Concept: Choice architecture
Socioeconomically vulnerable people are likely to have more health risks because of inadequate behaviour choices related to chronic social stresses. Brain science suggests that stress causes cognitively biased automatic decision making, preferring instant stress relief and pleasure (eg, smoking, alcohol use and drug abuse) as opposed to reflectively seeking health-maintenance services (eg, health check-ups). As such, hedonic stimuli that nudge people towards preventive actions could reduce health behaviour disparities. The purpose of this intervention study was to test this hypothesis.
Tens of millions of people are currently choosing health coverage on a state or federal health insurance exchange as part of the Patient Protection and Affordable Care Act. We examine how well people make these choices, how well they think they do, and what can be done to improve these choices. We conducted 6 experiments asking people to choose the most cost-effective policy using websites modeled on current exchanges. Our results suggest there is significant room for improvement. Without interventions, respondents perform at near chance levels and show a significant bias, overweighting out-of-pocket expenses and deductibles. Financial incentives do not improve performance, and decision-makers do not realize that they are performing poorly. However, performance can be improved quite markedly by providing calculation aids, and by choosing a “smart” default. Implementing these psychologically based principles could save purchasers of policies and taxpayers approximately 10 billion dollars every year.
It is important to understand the magnitude and distribution of the economic burden of prescription opioid overdose, abuse, and dependence to inform clinical practice, research, and other decision makers. Decision makers choosing approaches to address this epidemic need cost information to evaluate the cost effectiveness of their choices.
The way choices are framed influences decision-making. These “framing effects” emerge through the integration of emotional responses into decision-making under uncertainty. It was previously reported that susceptibility to the framing effect was reduced in individuals with autism spectrum disorder (ASD) due to a reduced tendency to incorporate emotional information into the decision-making process. However, recent research indicates that, where observed, emotional processing impairments in ASD may be due to co-occurring alexithymia. Alexithymia is thought to arise due to impaired interoception (the ability to perceive the internal state of one’s body), raising the possibility that emotional signals are not perceived and thus not integrated into decision-making in those with alexithymia and that therefore reduced framing effects in ASD are a product of co-occurring alexithymia rather than ASD per se. Accordingly, the present study compared framing effects in autistic individuals with neurotypical controls matched for alexithymia. Results showed a marked deviation between groups. The framing effect was, in line with previous data, significantly smaller in autistic individuals, and there was no relationship between alexithymia or interoception and decision-making in the ASD group. In the neurotypical group, however, the size of the framing effect was associated with alexithymia and interoception, even after controlling for autistic traits. These results demonstrate that although framing effects are associated with interoception and alexithymia in the neurotypical population, emotional and interoceptive signals have less impact upon the decision-making process in ASD.
- Women's health issues : official publication of the Jacobs Institute of Women's Health
- Published about 5 years ago
As the least-chosen option when faced with an unplanned pregnancy, adoption remains largely unexamined as a reproductive choice. Although the anti-abortion movement promotes adoption as its preferred alternative to abortion, little is known of birth mothers' pregnancy decision making and whether adoption was chosen in lieu of abortion.
Adaptive decision-making uses information gained when exploring alternative options to decide whether to update the current choice strategy. Magnocellular mediodorsal thalamus (MDmc) supports adaptive decision-making, but its causal contribution is not well understood. Monkeys with excitotoxic MDmc damage were tested on probabilistic three-choice decision-making tasks. They could learn and track the changing values in object-reward associations, but they were severely impaired at updating choices after reversals in reward contingencies or when there were multiple options associated with reward. These deficits were not caused by perseveration or insensitivity to negative feedback though. Instead, monkeys with MDmc lesions exhibited an inability to use reward to promote choice repetition after switching to an alternative option due to a diminished influence of recent past choices and the last outcome to guide future behavior. Together, these data suggest MDmc allows for the rapid discovery and persistence with rewarding options, particularly in uncertain or changing environments.
The success of efforts to reduce inappropriate use of medical tests and interventions may be limited by our tendency to overestimate the effect of our actions. Efforts to promote more rational medical decision making will need to address this illusion of control.
Decision Making for Risk Management: A Comparison of Graphical Methods for Presenting Quantitative Uncertainty
- Risk analysis : an official publication of the Society for Risk Analysis
- Published about 8 years ago
Previous research has shown that people err when making decisions aided by probability information. Surprisingly, there has been little exploration into the accuracy of decisions made based on many commonly used probabilistic display methods. Two experiments examined the ability of a comprehensive set of such methods to effectively communicate critical information to a decision maker and influence confidence in decision making. The second experiment investigated the performance of these methods under time pressure, a situational factor known to exacerbate judgmental errors. Ten commonly used graphical display methods were randomly assigned to participants. Across eight scenarios in which a probabilistic outcome was described, participants were asked questions regarding graph interpretation (e.g., mean) and made behavioral choices (i.e., act; do not act) based on the provided information indicated that decision-maker accuracy differed by graphical method; error bars and boxplots led to greatest mean estimation and behavioral choice accuracy whereas complementary cumulative probability distribution functions were associated with the highest probability estimation accuracy. Under time pressure, participant performance decreased when making behavioral choices.
In this issue of Neuron,Steinbeis et al. (2012) show that DLPFC structure and functions are associated with strategic social choices during an economic task and relate to impulse control abilities in both age dependent and independent manners.
Choice confidence represents the degree of belief one’s actions are likely to be correct or rewarding and plays a critical role in optimising our decisions. Despite progress in understanding the neurobiology of human perceptual decision-making, little is known about the representation of confidence. Importantly, it remains unclear whether confidence forms an integral part of the decision process itself or represents a purely post-decisional signal. To address this issue we employed a paradigm whereby on some trials, prior to indicating their decision, participants could opt-out of the task for a small but certain reward. This manipulation captured participants' confidence on individual trials and allowed us to discriminate between electroencephalographic signals associated with certain-vs-uncertain trials. Discrimination increased gradually and peaked well before participants indicated their choice. These signals exhibited a temporal profile consistent with a process of evidence accumulation, culminating at time of peak discrimination. Moreover, trial-by-trial fluctuations in the accumulation rate of nominally identical stimuli were predictive of participants' likelihood to opt-out of the task, suggesting confidence emerges from the decision process itself and is computed continuously as the process unfolds. Correspondingly, source reconstruction placed these signals in regions previously implicated in decision making, within the prefrontal and parietal cortices. Crucially, control analyses ensured that these results could not be explained by stimulus difficulty, lapses in attention or decision accuracy.