Predicting medical practices using various risk attitude measures

Risk attitude and belief updating: theory and experiment

Despite the importance of risk attitude in decision-making, its role in belief updating has been overlooked. Using economic theory, we analyzed a dual-self equilibrium where an individual first updates her belief about an uncertain state and then takes an action to maximize her payoff. We showed that stronger risk aversion drives more conservative actions and thus decreases the instrumental value of information relative to the importance of belief-based utility. As a result, the relationship between risk attitude and belief updating depends on the nature of the belief-based utility. With self-relevant information, stronger risk aversion leads to more belief change, whereas with self-irrelevant information, stronger risk aversion leads to less belief change. Our experimental results concur with the theoretical predictions with two settings where subjects update their belief about their IQ and a randomly drawn number, respectively. We discuss implications on persuasion, advertisements, and political campaigns.

Eliciting risk preferences that predict risky health behavior: A comparison of two approaches

Information on attitudes to risk could increase understanding of and explain risky health behaviors. We investigate two approaches to eliciting risk preferences in the health domain, a novel "indirect" lottery elicitation approach with health states as outcomes and a "direct" approach where respondents are asked directly about their willingness to take risks. We compare the ability of the two approaches to predict health-related risky behaviors in a general adult population. We also investigate a potential framing effect in the indirect lottery elicitation approach. We find that risk preferences elicited using the direct approach can better predict health-related risky behavior than those elicited using the indirect approach. Moreover, a seemingly innocuous change to the framing of the lottery question results in significantly different risk preference estimates, and conflicting conclusions about the ability of the indicators to predict risky health behaviors.

Context-Dependent Risk & Benefit Sensitivity Mediate Judgments About Cognitive Enhancement

Opinions about cognitive enhancement (CE) are context-dependent. Prior research has demonstrated that factors like peer pressure, the influence of authority figures, competition, moral relevance, familiarity with enhancement devices, expertise, and the domain of CE to be enhanced can influence opinions. The variability and malleability of patient, expert, and public attitudes toward CE is important to describe and predict because these attitudes can influence at-home, clinical, research, and regulatory decisions. If individual preferences vary, they could influence opinions about practices and regulations due to disagreements about the desirable levels of risks and benefits. The study of attitudes about CE would benefit from psychological theories that explain judgments. In particular, we suggest that variability in risk and benefit sensitivity could psychologically mediate judgments about CE in many contexts. Drawing from prospect theory, which originated in behavioral economics, it is likely that framing effects, shifted reference points, and the tendency to weigh losses (risks) more heavily than gains (benefits) predict decisions about CE. We suggest that public policy could benefit from a shared conceptual framework, such as prospect theory, that allows us to describe and predict real-world decisions about CE by patients, experts, and the public.

Impact of Physicians' Personalities and Behavioral Traits on Treatment-Related Decision-making for Elderly Acute Myeloid Leukemia

BACKGROUND

Elderly patients with acute myeloid leukemia (AML) can be treated with intensive therapy, low-intensity therapy, or best supportive care. Medical decision-making might be affected by physicians' occupational and non-occupational factors.

OBJECTIVE

To explore the impact of physicians' personalities and behavioral traits on treatment-related decision-making for elderly AML patients.

DESIGN

A nationwide cross-sectional survey.

PARTICIPANTS

Hematologists in mainland China (N = 529; response rate 64.5%).

MAIN MEASURES

The medical decision-making for elderly AML patients was evaluated using 6 clinical vignettes. Hematologists' attitudes toward risk and uncertainty, Big Five personality traits, and decision-making styles were assessed using binary lottery choices and well-recognized self-report inventories.

KEY RESULTS

The resulting binary regression model in predicting treatment intensity contained professional title group (OR = 0.012, 95% CI 0.001 to 0.136, P < 0.001), conscientiousness (OR = 0.336, 95% CI 0.121 to 0.932, P = 0.036), extraversion (OR = 0.403, 95% CI 0.166 to 0.974, P = 0.044), conscientiousness by title group (OR = 2.009, 95% CI 1.100 to 3.667, P = 0.023), and extraversion by title group (OR = 1.627, 95% CI 0.965 to 2.743, P = 0.068) as predictors of therapy intensity preference. Junior physicians with a higher level of extraversion (mean difference = 0.27; 95% CI 0.07 to 0.45; P = 0.009) or conscientiousness (mean difference = 0.19; 95% CI 0.01 to 0.36; P = 0.028) tended to prescribe more intensive therapy. Meanwhile, no significant correlation was found between physicians' personalities or behavioral traits and treatment-related decision-making in senior physicians.

CONCLUSIONS

Physicians' personalities contribute to treatment-related decision-making for elderly AML patients, depending on the professional titles. More extravert or conscientious attending physicians tended to prescribe more intensive therapy. Meanwhile, the decisions made by chief and associate chief physicians were not impacted by their personal traits. Junior physicians should be aware of such potential influence when making medical decisions.

Gender differences in physician decisions to adopt new prescription drugs

Physician adoption of new technologies is a key issue for population health and the sustainability of the healthcare system. This paper explores gender differences in general practitioners' (GPs) adoption of new oral anticoagulants. We combine detailed individual data on physician and practice style characteristics from the Medicine in Australia: Balancing Employment and Life (MABEL) panel survey of Australian physicians with administrative prescribing data from the Australian Pharmaceutical Benefits Scheme (PBS) and the Medicare Benefits Schedule (MBS) for the period January 1, 2012 and December 31, 2015. After adjusting for various factors proposed in the literature as drivers of this gender gap, in addition to risk preferences and personality traits, we find a large statistical gender difference in the speed of adoption with men being faster than women in uptake. However, conditional on having prescribed for the first time, female and male GPs differ only slightly in the intensity of use of these new drugs. We show that the gender gap depends on the measure of uptake and discuss possible channels that could be driving the relatively large gender difference that remains in the speed of adoption.

A qualitative study of key stakeholders' perceived risks and benefits of psychiatric electroceutical interventions

Amid a renewed interest in alternatives to psychotherapy and medication to treat depression, there is limited data as to how different stakeholders perceive of the risks and benefits of psychiatric electroceutical interventions (PEIs), including electroconvulsive therapy (ECT) and deep brain stimulation (DBS). To address this gap, we conducted 48 semi-structured interviews, including 16 psychiatrists, 16 persons diagnosed with depression, and 16 members of the general public. To provide a basis of comparison, we asked participants to also compare each modality to front-line therapies for depression and to neurosurgical procedures used for non-psychiatric conditions. Across all stakeholder groups, perceived memory loss was the most frequently mentioned potential risk with ECT. The most discussed benefits across all stakeholder groups were efficacy and quick response. Psychiatrists most often referenced effectiveness when discussing ECT, while patients and the public did so when discussing DBS. Taken as a whole, these data highlight stakeholders' contrasting perspectives on the risks and benefits of electroceuticals.

Are health risk attitude and general risk attitude associated with healthcare utilization, costs and working ability? Results from the German KORA FF4 cohort study

BACKGROUND

Risk attitudes influence decisions made under uncertainty. This paper investigates the association of risk attitudes with the utilization of preventive and general healthcare services, work absence and resulting costs to explore their contribution to the heterogeneity in utilization.

METHODS

Data of 1823 individuals (56.5 ± 9.5 years), participating in the German KORA FF4 population-based cohort study (2013/2014) were analyzed. Individuals' general and health risk attitude were measured as willingness to take risk (WTTR) on 11-point scales. Utilization of preventive and medical services and work absence was assessed and annual costs were calculated from a societal perspective. Generalized linear models with log-link function (logistic, negative-binomial and gamma regression) adjusted for age, sex, and height were used to analyze the association of WTTR with the utilizations and costs.

RESULTS

Higher WTTR was significantly associated with lower healthcare utilization (physician visits, physical therapy, and medication intake), work absence days and indirect costs. Regarding preventive services, an overall negative correlation between WTTR and utilization was examined but this observation remained non-significant except for the outcome medical check-up. Here, higher WTTR was significantly associated with a lower probability of participation. For all associations mentioned, Odds Ratios ranged between 0.90 and 0.79, with p < 0.05. Comparing the two risk attitudes (general and regarding health) we obtained similar results regarding the directions of associations.

CONCLUSIONS

We conclude that variations in risk attitudes contribute to the heterogeneity of healthcare utilization. Thus, knowledge of their associations with utilization might help to better understand individual decision-making - especially in case of participation in preventive services.

Comparing GPs' risk attitudes for their own health and for their patients' : a troubling discrepancy?

Background

In this paper, we report the results of risk attitudes elicitation of a French general practitioners national representative sample (N=1568).

Methods

Willingness to take risks in four different domains (daily life, financial matters, own health and patient health) was collected through a large-scale telephone interview of GPs using self-reported 11-point Likert scale questions.

Results

We uncover some specificities of the GPs population regarding their attitudes towards risk. In particular, we detect an important positive gap between their willingness to take risks in the domain of their own health and in the domain of the heath of their patients. This “patient-regarding” risk aversion is discussed with respect to its important consequences regarding medical behavior bias.

Conclusions

We confirm the self-other discrepancy found in the medical literature on physicians’ behaviors and emphasize the utility of the study and measures of personality traits such as “risk attitudes” for the medical professions and for the population they address.