Perceived Social Norms Guide Health Care Decisions for Oneself and Others: A Cross-Sectional Experiment in a US Online Panel

Abstract

Background: Global aging has increased the reliance on surrogates to make health care decisions for others. We investigated the differences between making health care decisions and predicting health care decisions, self-other differences for made and predicted health care decisions, and the roles of perceived social norms, emotional closeness, empathy, age, and gender. Methods: Participants ( N = 2037) from a nationally representative US panel were randomly assigned to make or to predict a health care decision. They were also randomly assigned to 1 of 5 recipients: themselves, a loved one 60 y or older, a loved one younger than 60 y, a distant acquaintance 60 y or older, or a distant acquaintance younger than 60 y. Hypothetical health care scenarios depicted choices between relatively safe lower-risk treatments with a good chance of yielding mild health improvements versus higher-risk treatments that offered a moderate chance of substantial health improvements. Participants reported their likelihood of choosing lower- versus higher-risk treatments, their perceptions of family and friends’ approval of risky health care decisions, and their empathy. Results: We present 3 key findings. First, made decisions involved less risk taking than predicted decisions, especially for distant others. Second, predicted decisions were similar for others and oneself, but made decisions were less risk taking for others than oneself. People predicted that loved ones would be less risk taking than distant others would be. Third, perceived social norms were more strongly associated than empathy with made and predicted decisions. Limitations: Hypothetical scenarios may not adequately represent emotional processes in health care decision making. Conclusions: Perceived social norms may sway people to take less risk in health care decisions, especially when making decisions for others. These findings have implications for improving surrogate decision making. Highlights People made less risky health care decisions for others than for themselves, even though they predicted others would make decisions similar to their own. This has implications for understanding how surrogates apply the substituted judgment standard when making decisions for patients. Perceived social norms were more strongly related to decisions than treatment-recipient (relationship closeness, age) and decision-maker (age, gender, empathy) characteristics. Those who perceived that avoiding health care risks was valued by their social group were less likely to choose risky medical treatments. Understanding the power of perceived social norms in shaping surrogates’ decisions may help physicians to engage surrogates in shared decision making. Knowledge of perceived social norms may facilitate the design of decision aids for surrogates.

Randomized Experiments to Reduce Overuse of Health Care

“…In one study, Strough et al 45 asked members of an online panel to either make or predict a health care decision for one of 5 recipients: (1) themselves; (2) an older loved one; (3) a younger loved one; (4) an older acquaintance; or (5) a younger acquaintance. They measured panel members’ hypothetical choices between relatively safe lower-risk treatments with a good chance of yielding mild health improvements versus high-risk treatments that offered a moderate chance of substantial health improvements.…”

“…Social norms 45 Altruism 45 Penalty/Rewards Gain in money 47 Social norms 47 intentions, perceived risks, and decisional conflict. Miller and Holdaway 25 focused on women's decisions about birth after a cesarean section.…”

Risk-Adapted Breast Screening for Women at Low Predicted Risk of Breast Cancer: An Online Discrete Choice Experiment

“… 24 , 74 When considering others, decision making could be more risk averse to avoid deterring others from breast screening. 74 – 76 Consequently, further research is required to investigate the potential for self-other decisional asymmetry.…”

COVID-19 vaccination attitudes across the European continent

“…This corroborates our findings regarding attitudes to influenza vaccination as a strong predictor of current COVID-19 vaccination attitudes. Finally, perceived social norms (perceptions of other people's typical behaviours and attitudes, distinct from actual norms) have long been associated with a variety of health-related behaviours [ [26] , [27] , [28] ]. Our findings in this study agree with the results of other research studies that have considered the role of perceived social norms in the context of the COVID-19 vaccination behaviours.…”