Lung cancer can be deadly, so early detection and treatment are important. When a patient is at risk for lung cancer due to her age and history of smoking, she and her physician have to make important decisions about how and when to screen for lung cancer.
Low-dose computed tomography (LDCT) is recommended for smokers, but a doctor and patient need to work together to decide if this type of lung cancer screening is right for the patient. Because the decision is complex and the stakes are high, some cognitive biases can interfere with a patient’s ability to make good choices.
Behavioral economics helps explain how human biases and cognitive limitations interfere with rational decision making. If physicians and patients recognize and understand these biases, they can take steps to address them and reach the best decision.
Understanding Human Biases
One bias explained through behavioral economics is loss aversion, the tendency for people to weigh losses more heavily than gains. For example, a patient might consider the costs of LDCT — such as travel time, anxiety about the results, and time off work — to be greater than the benefits of LDCT, such as early detection of lung cancer.
Similarly, present bias allows people to weigh the present more heavily than the future. Screening for lung cancer with LDCT could be uncomfortable and requires an investment of time, whereas the benefits of LDCT occur in the future. These biases could make patients less likely to choose certain screening options.
Doctors, however, might get around these biases by framing risks appropriately. The framing effect shows how patients might respond differently to information if it is presented in a different way. For example, patients might respond more favorably to a risk framed as “a 40% chance of survival” rather than as “a 60% chance of death,” even though the two expressions mean the same thing. Doctors could take advantage of this cognitive bias to help their patients make the best decisions by framing outcomes in positive ways.
Sometimes, a patient might be too emotional to make a rational decision. When someone experiences an empathy gap, he makes a decision while in a highly emotional state that he might later regret. A patient faced with the looming threat of lung cancer, or a smoker who is in nicotine withdrawal, might not be able to make rational decisions. To prevent these empathy gaps, patients could be given time to consider the decision outside of the emotionally charged setting of a doctor’s office.
Decision fatigue occurs when a patient is faced with too many options. The more options there are, the less likely it is that someone will make the best decision. So, a doctor who limits the number of lung cancer screening options, or helps to rank them, could help a patient make a better decision.
Finally, people will often choose the default option when one is provided. This default bias can be a problem if the default option is no screening. Physicians could default patients into a screening option, like LDCT, that they think is best for their patients.
Each of these biases represents an obstacle to rational, informed decision making. Understanding how these biases work is critical to helping doctors and patients make decisions that align the best with the patient’s values and preferences.
To learn more about the role of behavioral economics in lung cancer screening decisions, please see the article in the December 2016 JACR Special Issue: Patient- and Family-Centered Care.
Barnes AJ, Groskaufmanis L, Thomson NB III. Promising Approaches From Behavioral Economics to Improve Patient Lung Cancer Screening Decisions. J Am Coll Radiol December 2016;13(12 Pt B):1566-1570.
