Behavioral Change in Clinical Practice: Hard But Not Hopeless

“It’s hard to change habits,” said Leslie Eber, MD, CMD, at the start of a program on “Changing Provider Behavior: Beyond ‘Just Do It’ Mentality” PALTC21, Virtual Annual Conference AMDA – The Society for Post-Acute and Long-Term Care Medicine. She recalled how she would often come back from meetings bursting with ideas plans, then was faced “how challenging it is behaviors habits.” But stressed that there hope. To start, Dr. Eber talked about economist Daniel Kahneman’s systems decision-making. System 1 fast intuitive, uses past experiences immediately available facts. 2 deliberate process questioning further investigation. “It feels really good use 1. It makes us feel comfortable secure,” said. “But also correlated predictable mistakes. decisions are famous jumping conclusions if we don’t have all facts.” That is, said, “If looks like duck quacks duck, it’s duck.” relies expert intuition, recognition patterns. This can be useful, suggested, “but in medicine, as learn more fine-tune best practices, pitfall.” 1, does not allow possibility evidence critical our missing. “We heuristics, shortcut solving problem or making decision.” where people revert something they know do experience habit. time consuming less comfortable, explained. However, “When measured deliberate, divert habits make much better decisions.” When this, address cognitive ease — confidence trusting intuition mistakes likely. At same time, focus must strain, which vigilance, suspicion, an investment effort. decision-making may take practitioners out their comfort zone, but result likely fewer Our beliefs help shape decisions, “our deeply engrained.” isn’t surprising; human reasoning belief based, built experience. Unfortunately, lead inaccurate medical beliefs. Along beliefs, noted, biases. need recognize them,” stressed. Base rate neglect gap between statistical practices practitioner’s thinking individual patient sort bias common geriatrics, suggested. when clinical knowledge point one decision, yet practitioner different because “I Mrs. Jones.” Compelling statistics, “will long-held rooted personal experience.” COVID-19 vaccine hesitancy example offered, many dismiss scientific own vaccinations. So decisions? First, overcome inertia. We embrace strain consider alternatives what possible.” In recent years, “nudges,” described effective ways influence behaviors, become popular strategy, Sing Palat, CMD. These, “are used alter behavior, forbid options remove freedom choice.” There types nudges. Among them default option, “which creates path least resistance,” Palat type nudge designed expectation biases natural. One option organ donor opt-out consent, has resulted high percentage donors across states. “Removing small obstacles rather than shoving direction impact.” Mapping information various explicitly laid made easy understand choose from, observed Palat. “Clinical algorithms put idea mapping paper. Algorithms give providers necessary cues appropriate sequential actions.” These resources such Society’s Clinical Practice Guidelines. “Giving feedback, especially real improves performance,” Another spotlight effect: think everyone watching, tend conform social norms,” For instance, facility posted commitment letter signed by physicians decrease inappropriate antibiotic prescriptions. public declaration intent led reduction behavior. Framing, another nudge, refers focusing way choices presented. this most involves scripted communication giving specific words phrases use. Other nudges include priming education herd effect, peer comparisons create norms. important first identify opportunities determine measurable outcomes. implemented strategically pragmatically won’t work practical. You align stakeholders, including leadership frontline clinicians, compare effectiveness, translate findings scale. Not every situation should addressed nudge. As “Sometimes sense sometimes doesn’t.” Lea Watson, MPH, psych-pharma changes. Nudging successful meeting, requires being efficient persons, respecting voices, keeping tone light, fun, learning together.