Abstract
BackgroundProspect theory suggests that when faced with an uncertain outcome, people display loss aversion by preferring to risk a greater loss rather than incurring certain, lesser cost. Providing probability information improves decision making towards the economically optimal choice in these situations. Clinicians frequently make decisions when the outcome is uncertain, and loss aversion may influence choices. This study explores the extent to which prospect theory, loss aversion, and probability information in a non-clinical domain explains clinical decision making under uncertainty.MethodsFour hundred sixty two participants (n = 117 non-medical undergraduates, n = 113 medical students, n = 117 resident trainees, and n = 115 medical/surgical faculty) completed a three-part online task. First, participants completed an iced-road salting task using temperature forecasts with or without explicit probability information. Second, participants chose between less or more risk-averse (“defensive medicine”) decisions in standardized scenarios. Last, participants chose between recommending therapy with certain outcomes or risking additional years gained or lost.ResultsIn the road salting task, the mean expected value for decisions made by clinicians was better than for non-clinicians(−$1,022 vs -$1,061; <0.001). Probability information improved decision making for all participants, but non-clinicians improved more (mean improvement of $64 versus $33; p = 0.027). Mean defensive decisions decreased across training level (medical students 2.1 ± 0.9, residents 1.6 ± 0.8, faculty1.6 ± 1.1; p-trend < 0.001) and prospect-theory-concordant decisions increased (25.4%, 33.9%, and 40.7%;p-trend = 0.016). There was no relationship identified between road salting choices with defensive medicine and prospect-theory-concordant decisions.ConclusionsAll participants made more economically-rational decisions when provided explicit probability information in a non-clinical domain. However, choices in the non-clinical domain were not related to prospect-theory concordant decision making and risk aversion tendencies in the clinical domain. Recognizing this discordance may be important when applying prospect theory to interventions aimed at improving clinical care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-016-0391-3) contains supplementary material, which is available to authorized users.
Highlights
Prospect theory suggests that when faced with an uncertain outcome, people display loss aversion by preferring to risk a greater loss rather than incurring certain, lesser cost
To explore the applications of prospect theory, this study aims to build on growing medical decision making research activities over the last several decades by describing some unique decision making in scenarios with uncertainty by doctors
Medical training is expected to change one’s experience with making decisions under uncertainty and we found trends in risk aversion and prospect theory concordance across education levels
Summary
Prospect theory suggests that when faced with an uncertain outcome, people display loss aversion by preferring to risk a greater loss rather than incurring certain, lesser cost. This study explores the extent to which prospect theory, loss aversion, and probability information in a non-clinical domain explains clinical decision making under uncertainty. Clinicians routinely make decisions for and with their patients that are complex, under time constraints, and involve risks or uncertain outcomes [1, 2] These decisions are informed by medical literature, clinical decision rules, predictive models, and, in practice, a number of subjective “rules of thumb” or heuristics that may deviate from what is considered economically “rational.” Decision scientists, psychologists, and behavioral economists have identified many such “decisional short-cuts” that impact judgment and decision making [3, 4], and some have extended heuristic-based decision theories to clinician decision making. Prospect theory holds that people have a tendency to make risk-seeking decisions in cost/loss situations They would rather risk a greater cost than incur a certain, lesser cost to protect themselves against the greater loss [8, 9]. Prospect theory was developed in non-clinical domains with non-clinical participants, and there are gaps in the empirical evidence of the utility of these theories to explain clinical decision making of doctors
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