The Frame and Name of the Medical Treatment and their Influence on Health Decisions

  • Kaja Damnjanović University of Belgrade, Faculty of Philosophy, Department of Psychology, Laboratory for Experimental Psychology
  • Sandra Ilić University of Belgrade, Faculty of Philosophy, Department of Psychology, Laboratory for Experimental Psychology
  • Predrag Teovanović University of Belgrade, Faculty of Special Education and Rehabilitation
Keywords: health decision, shared decision making, risky choice, framing effect, medical treatment, surgery, radiation, prospect theory, fuzzy-trace theory, patient,

Abstract


Decisions about one’s own health range from everyday and easy ones, such as taking a vitamin pill, to those made in the situations of life-threatening diseases. When it comes to choosing treatments, patients have difficulty understanding statistical information about the possible outcomes of alternative treatments such as probabilities and risks. These challenges are especially important in the context of the shared decision-making. The aim of this study was to examine influence of the labelling of the treatment in risky choice decision tasks. The risky choice framing effect (FE) pertains to the systematic preference reversal because different aspects of formally identical situations are emphasized. In the present study, the participants made a forced choice between a non-risky and risky treatment presented in terms of gains and losses. In the first condition, surgery was the risky option and in the second it was the radiation. In the third condition, the treatments’ labels were replaced with ’A’ and ’B’. Chi-square tests revealed a significant difference in proportions of risky choices between the three conditions. The FE was registered only in the first and the second condition, and it was moderate and strong, respectively. When choosing between surgery and radiation, participants’ choices were indeed influenced by the naming of the treatment, but not exclusively - they generally preferred surgery, and when it was offered in terms of losses, they preferred it even more.

References

Almashat, S., Ayotte, B., Edelstein, B., &Margrett, J. (2008).Framing effect debiasing in medical decision making. Patient Education and Counseling, 71(1), 102-107. doi:10.1016/j.pec.2007.11.004

Appelbaum, P.S., &Grisso, T. (1988).Assessing Patients' Capacities to Consent to Treatment. New England Journal of Medicine, 319(25), 1635-1638. doi:10.1056/nejm198812223192504

Damnjanovic, K., &Gvozdenovic, V. (2016). Influence of the probability level on the framing effect. Psychological Topics, 25(3); 405-429; Available from: https://hrcak.srce.hr/169520.

Damnjanović, K. (2013). Framing effect and domain of decision. In Book of abstracts of the Scientific-Professional Conference: Current Trends in Psychology; 2013 October 11-13, Novi Sad, Serbia. Novi Sad, Serbia: Faculty of Philosophy. pp 113-115; Available from: http://psihologija.ff.uns.ac.rs/repository/puni.php?sifra=stup2013081#page=115.

Bigman, C.A., Cappella, J.N., &Hornik, R.C. (2010). Effective or ineffective: Attribute framing and the human papillomavirus (HPV) vaccine. Patient Education and Counseling, 81, 70-76. doi:10.1016/j.pec.2010.08.014

Blumenthal-Barby, J.S., & Krieger, H. (2015). Cognitive Biases and Heuristics in Medical Decision Making: A critical review using a systematic search strategy. Medical Decision Making, 35(4), 539-557. doi:10.1177/0272989x14547740

Brewer, N.T., Weinstein, N.D., Cuite, C.L., & Herrington, J.E. (2004).Risk perceptions and their relation to risk behavior. Annals of Behavioral Medicine, 27(2), 125-130. doi:10.1207/s15324796abm2702_7

Coulter, A., & Collins, A. (2011). Making shared decision-making a reality. London: King's Fund.

Covey, J. (2007).A Meta-analysis of the Effects of Presenting Treatment Benefits in Different Formats. Medical Decision Making, 27(5), 638-654. doi:10.1177/0272989x07306783

Dawson, N.V., &Arkes, H.R. (1987).Systematic errors in medical decision making. Journal of General Internal Medicine, 2(3), 183-187. doi:10.1007/bf02596149

Edwards, A., Elwyn, G., Covey, J., Matthews, E., & Pill, R. (2001). Presenting Risk Information A Review of the Effects of Framing and other Manipulations on Patient Outcomes. Journal of Health Communication, 6(1), 61-82. doi:10.1080/10810730150501413

Elwyn, G., Laitner, S., Coulter, A., Walker, E., Watson, P., & Thomson, R. (2010).Implementing shared decision making in the NHS. BMJ, 341(14 2), 5146-5146. doi:10.1136/bmj.c5146

Fagley, N.S., & Miller, P.M. (1997). Framing Effects and Arenas of Choice: Your Money or Your Life. Organizational Behavior and Human Decision Processes, 71(3), 355-373. doi:10.1006/obhd.1997.2725

Ferrer, R.A., & Klein, W.M.P. (2015).Risk perceptions and health behavior. Current Opinion in Psychology, 5, 85-89. doi:10.1016/j.copsyc.2015.03.012

Ferrer, R.A., Klein, W., Lerner, J.S., Reyna, V., &Keltner, D. (2014). Emotions and health decision making: Extending the Appraisal Tendency Framework to improve health and health care. Behav Econ Public Health, Doi: https://doi.org/10.1093/med/9780199398331.003.0004.

Fischer, G.W., & Hawkins, S.A. (1993).Strategy compatibility, scale compatibility, and the prominence effect. Journal of Experimental Psychology: Human Perception and Performance, 19(3), 580-597. doi:10.1037/0096-1523.19.3.580

Garcia-Retamero, R., &Galešić, M. (2010). How to Reduce the Effect of Framing on Messages About Health. Journal of General Internal Medicine, 25(12), 1323-1329. doi:10.1007/s11606-010-1484-9

Haward, M.F., Murphy, R.O., & Lorenz, J.M. (2008).Message Framing and Perinatal Decisions. Pediatrics, 122(1), 109-118. doi:10.1542/peds.2007-0620

Horne, R., &Weinman, J. (1999).Patients' beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. Journal of Psychosomatic Research, 47(6), 555-567. doi:10.1016/s0022-3999(99)00057-4

Huang, Y., & Wang, L. (2010).Sex differences in framing effects across task domain. Personality and Individual Differences, 48(5), 649-653. doi:10.1016/j.paid.2010.01.005

Kahneman, D., &Tversky, A. (1979). Prospect Theory: An Analysis of Decision under Risk. Econometrica, 47(2), doi:10.2307/1914185

Levin, I.P., Schnittjer, S.K., & Thee, S.L. (1988).Information framing effects in social and personal decisions. Journal of Experimental Social Psychology, 24(6), 520-529. doi:10.1016/0022-1031(88)90050-9

Levin, I.P., Gaeth, G.J., Schreiber, J., &Lauriola, M. (2002). A New Look at Framing Effects: Distribution of Effect Sizes, Individual Differences, and Independence of Types of Effects. Organizational Behavior and Human Decision Processes, 88(1), 411-429. doi:10.1006/obhd.2001.2983

Mazur, D.J., & Hickam, D.H. (1996). Patient preferences for management of localized prostate cancer. Western journal of medicine, 165(1-2), 26–30; Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1307537/pdf/westjmed00347-0028.pdf.

McNeil, B.J., Pauker, S.G., Sox, H.C., &Tversky, A. (1982).On the Elicitation of Preferences for Alternative Therapies. New England Journal of Medicine, 306(21), 1259-1262. doi:10.1056/nejm198205273062103

Moxey, A., O’Connell, D., McGettigan, P., & Henry, D. (2003).Describing treatment effects to patients. Journal of General Internal Medicine, 18(11), 948-959. doi:10.1046/j.1525-1497.2003.20928.x

Ozdemir, S., & Finkelstein, E.A. (2018). Cognitive Bias: The Downside of Shared Decision Making. JCO Clinical Cancer Informatics, 2, 1-10. doi:10.1200/cci.18.00011

Payne, J.W., Bettman, J.R., & Johnson, E.J. (1988).Adaptive strategy selection in decision making. Journal of Experimental Psychology: Learning, Memory, and Cognition, 14(3), 534-552. doi:10.1037//0278-7393.14.3.534

Peters, E., Västfjäll, D., Slovic, P., Mertz, C.K., Mazzocco, K., &Dickert, S. (2006). Numeracy and Decision Making. Psychological Science, 17(5), 407-413. doi:10.1111/j.1467-9280.2006.01720.x

Petrova, D., Garcia-Retamero, R., &Cokely, E.T. (2015).Understanding the Harms and Benefits of Cancer Screening: A model of factors that shape informed decision making. Medical Decision Making, 35(7), 847-858. doi:10.1177/0272989x15587676

Reyna, V.F., & Brainerd, C.J. (1991). Fuzzy-trace theory and framing effects in choice: Gist extraction, truncation, and conversion. Journal of Behavioral Decision Making, 4(4), 249-262. doi:10.1002/bdm.3960040403

Reyna, V.F., Lloyd, F.J., & Brainerd, C.J. (2003). Memory, Development, and Rationality: An Integrative Theory of Judgment and Decision Making. In S.L. Schneider & J. Shanteau (Eds.), Emerging Perspectives on Judgment and Decision Research. (pp. 201-245). New York, NY: Cambridge University Press (CUP). doi:10.1017/cbo9780511609978.009

Reyna, V.F., & Brainerd, C.J. (1995). Fuzzy-trace theory: Some foundational issues. Learning and Individual Differences, 7(2), 145-162. doi:10.1016/1041-6080(95)90028-4

Reyna, V.F. (2008). A Theory of Medical Decision Making and Health: Fuzzy Trace Theory. Medical Decision Making, 28(6), 850-865. doi:10.1177/0272989x08327066

Reyna, V.F., & Brainerd, C.J. (2008). Numeracy, ratio bias, and denominator neglect in judgments of risk and probability. Learning and Individual Differences, 18(1), 89-107. doi:10.1016/j.lindif.2007.03.011

Reyna, V.F., Nelson, W.L., Han, P.K., &Dieckmann, N.F. (2009). How numeracy influences risk comprehension and medical decision making. Psychological Bulletin, 135(6), 943-973. doi:10.1037/a0017327

Reyna, V.F., Nelson, W.L., Han, P.K., &Pignone, M.P. (2015).Decision making and cancer. American Psychologist, 70(2), 105-118. doi:10.1037/a0036834

Reyna, V.F., & Brainerd, C.J. (2007). The importance of mathematics in health and human judgment: Numeracy, risk communication, and medical decision making. Learning and Individual Differences, 17(2), 147-159. doi:10.1016/j.lindif.2007.03.010

Saposnik, G., Redelmeier, D., Ruff, C.C., &Tobler, P.N. (2016). Cognitive biases associated with medical decisions: A systematic review. BMC Medical Informatics and Decision Making, 16(1), doi:10.1186/s12911-016-0377-1

Slade, M. (2017).Implementing shared decision making in routine mental health care. World Psychiatry, 16(2), 146-153. doi:10.1002/wps.20412

Steginga, S.K., Occhipinti, S., Gardiner, R.A., Yaxley, J., &Heathcote, P. (2002). Making decisions about treatment for localized prostate cancer. BJU International, 89(3), 255-260. doi:10.1046/j.1464-4096.2001.01741.x

Stokes, W.A., Bronsert, M.R., Meguid, R.A., Blum, M.G., Jones, B.L., Koshy, M., . . .Rusthoven, C.G. (2018). Post-Treatment Mortality After Surgery and Stereotactic Body Radiotherapy for Early-Stage Non–Small-Cell Lung Cancer. Journal of Clinical Oncology, 36(7), 642-651. doi:10.1200/jco.2017.75.6536

Marsh, K., IJzerman, M., Thokala, P., Baltussen, R., Boysen, M., Kaló, Z., . . . Devlin, N. (2016). Multiple Criteria Decision Analysis for Health Care Decision Making: Emerging Good Practices: Report 2 of the ISPOR MCDA Emerging Good Practices Task Force. Value in Health, 19(2), 125-137. doi:10.1016/j.jval.2015.12.016

Tversky, A., &Kahneman, D. (1981).The framing of decisions and the psychology of choice. Science, 211(4481), 453-458. doi:10.1126/science.7455683

Wang, X.T. (1996). Framing Effects: Dynamics and Task Domains. Organizational Behavior and Human Decision Processes, 68(2), 145-157. doi:10.1006/obhd.1996.0095

Wang, X.T. (1996). Domain-specific rationality in human choices: Violations of utility axioms and social contexts. Cognition, 60(1), 31-63. doi:10.1016/0010-0277(95)00700-8

Published
2020/01/14
Section
Scientific Articles