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Psychology of Patient Sections
Author Bio
Introduction
Omission Bias
Discount Rates
Currently selected section: Framing
Assessing Probabilities
Predicting Utility
Sequences
Role-based decisions
Role of Emotions
Visceral Influences
Conclusion
Chapter 4: The Psychology of Patient Decision Making: Framing
        

Consider the situation depicted in Figure 3.  Here is a case in which a potential gain is being considered.  The future benefit lies to the “gain” side of the present status, indicating that an improvement is being contemplated.  The impact of that improvement can be measured along the y-axis.

Figure 3: Status is on the x axis, and Value is on the y axis. "Present" lies at point (0,0). "Future" lies partially along the X axis to the right of point 0,0. Improvement is measured on the Y axis above point 0,0. A curved line runs from the lower left quadrant through point 0,0 to the upper right quadrant. 

Figure 4 represents a different situation.  Now the status quo is a deficient state.  The improvement under consideration is a return to a better previous condition.

Figure 4: Status is on the x axis, and Value is on the y axis. "Past" lies at point (0,0). "Present" lies partially along the X axis to the left of point 0,0. Improvement is measured on the Y axis below point 0,0. A curved line runs from the lower left quadrant through point 0,0 to the upper right quadrant.

Note that the magnitude of the improvement is greater when one returns to a prior better situation than when one tries to convert a current situation to a better future (Gregory, Lichtenstein, and MacGregor, 1993).  Gregory et al. showed that persons were more willing to pay for public health programs which returned the community to a safe prior state than they were to pay for improvements in public health.

People react strongly if they perceive their current state as deficient.  An improvement will move one up the steep portion of the value function located in the loss domain (“If only we could return to the good old days”). On the other hand, the gain to be derived from improvements to the status quo climb the relatively shallow right side of the value function.  People do not find such gains very compelling. Patients who perceive that they have suffered a loss are more motivated than persons who perceive no loss but who contemplate an equal-sized gain.  

 

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