How a situation is framed affects the decisions that people make. For example, consider a situation where there is the opportunity to risk the loss of money so that one can gain a larger sum (much like we see in gambling). When framed as a loss, people respond more strongly to losing something than they do to a corresponding gain.
Now consider a similar situation that has health implications. A patient has to decide what treatment course to take and has been told that there is the potential for a fatal or catastrophic outcome, along with the potential benefit of that treatment. Patients often focus more strongly on the potential risk versus the potential benefit – a phenomenon known as the “loss aversion bias.”
As physicians, it is important to understand this predisposition so that you can better prepare patients for certain procedures, interventions, and health behaviors. There is actually an evolutionary basis to loss aversion bias. We are wired to avoid losses more than to seek gains because we are more likely to stay alive and reproduce if we perceive threats (losses) as more urgent than rewards. Therefore, patients will often make decisions based on the perceived negative risks or outcomes without giving sufficient weight to the potential benefits and/or risks of NOT pursuing a certain course of action.
Consider this example: A 67-year-old male has refused a colonoscopy because he read on the internet that it could cause bowel perforation. When asked why he will not have a screening colonoscopy, he states, “they tear people’s bowels open.” His bias towards loss aversion cause him to believe that the risks of the procedure far outweigh the benefits. The more someone perceives a potential loss (to life, limb, or in this case, bowel), the greater the loss aversion.
Loss aversion and the “framing effect” often work together and can get activated depending upon how information is framed. Our brains respond fairly quickly to emotion, thus, language that conveys emotion will get people’s attention. And if people hear words that have a negative connotation – “bad news,” “cancer,” “death,” “fatal,” “complications” – they pay even more attention to those words.
I am not suggesting that we avoid giving patients all the relevant information. What I am suggesting is that physicians be aware that the way in which information is presented has a strong influence on risk perception. When patients are told the potential risks and benefits of various treatment options, their ability to rationally reflect can be impacted (often unconsciously) by various factors. For example, there is the impact of associative memory – “my grandmother died during surgery.”