Journal of General Internal Medicine

, Volume 23, Issue 10, pp 1708–1712 | Cite as

Affective Forecasting: An Unrecognized Challenge in Making Serious Health Decisions

  • Jodi HalpernEmail author
  • Robert M. Arnold


Patients facing medical decisions that will impact quality of life make assumptions about how they will adjust emotionally to living with health declines and disability. Despite abundant research on decision-making, we have no direct research on how accurately patients envision their future well-being and how this influences their decisions. Outside medicine, psychological research on “affective forecasting” consistently shows that people poorly predict their future ability to adapt to adversity. This finding is important for medicine, since many serious health decisions hinge on quality-of-life judgments. We describe three specific mechanisms for affective forecasting errors that may influence health decisions: focalism, in which people focus more on what will change than on what will stay the same; immune neglect, in which they fail to envision how their own coping skills will lessen their unhappiness; and failure to predict adaptation, in which people fail to envision shifts in what they value. We discuss emotional and social factors that interact with these cognitive biases. We describe how caregivers can recognize these biases in the clinical setting and suggest interventions to help patients recognize and address affective forecasting errors.


decision-making communication patient preferences doctor–patient relationship quality of life 



Financial support: Dr. Halpern’s work was supported by the Greenwall Foundation Faculty Scholar’s Program, the Robert Wood Johnson Foundation, and the National Institute of Mental Health. Dr. Arnold was supported by the Greenwall Foundation, Ladies Hospital Aid Society of Western Pennsylvania, the Jewish Health Care Foundation, the National Center for Palliative Care Research, and the LAS Trust Foundation.

Acknowledgement for Katie Hasson and Deb Seltzer: “For excellent editorial assistance.” And Anthony Back and Peter Ubel: “For useful comments about how to improve paper.”

Conflicts of Interest

None disclosed.


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Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  1. 1.Joint Medical Program, School of Public HealthUniversity of CaliforniaBerkeleyUSA
  2. 2.Division of General Internal Medicine, Department of MedicineLeo H Criep Chair in Patient CarePittsburghUSA
  3. 3.Section of Palliative Care and Medical Ethics, Institute for Doctor-Patient Communication, Institute to Enhance Palliative Care, Center for Bioethics and Health Law, University of Pittsburgh Cancer InstituteUniversity of Pittsburgh School of MedicinePittsburghUSA

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