tools to improve patient care without increasing burden on clinicians

Key learnings from research and consulting projects

Active choice

Active choice is the act of prompting a decision now, rather than delaying that decision to the future. Active choice can be used to prompt a clinician to engage in a behavior (e.g. prompt a patient to receive a flu vaccine) or a patient (e.g. complete advanced directives).

Defaults

In a clinical environment with an electronic health record, defaults automatically exist. Sometimes defaults can be alphabetical, other times numeric. However, not much thought is put into the design of choices. Setting defaults will require more access to systems.

  • Reduce waste

    Defaults are a strong tool to initiate and sustain behavior change amongst clinicians, especially when attempting to decrease low-value care.In a randomized trial of radiation oncologists, we used nudges in the electronic health record to reduce the rate of unnecessary imaging in palliative cancer patients from 68% to 32%. This saved more than 3000 unnecessary imaging tests per year.

  • Consider existing workflows

    When designing a behavior change strategy, it’s essential to consider existing workflows in order to determine if a default is best path for change. Any process change must be designed with the intention of reducing work.

Information framing

The way in which information is presented can have a considerable impact on what someone does with that information.

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