Effect of two behavioural 'nudging' interventions on management decisions for low back pain: A randomised vignette-based study in general practitioners

Jason Soon, Adrian C. Traeger, Adam G. Elshaug, Erin Cvejic, Chris G. Maher, Jenny A. Doust, Stephanie Mathieson, Kirsten McCaffery, Carissa Bonner

Research output: Contribution to journalArticleResearchpeer-review

1 Citation (Scopus)
29 Downloads (Pure)

Abstract

Objective: 'Nudges' are subtle cognitive cues thought to influence behaviour. We investigated whether embedding nudges in a general practitioner (GP) clinical decision support display can reduce low-value management decisions. Methods: Australian GPs completed four clinical vignettes of patients with low back pain. Participants chose from three guideline-concordant and three guideline-discordant (low-value) management options for each vignette, on a computer screen. A 2×2 factorial design randomised participants to two possible nudge interventions: 'partition display' nudge (low-value options presented horizontally, high-value options listed vertically) or 'default option' nudge (high-value options presented as the default, low-value options presented only after clicking for more). The primary outcome was the proportion of scenarios where practitioners chose at least one of the low-value care options. Results: 120 GPs (72% male, 28% female) completed the trial (n=480 vignettes). Participants using a conventional menu display without nudges chose at least one low-value care option in 42% of scenarios. Participants exposed to the default option nudge were 44% less likely to choose at least one low-value care option (OR 0.56, 95% CI 0.37 to 0.85; p=0.006) compared with those not exposed. The partition display nudge had no effect on choice of low-value care (OR 1.08, 95% CI 0.72 to 1.64; p=0.7). There was no interaction between the nudges (OR 0.94, 95% CI 0.41 to 2.15; p=0.89). Interpretation: A default option nudge reduced the odds of choosing low-value options for low back pain in clinical vignettes. Embedding high value options as defaults in clinical decision support tools could improve quality of care. More research is needed into how nudges impact clinical decision-making in different contexts.

Original languageEnglish
Pages (from-to)547-555
Number of pages9
JournalBMJ Quality and Safety
Volume28
Issue number7
Early online date19 Nov 2018
DOIs
Publication statusPublished - Jul 2019

Fingerprint

Clinical Decision Support Systems
Low Back Pain
General Practitioners
Guidelines
Quality of Health Care
Cues
Research

Cite this

Soon, Jason ; Traeger, Adrian C. ; Elshaug, Adam G. ; Cvejic, Erin ; Maher, Chris G. ; Doust, Jenny A. ; Mathieson, Stephanie ; McCaffery, Kirsten ; Bonner, Carissa. / Effect of two behavioural 'nudging' interventions on management decisions for low back pain : A randomised vignette-based study in general practitioners. In: BMJ Quality and Safety. 2019 ; Vol. 28, No. 7. pp. 547-555.
@article{3dc8a847e2474f138534a1d0d2492e83,
title = "Effect of two behavioural 'nudging' interventions on management decisions for low back pain: A randomised vignette-based study in general practitioners",
abstract = "Objective: 'Nudges' are subtle cognitive cues thought to influence behaviour. We investigated whether embedding nudges in a general practitioner (GP) clinical decision support display can reduce low-value management decisions. Methods: Australian GPs completed four clinical vignettes of patients with low back pain. Participants chose from three guideline-concordant and three guideline-discordant (low-value) management options for each vignette, on a computer screen. A 2×2 factorial design randomised participants to two possible nudge interventions: 'partition display' nudge (low-value options presented horizontally, high-value options listed vertically) or 'default option' nudge (high-value options presented as the default, low-value options presented only after clicking for more). The primary outcome was the proportion of scenarios where practitioners chose at least one of the low-value care options. Results: 120 GPs (72{\%} male, 28{\%} female) completed the trial (n=480 vignettes). Participants using a conventional menu display without nudges chose at least one low-value care option in 42{\%} of scenarios. Participants exposed to the default option nudge were 44{\%} less likely to choose at least one low-value care option (OR 0.56, 95{\%} CI 0.37 to 0.85; p=0.006) compared with those not exposed. The partition display nudge had no effect on choice of low-value care (OR 1.08, 95{\%} CI 0.72 to 1.64; p=0.7). There was no interaction between the nudges (OR 0.94, 95{\%} CI 0.41 to 2.15; p=0.89). Interpretation: A default option nudge reduced the odds of choosing low-value options for low back pain in clinical vignettes. Embedding high value options as defaults in clinical decision support tools could improve quality of care. More research is needed into how nudges impact clinical decision-making in different contexts.",
author = "Jason Soon and Traeger, {Adrian C.} and Elshaug, {Adam G.} and Erin Cvejic and Maher, {Chris G.} and Doust, {Jenny A.} and Stephanie Mathieson and Kirsten McCaffery and Carissa Bonner",
year = "2019",
month = "7",
doi = "10.1136/bmjqs-2018-008659",
language = "English",
volume = "28",
pages = "547--555",
journal = "Quality and Safety in Health Care",
issn = "1475-3898",
publisher = "BMJ Publishing Group",
number = "7",

}

Effect of two behavioural 'nudging' interventions on management decisions for low back pain : A randomised vignette-based study in general practitioners. / Soon, Jason; Traeger, Adrian C.; Elshaug, Adam G.; Cvejic, Erin; Maher, Chris G.; Doust, Jenny A.; Mathieson, Stephanie; McCaffery, Kirsten; Bonner, Carissa.

In: BMJ Quality and Safety, Vol. 28, No. 7, 07.2019, p. 547-555.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Effect of two behavioural 'nudging' interventions on management decisions for low back pain

T2 - A randomised vignette-based study in general practitioners

AU - Soon, Jason

AU - Traeger, Adrian C.

AU - Elshaug, Adam G.

AU - Cvejic, Erin

AU - Maher, Chris G.

AU - Doust, Jenny A.

AU - Mathieson, Stephanie

AU - McCaffery, Kirsten

AU - Bonner, Carissa

PY - 2019/7

Y1 - 2019/7

N2 - Objective: 'Nudges' are subtle cognitive cues thought to influence behaviour. We investigated whether embedding nudges in a general practitioner (GP) clinical decision support display can reduce low-value management decisions. Methods: Australian GPs completed four clinical vignettes of patients with low back pain. Participants chose from three guideline-concordant and three guideline-discordant (low-value) management options for each vignette, on a computer screen. A 2×2 factorial design randomised participants to two possible nudge interventions: 'partition display' nudge (low-value options presented horizontally, high-value options listed vertically) or 'default option' nudge (high-value options presented as the default, low-value options presented only after clicking for more). The primary outcome was the proportion of scenarios where practitioners chose at least one of the low-value care options. Results: 120 GPs (72% male, 28% female) completed the trial (n=480 vignettes). Participants using a conventional menu display without nudges chose at least one low-value care option in 42% of scenarios. Participants exposed to the default option nudge were 44% less likely to choose at least one low-value care option (OR 0.56, 95% CI 0.37 to 0.85; p=0.006) compared with those not exposed. The partition display nudge had no effect on choice of low-value care (OR 1.08, 95% CI 0.72 to 1.64; p=0.7). There was no interaction between the nudges (OR 0.94, 95% CI 0.41 to 2.15; p=0.89). Interpretation: A default option nudge reduced the odds of choosing low-value options for low back pain in clinical vignettes. Embedding high value options as defaults in clinical decision support tools could improve quality of care. More research is needed into how nudges impact clinical decision-making in different contexts.

AB - Objective: 'Nudges' are subtle cognitive cues thought to influence behaviour. We investigated whether embedding nudges in a general practitioner (GP) clinical decision support display can reduce low-value management decisions. Methods: Australian GPs completed four clinical vignettes of patients with low back pain. Participants chose from three guideline-concordant and three guideline-discordant (low-value) management options for each vignette, on a computer screen. A 2×2 factorial design randomised participants to two possible nudge interventions: 'partition display' nudge (low-value options presented horizontally, high-value options listed vertically) or 'default option' nudge (high-value options presented as the default, low-value options presented only after clicking for more). The primary outcome was the proportion of scenarios where practitioners chose at least one of the low-value care options. Results: 120 GPs (72% male, 28% female) completed the trial (n=480 vignettes). Participants using a conventional menu display without nudges chose at least one low-value care option in 42% of scenarios. Participants exposed to the default option nudge were 44% less likely to choose at least one low-value care option (OR 0.56, 95% CI 0.37 to 0.85; p=0.006) compared with those not exposed. The partition display nudge had no effect on choice of low-value care (OR 1.08, 95% CI 0.72 to 1.64; p=0.7). There was no interaction between the nudges (OR 0.94, 95% CI 0.41 to 2.15; p=0.89). Interpretation: A default option nudge reduced the odds of choosing low-value options for low back pain in clinical vignettes. Embedding high value options as defaults in clinical decision support tools could improve quality of care. More research is needed into how nudges impact clinical decision-making in different contexts.

UR - http://www.scopus.com/inward/record.url?scp=85057062341&partnerID=8YFLogxK

U2 - 10.1136/bmjqs-2018-008659

DO - 10.1136/bmjqs-2018-008659

M3 - Article

VL - 28

SP - 547

EP - 555

JO - Quality and Safety in Health Care

JF - Quality and Safety in Health Care

SN - 1475-3898

IS - 7

ER -