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Annals of Behavioral Medicine

, Volume 50, Issue 2, pp 297–309 | Cite as

Being Kind to Your Future Self: Probability Discounting of Health Decision-Making

  • Jared M. Bruce
  • Amanda S. Bruce
  • Delwyn Catley
  • Sharon Lynch
  • Kathleen Goggin
  • Derek Reed
  • Seung-Lark Lim
  • Lauren Strober
  • Morgan Glusman
  • Abigail R. Ness
  • David P. Jarmolowicz
Original Article

Abstract

Introduction

Nearly 50 % of patients with chronic medical illness exhibit poor treatment adherence. When making treatment decisions, these patients must balance the probability of current side effects against the probability of long-term benefits. This study examines if the behavioral economic construct of probability discounting can be used to explain treatment decisions in chronic disease.

Methods

Thirty-eight nonadherent and 39 adherent patients with multiple sclerosis (MS) completed a series of hypothetical treatment scenarios with varied risk and benefit probabilities.

Results

As described by a hyperbolic probability discounting model, all patients reported decreased medication initiation as the probability of treatment efficacy decreased and the probability of treatment side effects increased. When compared to adherent patients, nonadherent patients significantly devalued treatment efficacy and inflated treatment risk.

Discussion

The methods in this study can be used to identify optimal risk/benefit ratios for treatment development and inform the process by which patients make treatment decisions.

Keywords

Probability discounting Multiple sclerosis Temporal discounting Medical decision-making Behavioral economics Treatment adherence Compliance 

Notes

Acknowledgments

This project was supported in part by grant to J. Bruce from the National Multiple Sclerosis (HC 0138) and a grant to M. Glusman from the University of Missouri-Kansas City School of Graduate Studies.

Compliance with Ethical Standards

Authors’ Statement of Conflict of Interest and Adherence to Ethical Standards

Dr. J. Bruce is a member of the Novartis Unbranded Speakers Bureau and the Novartis MS Cognition Medical Advisory Board. He is also a consultant to the National Hockey League. Authors A. Bruce, Catley, Lynch, Goggin, Reed, Lim, Strober, Glusman, Ness, and Jarmolowicz declare that they have no conflict of interest. All procedures, including the informed consent process, were conducted in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

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Copyright information

© The Society of Behavioral Medicine 2015

Authors and Affiliations

  • Jared M. Bruce
    • 1
  • Amanda S. Bruce
    • 2
    • 3
  • Delwyn Catley
    • 1
  • Sharon Lynch
    • 4
  • Kathleen Goggin
    • 3
  • Derek Reed
    • 5
  • Seung-Lark Lim
    • 1
  • Lauren Strober
    • 6
  • Morgan Glusman
    • 1
  • Abigail R. Ness
    • 1
  • David P. Jarmolowicz
    • 5
  1. 1.University of Missouri-Kansas CityKansas CityUSA
  2. 2.Department of PediatricsUniversity of Kansas Medical CenterKansas CityUSA
  3. 3.Children’s Mercy HospitalKansas CityUSA
  4. 4.Department of NeurologyUniversity of Kansas Medical CenterKansas CityUSA
  5. 5.University of KansasLawrenceUSA
  6. 6.Kessler FoundationWest OrangeUSA

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