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

Sophie Y Wang,Oliver Groene,Stefano Triberti

doi:10.1371/journal.pone.0234149

Abstract

ObjectiveInterventions informed by behavioral economics have the potential to change behaviors governed by underlying cognitive biases. This has been explored extensively for various use in healthcare including changing patient behavior and, more recently, physician behavior. We aimed to systematically review the literature on the use and effectiveness of behavioral economics-informed interventions in changing physician behavior.MethodWe searched Medline, Cochrane Library, EBM Reviews, PsychINFO, EconLit, Business Source Complete and Web of Science for peer-reviewed studies published in English that examined the effectiveness of behavioral economics-informed interventions on physician behavioral change. We included studies of physicians in all care settings and specialties and all types of objectively measured behavioral outcomes. The reporting quality of included studies was appraised using the Effective Public Health Practice Project tool.ResultsWe screened 6,439 studies and included 17 studies that met our criteria, involving at least 9,834 physicians. The majority of studies were conducted in the United States, published between 2014 and 2018, and were in the patient safety and quality domain. Reporting quality of included studies included strong (n = 7), moderate (n = 6) and weak (n = 4). Changing default settings and providing social reference points were the most widely studied interventions, with these studies consistently demonstrating their effectiveness in changing physician behavior despite differences in implementation methods among studies. Prescribing behavior was most frequently targeted in included studies, with consistent effectiveness of studied interventions.ConclusionChanging default settings and providing social reference points were the most frequently studied and consistently effective interventions in changing physician behavior towards guideline-concordant practices. Additional theory-informed research is needed to better understand the mechanisms underlying the effectiveness of these interventions to guide implementation.

Highlights

The integration of research evidence into routine clinical practice to ensure safe and effective care for patients and reduce unnecessary expenditures has been a long-standing challenge [1,2]Studies in the United States, Netherlands, and Canada have shown that 30% to 40% of patients do not receive guideline-concordant care, and that more than 20% of care provided is unnecessary or potentially harmful [3,4]
Changing default settings and providing social reference points were the most widely studied interventions, with these studies consistently demonstrating their effectiveness in changing physician behavior despite differences in implementation methods among studies
We chose the term “behavioral economics-informed intervention” to broaden the concept, and we define this as an intervention designed to change behavior within a decision context by counteracting an underlying cognitive bias [24,25,26]

Summary

Introduction

The integration of research evidence into routine clinical practice to ensure safe and effective care for patients and reduce unnecessary expenditures has been a long-standing challenge [1,2]Studies in the United States, Netherlands, and Canada have shown that 30% to 40% of patients do not receive guideline-concordant care, and that more than 20% of care provided is unnecessary or potentially harmful [3,4]. Given physicians’ role as key decision makers in healthcare, an increased focus on physician behavioral change has emerged [4,5,6]. Traditional behavioral change approaches to better align clinical practice with research evidence have mainly focused on improving access to information, such as guideline dissemination and education seminars. These methods are based on conventional economic theory and presume that physicians are perfectly rational decision-makers. Research in behavioral economics, an evolving field rooted in economics and psychology, finds that humans have a “predictable” bounded rationality and rarely behave as the utility maximizers conventional economics theory would predict [8]

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Results

Conclusion