BACKGROUND: Many people display omission bias in medical decision making, accepting the risk of passive nonintervention rather than actively choosing interventions (such as vaccinations) that result in lower levels of risk.
OBJECTIVE: Testing whether people’s preferences for active interventions would increase when deciding for others versus for themselves.
RESEARCH DESIGN: Survey participants imagined themselves in 1 of 4 roles: patient, physician treating a single patient, medical director creating treatment guidelines, or parent deciding for a child. All read 2 short scenarios about vaccinations for a deadly flu and treatments for a slow-growing cancer.
PARTICIPANTS: Two thousand three hundred and ninety-nine people drawn from a demographically stratified internet sample.
MEASURES: Chosen or recommended treatments. We also measured participants’ emotional response to our task.
RESULTS: Preferences for risk-reducing active treatments were significantly stronger for participants imagining themselves as medical professionals than for those imagining themselves as patients (vaccination: 73% [physician] & 63% [medical director] vs 48% [patient], Ps<.001; chemotherapy: 68% & 68% vs 60%, Ps<.012). Similar results were observed for the parental role (vaccination: 57% vs 48%, P=.003; chemotherapy: 72% vs 60%, P<.001). Reported emotional reactions were stronger in the responsible medical professional and parental roles yet were also independently associated with treatment choice, with higher scores associated with reduced omission tendencies (OR=1.15 for both regressions, Ps<.01).
CONCLUSIONS: Treatment preferences may be substantially influenced by a decision-making role. As certain roles appear to reinforce “big picture” thinking about difficult risk tradeoffs, physicians and patients should consider re-framing treatment decisions to gain new, and hopefully beneficial, perspectives.
decision making risk communication omission bias
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Ritov I, Baron J. Reluctance to vaccinate: omission bias and ambiguity. J Behav Decis Making. 1990;3:263–77.Google Scholar
Spranca M, Minsk E, Baron J. Omission and commission in judgment and choice. J Exp Soc Psychol. 1991;27:76–105.CrossRefGoogle Scholar
Meszaros JR, Asch DA, Baron J, Hershey JC, Kunreuther H, Schwartz-Buzaglo J. Cognitive processes and the decisions of some parents to forego pertussis vaccination for their children. J Clin Epidemiol. 1996;49:697–703.CrossRefPubMedGoogle Scholar
Baron J, Ritov I. Omission bias, individual differences, and normality. Organ Behav Hum Decis Process. 2004;94:74–85.CrossRefGoogle Scholar
Haidt J, Baron J. Social roles and the moral judgment of acts and omissions. Eur J Soc Psychol. 1996;26:201–18.CrossRefGoogle Scholar
Kray L, Gonzalez R. Differential weighting in choice versus advice: I’ll do this, you do that. J Behav Decis Making. 1999;12:207–17.CrossRefGoogle Scholar
Jonas E, Schulz-Hardt S, Frey D. Giving advice or making decisions in someone else’s place: the influence of impression, defense, and accuracy motivation on the search for new information. Pers Soc Psychol Bull. 2005;31:977–90.CrossRefPubMedGoogle Scholar
Demoratz MJ. Advance directives: getting patients to complete them before they need them. Case Manager. 2005;16:61–3.PubMedGoogle Scholar
Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol. 1988;54:1063–70.CrossRefPubMedGoogle Scholar
Carstensen LL, Isaacowitz DM, Charles CT. Taking time seriously: a theory of socioemotional selectivity. Am Psychol. 1999;54:165–81.CrossRefPubMedGoogle Scholar
Charles S, Mather M, Carstensen LL. Aging and emotional memory: the forgettable nature of negative images for older adults. J Exp Psychol Gen. 2003;132:310–24.CrossRefPubMedGoogle Scholar
Peters E, Finucane ML, MacGregor DG, Slovic P. The bearable lightness of aging: judgment and decision processes in older adults. In: Stern PC, Carstensen LL, eds. The Aging Mind: Opportunities in Cognitive Research. Washington, DC: National Research Council, National Academy Press; 2000:144–65.Google Scholar
Williams P, Drolet A. Age-related differences in responses to emotional advertisements. J Consum Res. 2005;32:343–54.CrossRefGoogle Scholar