Outlook: Newsletter of the Society of Behavorial Medicine

Health Decision Making 101

Aisha Langford, PhD Health Decision Making Special Interest Group (HDM SIG) Co-Chair; Kristen Riley, PhD,  HDM SIG Student Liaison; and Megan Oser, PhD MPH, HDM SIG Chair

For those interested, or those wanting to pursue research in health decision making, we present definitions of decision making, seminal papers, relevant journals, and a snapshot of types of research HDM SIG members are exploring.

Definition of Health Decision Making

Broadly, health decision making is the cognitive and affective processes through which individuals make decisions about health behavior engagement, their risk for an illness, or their management of an illness across the medical and behavioral health spectrum. The Society of Behavioral Medicine’s (SBM) HDM SIG  has a special interest in understanding informed decision making by patients and the general population, shared decision making between patients and health professionals, and clinical decision making by health professionals.

Theories and Papers of Interest

Health decision making is impacted by many factors1, 2 and can be evaluated in the context of several theories.3 For example, Prospect Theory posits that people make decisions based on how they value potential gains and losses while Fuzzy Trace Theory explains memory and reasoning in the context of “gist” or bottom line understanding versus verbatim recall of information.4,5

Clinical Risk Communication

Patients are increasingly asked to make difficult decisions about medical and behavioral health screening, prevention, and treatment. Patients are often presented with numbers and statistics, but many Americans do not have the skillsets to accurately digest and objectively make decisions based on these numbers. A number of empirical articles have developed recommendations for communicating risk effectively to patients, including using plain language, using absolute instead of relative risk terms, using pictographs, etc. Here are resources and summaries of tips for helping patients make medical and behavioral health decisions. 6, 7

Journals

In addition to SBM journals, a number of other journals regularly feature health decision making research, including Medical Decision Making, Health Psychology, BMC Medical Informatics and Decision Making, and Social Science and Medicine.

Methods

To learn about methods for conducting and evaluating health decision making research, check out the sessions at SBM and short courses at the Society for Medical Decision Making (SMDM). The SBM/SMDM Crosstalk Committee continues to promote collaboration between the two organizations. The Ottawa Hospital Research Institute and International Patient Decision Aid Standards (IPDAS) websites are also good resources.

Current and Future Research

PCORI recently released notes from an Expert Panel Meeting on Advancing Medical Decision Making here. HDM SIG members are exploring a number of Health Decision Making research questions, including information avoidance, superstitious thinking about risk, shared decision making in cancer screening, beliefs among cigarette smokers, the connection between affect and eating, message sourcing for national public health campaigns for behaviors like smoking and receiving the HPV vaccine, and creating measurement scales and methods to study these research questions.

If you’d like to learn more, visit our website, reach out to HDM researchers for collaboration, join our SIG, and/or attend our programming at SBM. We look forward to seeing you in New Orleans.

References

  1. Stacey D, Légaré F, Lewis K, et al. The Cochrane Library. April 2017. doi:10.1002/14651858.CD001431.pub5.
  2. Hamilton, J. G., Lillie, S. E., Alden, D. L., Scherer, L., Oser, M., Rini, C., ... & Goldstein, M. K. (2017). What is a good medical decision? A research agenda guided by perspectives from multiple stakeholders. Journal of behavioral medicine, 40(1), 52-68.
  3. Reyna VF. Theories of Medical Decision Making and Health: An Evidence-Based Approach. Med Decis Making. 2008;28(6):829.
  4. Kahneman D, Tversky A. Prospect Theory: An Analysis of Decision Under Risk.; 1979.
  5. Reyna VF. A theory of medical decision making and health: fuzzy trace theory. Med Decis Making. 2008;28(6):850-865.
  6. Fagerlin A, Zikmund-Fisher BJ, Ubel PA. Helping Patients Decide: Ten Steps to Better Risk Communication. JNCI Journal of the National Cancer Institute. 2011;103(19):1436.
  7.  https://www.samhsa.gov/brss-tacs/recovery-support-tools/shared-decision-making