Pushing my buttons: A 'shocking' study and patient-directed care

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Staff Writer Tim Mullaney
Staff Writer Tim Mullaney

Here's the scenario: You're going to receive an electric shock.

It's part of a study, and you're willing to undergo the highly unpleasant shock for the sake of science. Before you get started, the researcher in charge gives you the option of pressing a button, to end the shock 10 seconds earlier than it would otherwise last.

Do you press the button?

For 60% of you, the answer is no.

That's according to researchers who actually did this experiment. Participants who had to choose between pressing the button and doing nothing often did nothing, despite the potentially negative consequences.

However, if participants were told that they had to press a button, and one would shorten the shock time and one would keep it the same, most people chose to press the button to shorten the shock.

When I read about the study, it seemed at first to be confirming that people are fundamentally lazy. But the researchers from Stanford University and Tel Aviv University presented the phenomenon in different terms. It's not that people are lazy, it's that we are subject to inertia. You know, Newton's first law: An object in motion tends to stay in motion, and vice-versa.

In behavioral terms, that means we may have a hard-wired tendency to opt for the status quo. This is a tendency that can be hazardous to our health, as shown by this recent study. The results might explain why many patients do not take medicines or do exercises or otherwise follow doctor's orders.

The potentially good news: Participants who were forced to press a button in an early trial were more likely to continue to press a button in later trials, under different conditions. This, the researchers proposed, suggests “people may be capable of making productive choices about their health if given a nudge in the right direction.”

The findings seem pertinent to the recently proposed “Care Planning Act of 2013.” This bill, endorsed by the American Association for Long-Term Care Nursing, would provide Medicare and Medicaid reimbursement to healthcare professionals for holding discussions about care plan options with seriously or terminally ill patients. The bill would also put measures in place to increase providers' adherence to patients' wishes.

“When faced with a serious illness, you want the freedom to control how you will live," said Sen. Mark Warner (D-VA), one of the bill's sponsors. "The Care Planning Act will help align the care you receive with the care you want — no more, no less.”

This sounds great, but the electric shock experiment gave me pause.

Would these talks function as “nudges” getting people to make proactive choices, and therefore getting them to adhere more diligently to medication or therapy regimens? Perhaps the talks could work this way, if healthcare professionals are essentially laying out a range of options and saying to a patient, you must choose an approach.

Or would these talks play into patients' potentially self-sabotaging states of inertia? It's dizzying to think about a doctor and a director of nursing and a palliative care nurse and a patient's family and a faith leader sitting down together to go over all the choices. I can easily imagine myself choosing to ignore all the metaphorical buttons I'm being offered in favor of doing nothing.

Don't get me wrong. I wholeheartedly believe that depending on the circumstances, preserving quality of life by doing nothing — or at least taking a less aggressive course of action — should be on the table. But if the theory about behavioral inertia is true, it seems that healthcare professionals and patients ought to be very aware that if the choice is between doing something and doing nothing, we may be predisposed to choosing the “nothing” … even if the “something” is as simple as pushing a button.

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McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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