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Patient Behavior – Leveraging ‘Predictable Irrational’ Behavior for Better Patient Support Initiatives

Most healthcare solutions struggle to impact patient outcomes as expected because of seemingly irrational patient behavior [1].

Do patients simply not understand or appreciate the risks or impact on their health? These irrationalities can constitute barriers to effective behavior change, appropriate management of a chronic condition or maintaining a healthier lifestyle over time.

But what if we could ‘predict’ patient behavior, or more importantly what appears to be ‘irrational’ patient behavior. This is where behavioral science (the study of human behavior) comes into play, as it gives us a new lens through which to evaluate patients’ seemingly irrational behavior (and inaction), and address systematic shortcomings we all face.

Patient Behavior is Human Behavior

It is seductively appealing to reason that if a patient is not doing a particular behavior (that would help them manage a condition effectively), it is because they simply do not comprehend or appreciate the risks associated with not performing the behavior. Unfortunately, this thinking doesn’t pass a scrutiny test in the real world. The problem of behavior change isn’t quite as simple as a lack of information.

Often, people are well aware of the consequences of their behavior (or lack thereof) and though they really might want to behave better, they are unable to act on their good intentions. This is commonly referred to as the ‘intention-action gap’ [4].

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This gap leads to negative outcomes such as obesity, with about 35% of people who intend to be more physically active failing to translate these intentions into action [5]. Information alone does not help to narrow this gap, as the intention to do the right thing is already there. Other factors are preventing the individual from acting (and doing so consistently over time).

Every patient is human, and we must treat and care for them accordingly. As such, they face challenges and have limitations the same as everyone else. We all have a limited amount of attention, limited capacity to process information, and can struggle to make the best choices in life.

One of the core ideas in behavioral science is ‘bounded rationality’. At any given moment, we generally have limited time, information, and cognitive capacity. Life pulls us in many different directions and the only way that we can manage to make decisions and not be overwhelmed is by deploying shortcuts and ‘rules of thumb’ (heuristics) [2].

Heuristics are mental shortcuts that allow us to solve complex problems using simplistic rules. They often lead to relatively good and efficient decisions in a given moment, but they can also lead to systematically biased decisions [3].

An understanding of ‘Bounded Rationality’ and the ‘Intention-action gap’ shows us some of the reasons behind ‘predictable irrational’ decisions. This matters greatly when we start to think about how best we can improve decision-making in healthcare.

Behavioral science seeks to recognize the challenges we all face, and looks to address the behavioral barriers patients face when seeking to change their behavior or follow treatment guidelines.

Behavioral Insights in the Healthcare Domain

There are many behavioral insights that patient support initiatives can leverage to improve healthcare outcomes:

  • Patients’ limited cognitive capacity;
  • How feelings of regret can influence behavior;
  • How patients make choices over time;
  • The power of relativity in patients’ lives and why reference points matter;
  • How patients are ultimately social beings.
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This article will take a look at two areas – patients’ limited cognitive capacity (Scarcity of Mind), and how patients make choices over time (Intertemporal Choice).

Scarcity of Mind

It’s no secret that people have limited cognitive capacity [2]. Patients simply cannot remember, or even process, an unlimited amount of information.

This issue is only worsening as we face an ever-increasing amount of distractions and information. For example, while in 1971, the average American encountered 560 daily advertising messages, it rose to over 5,000 per day in 2012 [8].

Not only are patients unable to manage the barrage of complex health information they’re often given, but of what they do absorb, they only have limited ability to process and use in order to make better and more informed decisions [7]

Information and Choice Overload

Although more information generally improves decision making, there can very easily be too much information, especially in the healthcare domain. Patients often find themselves overwhelmed by complex health information.

The relationship between information and decision quality is often described as an inverted U curve (See Image): in the beginning, more information leads to better decisions. At some point, the amount of information exceeds our processing capabilities and we feel overwhelmed by the information. This situation is called information overload and generally results in worse decisions [8].

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Patients aren’t the only ones who suffer from information overload, clinicians are also affected. What can happen when patients or clinicians are confronted with too much information is that they ignore the information altogether.

This is termed information avoidance or the ‘ostrich effect’: people bury their heads in the sand when confronted with too much and too complex information. Given the seriousness of the decisions in healthcare, this bias towards avoiding information overload can be very dangerous and result in very poor decisions being made [8].

Commonly it’s assumed that more options/choices are always better, but this is only true up until a certain threshold. After this threshold, people don’t feel confident to choose anymore. There are too many options and they suffer ‘choice overload’.

This can again be described by the inverted U-curve depicted above. Facing too many options, we can often decide not to choose at all. This state is called ‘decision paralysis’ and leads to complete inaction. It’s important to ensure that patients have an adequate amount of choice without being overwhelmed entirely.

Pro-tip: For patient support programs the ultimate goal is to find the sweet spot in which patients are still capable of processing all the information available, but are not overwhelmed by it [9].

Find more detail, examples and pro-tips by downloading the whitepaper

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Intertemporal Choice

We value things we can have in the present (immediately) much more than we do for the things we will get at some point in the future [10]. This is called ‘temporal discounting’.

Intertemporal choice plays a big role when trying to understand patient behavior because patients are constantly being asked to put off enjoyable things today (binging on Netflix, over-eating, drinking, not exercising, etc.) in order to live a healthier life tomorrow (and the day after that).

Present Bias

Present Bias is a special case of temporal discounting. We prefer to get nice things as soon as possible, and we especially like getting things right away [10].

It’s very easy to say to ourselves that we’ll go to the gym tomorrow, but it’s a lot harder to actually go to the gym when tomorrow comes around. Present bias leads to procrastination, which means that we’ll put off unpleasant things for as long as possible (sometimes indefinitely).

Pro-tip:  One way of addressing Present Bias so is to reward the otherwise unpleasant behavior right away. For example, patients could allow themselves to watch their favorite TV show only after they went for a run.

Affective Forecasting

We are very bad at predicting our own emotional responses to future events (‘affective forecasting bias’). In particular, we poorly predict our ability to adapt to adversity, such as disability or serious declines in health [11].

We underestimate our resilience and put too much focus on what would change for us and how hard everyday life would be. At the same time, we ignore all the parts of life that would be unaffected by the change [11].

Pro-tip: In order to help patients maintain a more realistic view of how they will feel in the future (especially in the case of a progressive chronic condition), it’s helpful to prompt them to reflect on all of the things that will not change in their life.

FIND MORE DETAIL, EXAMPLES AND PRO-TIPS BY DOWNLOADING THE WHITEPAPER

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Though patients’ ‘predictably irrational’ behavior is often puzzling, we can leverage behavioral insights to tackle the behavioral barriers (headwinds) preventing action being taken. Patient support programs can improve health outcomes, as well as increase frequency of interaction to reach patients when they are trying to address their own systematic shortcomings.

Download the full whitepaper which includes:

  • How Behavioral Science gives us a new lens through which we can evaluate seemingly irrational patient behavior
  • Extensive Insights into over 15 ‘predictably irrational’ behaviors in the Healthcare Domain
  • Examples and key takeaways on how to understand and address ‘predictably irrational’ patient behavior
  • 4 Steps to Designing Patient Support Programs that address ‘predictably irrational’ patient behavior
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References:

1. Searl, M. M., Borgi, L., & Chemali, Z. (2010). It is time to talk about people: a human-centered healthcare system. Health research policy and systems, 8(1), 35.
2. Simon, H. A. (1956). Rational choice and the structure of the environment. Psychological review, 63(2), 129.
3. Thaler, R. H., & Sunstein, C. R. (1999). Nudge: Improving decisions about health, wealth, and happiness. New Haven, CT Yales University Press.
4. Sheeran, P. (2002). Intention-behavior relations: a conceptual and empirical review. European review of social psychology, 12(1), 1-36.
5. Rhodes, R. E., & Bruijn, G. J. (2013). How big is the physical activity intention-behaviour gap? A meta-analysis using the action control framework. British journal of health psychology, 18(2), 296-309.
6. Anderson, S. P., & De Palma, A. (2012). Competition for attention in the information (overload) age. The RAND Journal of Economics, 43(1), 1-25.
7. Iyengar, S. S., & Lepper, M. R. (2000). When choice is demotivating: Can one desire too much of a good thing? Journal of personality and social psychology, 79(6), 995.
8. Fava, G. A., & Guidi, J. (2007). Information overload, the patient and the clinician. Psychotherapy and Psychosomatics, 76(1), 1-3.
9. Hyman, R., Schroder, H. M., Driver, M. J., & Streufert, S. (1970, 03). Human Information Processing: Individuals and Groups Functioning in Complex Situations. The American Journal of Psychology, 83(1), 136.
10. Frederick, S., Loewenstein, G., & O’donoghue, T. (2002). Time discounting and time preference: A critical review. Journal of economic literature, 40(2), 351-401.
11. Wilson, T. D., & Gilbert, D. T. (2005). Affective forecasting: Knowing what to want. Current Directions in Psychological Science, 14(3), 131-134.

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