The emergence of shared decision making in health care has empowered patients to take a more active role in managing their own treatment. In contrast to former care paradigms in which patients largely deferred decision making to technocratic providers and physicians, shared decision making focuses on empowering patients to make their own treatment decisions through education that incorporates the patient’s values and preferences.1 This shift places new importance on understanding what exactly drives decision making by patients.
The most obvious factors are those that would be considered by a “rational” patient in cost-benefit analyses: cost of treatment, indirect costs such as lost wages, likelihood of survival, probable complications, and quality of life, among others. But for a host of reasons, patients do not usually carry out this sort of rational economic analysis when making health care decisions. For one, outcomes data are notoriously difficult to obtain, making many relevant statistics only available to very enterprising patients. Patients can also be easily overwhelmed by the gravity and complexity of the medical decisions they face. With the vast amount of literature available and potential analyses that could be done to determine the optimal treatment, many patients, feeling intimidated, may simply leave important health care decisions to their doctors.2