A Qualitative Study on Nudging and Palliative Care: "An Attractive but Misleading Concept".

Ludovica De Panfilis,Marta Perin,Eduardo Bruera,Giovanna Artioli,Kevin Brazil,Silvia Tanzi,Carlo Peruselli

doi:10.3390/ijerph18189575

Abstract

The debate about the ethical decision-making process in the healthcare context has been enriched with a theory called “nudging”, which has been defined as the framing of information that can significantly influence behaviour without restricting choice. The literature shows very limited data on the opinion and experience of palliative care healthcare professionals on the use of nudging techniques in their care setting. The aim of this study is to explore the beliefs of experienced palliative care professionals towards nudging. We performed a qualitative study using textual data collected through a focus group. It was audio-recorded, and the transcripts were subjected to a thematic analysis. It was performed within an oncological research hospital with a small and multidisciplinary group of healthcare professionals specialised in PC. Participants reported two overarching positions grounded in two main themes: (1) translating nudging in the PC setting and (2) towards a neutral space. The participants found few justifications for the use of nudging in the PC field, even if it can be very attractive and reassuring. Participants also expressed concerns about the excessive risk of developing pure paternalism.

Highlights

Published: 11 September 2021The ethical debate on physician–patient relationships revolves around different approaches, such as classical principlism by Beauchamp and Childress [1], relational ethics [2]and virtue ethics [3]
This paper aimed to explore the beliefs of experienced palliative care (PC) HPs towards nudging
The literature shows very limited data on the personal and professional opinions and experiences of HPs regarding the use of nudging techniques, especially in a PC setting

Summary

Introduction

Published: 11 September 2021The ethical debate on physician–patient relationships revolves around different approaches, such as classical principlism by Beauchamp and Childress [1], relational ethics [2]and virtue ethics [3]. Since 1970, these theories have echoed new legislation, educational programmes and research projects with the aim of promoting patient self-determination through funding for the development, testing, and implementation of decision aids [5] According to these theoretical and ethical frameworks, the emphasis is on individual responsibility and the right to open communication and full disclosure [6]. The ethical debate about the decision-making process has been enriched with a novel theory, proposed by Thaler and Sunstein, called “nudging”. Authors define it as “the framing of information that can significantly influence behavior without restricting choice.” [7]. Nudge represents any aspects of choice architecture that can alter people’s behaviours without forbidding any options [8]

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