Promising Approaches From Behavioral Economics to Improve Patient Lung Cancer Screening Decisions
Promising Approaches From Behavioral Economics to Improve Patient Lung Cancer Screening Decisions
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DOI：
10.1016/j.jacr.2016.09.004
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发表时间：
2016-12-01
影响因子：
4.5
通讯作者：
Thomson, Norman B.
中科院分区：
文献类型：
--
作者：
Barnes, Andrew J.;Groskaufmanis, Lauren;Thomson, Norman B.
肺癌是一种毁灭性的疾病，是世界上和美国最致命的癌症形式。由于CMS决定为高危吸烟者提供低剂量CT（LDCT）作为承保服务，LDCT肺癌筛查现在是许多高危患者的承保服务，首先需要咨询和共同的临床决策，包括讨论LDCT筛查的风险和益处。然而，共享决策从根本上依赖于这样一个前提，即有了更好的信息，患者将做出符合其偏好和价值观的理性决策。来自行为经济学领域的证据提供了许多相反的观点，这些观点考虑到了患者的决策偏差和共享决策环境的作用，这些决策环境可能导致有缺陷的选择，并且与肺癌筛查和治疗特别相关。本文讨论了一些最相关的偏见，并建议将这些知识纳入筛查和治疗指南，并分享决策最佳实践，以增加这些努力产生预期目标的可能性，以提高生存率和生活质量。
Lung cancer is a devastating disease, the deadliest form of cancer in the world and in the United States. As a consequence of CMS's determination to provide low-dose CT (LDCT) as a covered service for at-risk smokers, LDCT lung cancer screening is now a covered service for many at-risk patients that first requires counseling and shared clinical decision making, including discussions of the risks and benefits of LDCT screening. However, shared decision making fundamentally relies on the premise that with better information, patients will arrive at rational decisions that align with their preferences and values. Evidence from the field of behavioral economics offers many contrary viewpoints that take into account patient decision making biases and the role of the shared decision environment that can lead to flawed choices and that are particularly relevant to lung cancer screening and treatment. This article discusses some of the most relevant biases, and suggests incorporating such knowledge into screening and treatment guidelines and shared decision making best practices to increase the likelihood that such efforts will produce their desired objectives to improve survival and quality of life.