Decision Aids: When ‘Nudging’ Patients To Make A Particular Choice Is More Ethical Than Balanced, Nondirective Content

• Published in: Health Affairs Vol. 32; no. 2; pp. 303 - 310
• Main Authors: Blumenthal-Barby, J.S., Cantor, Scott B., Russell, Heidi Voelker, Naik, Aanand D., Volk, Robert J.
• Format: Journal Article
• Language: English
• Published: United States The People to People Health Foundation, Inc., Project HOPE 01.02.2013
• Subjects: Age groups; Aged; Anticoagulants; Cancer; Cancer therapies; Choice Behavior; Colorectal cancer; Colorectal Neoplasms - diagnosis; Decision makers; Decision making; Decision Support Techniques; Decisions; Design; Early Detection of Cancer; Female; Humans; Leaflets; Male; Medical screening; Medical treatment; Middle Aged; Mortality; Patient education; Patient Education as Topic - ethics; Patient Education as Topic - methods; Patient Education as Topic - standards; Patient Participation - methods; Patient Participation - psychology; Patients; Physician-Patient Relations - ethics; Physicians; Prostate; Prostate cancer; Prostatic Neoplasms - therapy; Radiation; Studies; Surgery; Surveillance; Task forces; Thrombosis; Veins & arteries; Venous Thrombosis - prevention & control; Watchful Waiting; United States > US
• ISSN: 0278-2715; 2694-233X; 1544-5208; 2694-233X
• DOI: 10.1377/hlthaff.2012.0761

Patient decision aids, such as instructional leaflets describing treatment options for prostate cancer, are designed to help educate patients so that they can share in decisions about their care. Developers of these decision aids strive for balance, aiming to be as neutral, unbiased, and nondirective as possible. We argue that balance should not always be a goal, and we identify three situations where it should not be. For example, men diagnosed with early-stage prostate cancer frequently are not advised by their physicians that active surveillance is a reasonable alternative to immediate surgery or radiation. It may be desirable to design decision aids that promote active surveillance as an option. We recognize that the arguments put forth in this article are controversial. But they are also justified. We challenge medical decision makers and decision aid developers to determine if and when patients should be "nudged" toward one option or another.