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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
        

Prospect theory’s value function is depicted in Figure 2.  Objective measures such as number of lives or amount of money are located on the x-axis.  A psychological factor—value—is located on the y-axis.   The value function simply depicts the relationship between objective gains/losses and one’s psychological reaction to them.

Figure 2: Prospect theory's value function: Losses and gains are on the x axis, while value is on the y axis. Box A, in the lower left quadrant, represents losses and a curved line representing diminishing pain associated with the loss. Box B, in the upper right quadrant, represents gains, and a curved line represents diminishing value for each additional increment of gain.

 

There are two important points to note.  First, both gains and losses obey the law of diminishing returns.  As gains increase, each additional increment of gain becomes less valuable.  As losses increase, each additional increment of loss becomes less painful.  Second, the curve is steeper for losses than for gains.  This is the basis for loss aversion; losses have a greater psychological impact than do equivalent gains.

Rothman and Salovey (1997) have demonstrated how this analysis can explain several aspects of patient decision making.  Many detection procedures, such as breast self-examination, are perceived to involve risk.  A patient might detect a lump, which would be a frightening experience.  To get patients to perform breast self-examination, the physician might try entreaties framed in terms of either gains or losses.  A gain-framed message might highlight the reassurance of finding out that one’s breasts are healthy.  A loss-framed message might emphasize the dangers of not performing the breast self-examination.  To the extent that performing detection behaviors is perceived as involving the risk of a loss, a loss-framed message would be more effective than a gain-framed one.  In the lower-left quadrant of Figure 2 (the region of losses), people are likely to adopt risky behavior, such as examining one’s breasts for a lump.

 

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