Promising Approaches From Behavioral Economics to Improve Patient Lung Cancer Screening Decisions

Abstract

Lung cancer is a devastating disease, the deadliest form of cancer in the world and in the United States. As a consequence of CMS's determination to provide low-dose CT (LDCT) as a covered service for at-risk smokers, LDCT lung cancer screening is now a covered service for many at-risk patients that first requires counseling and shared clinical decision making, including discussions of the risks and benefits of LDCT screening. However, shared decision making fundamentally relies on the premise that with better information, patients will arrive at rational decisions that align with their preferences and values. Evidence from the field of behavioral economics offers many contrary viewpoints that take into account patient decision making biases and the role of the shared decision environment that can lead to flawed choices and that are particularly relevant to lung cancer screening and treatment. This article discusses some of the most relevant biases, and suggests incorporating such knowledge into screening and treatment guidelines and shared decision making best practices to increase the likelihood that such efforts will produce their desired objectives to improve survival and quality of life.

Nudging in screening: Literature review and ethical guidance

“…Nudging is also debated in areas such as screening for abdominal aorta aneurisms [14], obesity [30][31][32][33], diabetes [34,35], chronic beryllium disease [36], and HIV [21,[37][38][39]. However, the majority of references are to various types of cancer screening [40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58], predominantly breast cancer screening [2,[59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75].…”

Importance of weather monitoring for agricultural decision‐making – an exploratory behavioral study for Oklahoma Mesonet

“…At the same time, farmers are assumed to behave rationally with their decision making, which implies that their goal is to optimize their farm profitability (benefit) or utility. Behavioral economics theory has been applied to many research questions and several disciplines, including medicine, environmental policy, resource use, and education …”

“…At the same time, farmers are assumed to behave rationally with their decision making, which implies that their goal is to optimize their farm profitability (benefit) or utility. Behavioral economics theory has been applied to many research questions and several disciplines, including medicine, 11,12 environmental policy, 13,14 resource use, 15,16 and education. 17,18 In the context of the analysis presented here, it is also important to consider possible effects of risk and uncertainty in the face of unexpected weather events that might affect farmers' decision making.…”

The effectiveness of behavioral economics-informed interventions on physician behavioral change: A systematic literature review

“…Interventions that aim to counteract the adverse effects of these cognitive biases are receiving growing attention, and have been applied in a variety of fields including energy, finance, taxation, and environmental studies [14,15]. In healthcare, behavioral economics-informed interventions have primarily been applied to changing patient behaviors, such as improving dietary choices [16][17][18], increasing preventative health screening participation [19,20] and increasing vaccination rates [21]. There has also been an increasing interest in using such interventions for provider behavioral change, but a systematic synthesis of the empirical evidence is lacking.…”