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

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.

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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.

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Affiliations

Authors

Corresponding author

Correspondence to Amanda S. Bruce PhD.

Ethics declarations

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.

Appendix

Appendix

Medical Decision Making Questionnaire

When thinking about whether to take or not to take a Disease Modifying Medication, patients must weigh the potential costs and benefits associated with each decision. Please indicate how likely you would be to take a Disease Modifying Medication if each of the following statements were true.

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Bruce, J.M., Bruce, A.S., Catley, D. et al. Being Kind to Your Future Self: Probability Discounting of Health Decision-Making. ann. behav. med. 50, 297–309 (2016). https://doi.org/10.1007/s12160-015-9754-8

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Keywords

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