Mary Steffel

Making Better Decisions: From Measuring to Constructing Preferences

The authors examine how a constructive preferences perspective might change the prevailing view of medical decision making by suggesting that the methods used to measure preferences for medical treatments can change the preferences that are reported. The authors focus on 2 possible techniques that they believe would result in better outcomes. The 1st is the wise selection of default options. Defaults may be best applied when strong clinical evidence suggests a treatment option to be correct for most people but preserving patient choice is appropriate. The 2nd is the use of environments that explicitly facilitate the optimal construction of preferences. This seems most appropriate when choice depends on a patients ability to understand and represent probabilities and outcomes. For each technique, the authors describe the background and literature, provide a case study, and discuss applications.

Preference Assessment Method Affects Decision-Analytic Recommendations: A Prostate Cancer Treatment Example

Purpose. To evaluate the effect of preference assessment method on treatment recommended by an individualized decision-analytic model for early prostate cancer. Methods. Health state preferences were elicited by time tradeoff, rating scale, and a power transformation of the rating scale from 63 men ages 55 to 75. The authors used these values in a Markov model to determine whether radical prostatectomy or watchful waiting yielded the greater quality-adjusted life expectancy. Results. Time tradeoff and transformed rating scale recommendations differed widely. Time tradeoff and transformed rating scale utilities differed in their treatment recommendation for 21% to 52% of men, and the mean difference in quality-adjusted life years varied from less than 0.5 to greater than 1.0. Conclusions. Treatment recommendations from the prostate cancer decision model were sensitive to the method of preference assessment. If decision analysis is used to counsel individual patients, careful considerationmust be given to the method of preference elicitation.

Ethically Deployed Defaults: Transparency and Consumer Protection Through Disclosure and Preference Articulation.

Defaults are extremely effective at covertly guiding choices, which raises concerns about how to employ them ethically and responsibly. Consumer advocates have proposed that disclosing how defaults are intended to influence choices could help protect consumers from being unknowingly manipulated. This research shows that consumers appreciate transparency, but disclosure does not make defaults less influential. Seven experiments demonstrate that disclosure alters how fair consumers perceive defaults to be but does not attenuate default effects because consumers do not understand how to counter the processes by which defaults bias their judgment. Given that defaults lead consumers to focus disproportionately on reasons to choose the default even with disclosure, debiasing default effects requires that consumers engage in a more balanced consideration of the default and its alternative. Encouraging people to articulate their preferences for the default or its alternative, as in a forced choice, shifts the focus away from the default and reduces default effects.

Perspective mistaking:: Accurately understanding the mind of another requires getting perspective, not taking perspective.

Taking another person’s perspective is widely presumed to increase interpersonal understanding. Very few experiments, however, have actually tested whether perspective taking increases accuracy when predicting another person’s thoughts, feelings, attitudes, or other mental states. Those that do yield inconsistent results, or they confound accuracy with egocentrism. Here we report 25 experiments testing whether being instructed to adopt another person’s perspective increases interpersonal insight. These experiments include a wide range of accuracy tests that disentangle egocentrism and accuracy, such as predicting another person’s emotions from facial expressions and body postures, predicting fake versus genuine smiles, predicting when a person is lying or telling the truth, and predicting a spouse’s activity preferences and consumer attitudes. Although a large majority of pretest participants believed that perspective taking would systematically increase accuracy on these tasks, we failed to find any consistent evidence that it actually did so. If anything, perspective taking decreased accuracy overall while occasionally increasing confidence in judgment. Perspective taking reduced egocentric biases, but the information used in its place was not systematically more accurate. A final experiment confirmed that getting another person’s perspective directly, through conversation, increased accuracy but that perspective taking did not. Increasing interpersonal accuracy seems to require gaining new information rather than utilizing existing knowledge about another person. Understanding the mind of another person is therefore enabled by getting perspective, not simply taking perspective.