A Nudge Can Go a Long Way

When I first heard the term “behavioral economics” it didn’t get my attention. I assumed it had to do with marketing, not related to my interest in healthcare communication. Then I read an article about the role of behavioral economics in primary care (Using Behavioral Economics to Reduce Low-Value Care Among Older Adults, Kullgren, JT, Kim, HM, Stowey, M; Journal of the American Medical Association; January 30, 2024).


The article describes an intervention that nudges patients and clinicians to engage in conversations about reducing low-value care in three clinical situations, including managing diabetes. In the study, clinicians received weekly emails with alternatives to low-valued treatments and patients were mailed educational materials. This intervention resulted in lowering of diabetes medication doses while preserving patient autonomy in decision making.


What stood out to me was the term “nudge,” which is defined as a prod or light touch. That word made me think about the purpose of prompts used in SpeakSooner: A Patient’s Guide to Difficult Conversations (Guide). In fact, the guide nudges patients to identify questions and concerns and encourages talking with clinicians about health status and preferences for care. It sounds simple but it takes a mutual understanding of the importance of open communication, especially considering options when a cancer is treatable but not curable.


It’s worth noting that the Center for Communication in Medicine is collaborating with Adirondack Health (Saranac Lake, NY) oncology department and Rutland (VT) Foley Cancer Center on an intervention using prompts from the SpeakSooner guide to open channels of communication between patients and clinicians about hard-to-talk about topics. We’re discovering that a nudge can go a long way in improving quality of care.