Critical care physicians’ perspectives on nudging in communication

Critical care physicians’ perspectives on nudging in communication
JAMA Network Open; by Derek R. Soled, Christy L. Cummings, Laura M. Berbert, David N. Williams, William B. Feldman, Robert D. Truog, Emily B. Rubin; 9/25
Our qualitative study on the experiences and perspectives of nudges by critical care physicians identified multiple themes relating to the appropriate use and ethics of nudging patients in clinical decision-making. In the decision-making context, a nudge is defined as “any aspect of the choice architecture [the intentional arrangement and presentation of options to subtly guide people towards certain choices] that alters people’s behavior in a predictable way without forbidding any options or significantly changing their economic incentives.” While nudges preserve a person’s choice set without restricting options, they make it more likely that a person will choose some particular option by triggering decision-making heuristics and biases. Many physicians described nudging as an inevitable and natural part of communication—but one that must be used thoughtfully for it to be ethically justifiable.
Assistant Editor's note: As a clinician, I can see where nudging may be appropriate at certain times, and when the clinician knows the values, concerns and goals of the patient/family. However, often the critical care clinician does not have that intimate knowledge of their preferences. In these situations, a better choice than nudging might be to request a palliative care consult, so that goal concordant decision making can be explored.