Information Framing in Medical Decision Making

 Numerous studies from behavioral decision research have demonstrated that framing the  same information differently can lead to different responses.   In Chapter 1, I demonstrate  that variations in the information presented in transplant program report cards alters  participants’ evaluations of which programs are better performing and thus which programs  are better choices for transplant candidates.   Whereas historically,  these report cards focused  primarily on post-transplant outcomes, my work found that report cards featuring salient  information about donor organ utilization rates (transplant outcomes categorized by quality  of donor offers accepted), or overall survival rates (outcomes from both waitlist and  transplanted patients) both lay evaluators and medical trainees evaluate transplant centers with  open donor acceptance strategies more favorably than centers with conservative  strategies.  When report cards lacked this information, both populations preferred the more  conservative strategies.  In Chapter 2, I apply a behavioral decision science approach known  as the mental models methodology in order to conceptualize women’s beliefs, attitudes, and  perceived adherence practices about vaginal microbicide films, a novel antiretroviral drug  delivery system that is effective in preventing sexual transmission of HIV.  I find evidence  that an instructional video designed to convey key information about barriers and  misconceptions surrounding film use was effective at reducing women’s concerns on variables  related to physical properties of the films and worries the insertion process itself.  Finally in  Chapter 3, I explore errors in lay reasoning about vaccine efficacy and an intervention to bring  lay perceptions in line with normative efficacy calculations. I demonstrate that the tendency  to consider vaccine efficacy rates using a normative (or lure) computation depends on the  contextual information provided in the question format: people tend to more normative when  calculating an efficacy rate, but tend to follow a lure strategy when they are asked to calculate  the number of infections (given an efficacy rate). I show that a visual debiasing intervention  explained the concept behind the efficacy rate was effective in increasing the proportion of  normative responses to efficacy format questions and reducing the proportion of lure  responses in illness format questions.