9/16/2014. Genetic Counselors as Choice Architects Some Considerations for Presenting Genetic Testing Decisions In a Complex Choice Environment

Transcription

1 Genetic Counselors as Choice Architects Some Considerations for Presenting Genetic Testing Decisions In a Complex Choice Environment By Marci Barr Conflict of Interest Disclosures In relation to this presentation, I declare that there are no conflicts of interest. Choice architects are people in charge of laying out the context for another person s decision. Which tests to present? How to present them? 1

2 Education about Testing Build Choice Contexts Promote Informed Choices There is no truly neutral way to offer choice Talk Objectives Go over findings about how people make decisions from the literature Introduce a framework for thinking about tools of a genetic testing choice architect Suggest some research methods and areas of need 2

3 Which is more common being killed by excessive natural heat or a sharp object? Did you have a hunch as to which was the right answer? You probably used Intuitive /experiential processing Sometimes this can lead to the availability bias (National Safety Council, 2014) We should care about biases because we need to account for error in designing choices Ideal World Real World People make the best decisions and are consistent People make mistakes What should our goals be when we design genetic testing choices? Ultimate Goal Maximize medical and psychosocial outcomes Most directly attainable goals Maximize patient engagement with choice task Structure the choice to make it understandable Keep client wellbeing in mind when designing choice 3

4 Purpose of the genetic testing choice framework Guide: Use your Judgment Decision Point Genetic Testing Choice Framework Genetic Testing Landscape Which to offer Context Dependent i.e. attraction effect How to offer Attribute presentation Partition Translate Imagine you are deciding whether to offer one or two genetic tests No Testing 5 Gene Panel 15 Gene Panel Gene Gene 4

5 You can offer just the 5 gene test No Testing 5 Gene Panel Gene Gene You can offer just the 15 gene test No Testing 15 Gene Panel Or you can offer both No Testing 5 Gene Panel 15 Gene Panel Gene Gene 5

6 You decide to present both Both may have a $ copay I want the 15 gene test! More value for the same price! The attraction effect- making one option seem more appealing by presenting it next to an inferior option This can increase the likelihood of selecting the appealing option What should you do? Avoid using language that makes one option seem far superior If one option is far superior don t offer both! Think about discussing tradeoffs among tests in terms of how the patient might experience different outcomes 6

7 Genetic Testing Choice Framework Genetic Testing Landscape Which to offer Context Dependent i.e. attraction effect How to offer Attribute presentation Partition Translate The more complex you make a decision, the more likely people are to become cognitively overloaded and take shortcuts Now your patient asks you What would the differences be in the types of results I would get from the 5 gene test versus the 15 gene test? 7

8 You said he is more likely to get a: Variant of Unknown Significance Or A mutation in a gene we don t understand very well You could have said: more likely to get a result that is uncertain for cancer risk and medical management 1.) Partition two attributes into one big category 2.) Translate those test features into criterion that are useful for how the client will experience the result Genetic Testing Choice Framework Genetic Testing Landscape Which to offer Context Dependent i.e. attraction effect How to offer Attribute presentation Partition Translate We don t know much about how choice architecture interventions play out in a genetic testing context 8

9 Do the: test attributes most likely to drive decisions = attributes most likely to influence outcomes? Stated Preference Analysisalternative to real-life decisions Attribute Levels of Each Attribute Number of genes Time to result weeks 1 month 2 months 6 months Cost No copay $ $ $500 Chance of a VUS.5% 2.5% 7.5% 20% In the experiment you offer participants series of choices Question 1 Attribute Option 1.1 Option 2.1 Question 2 Attribute Option 1.2 Option 2.2 Number of genes 5 5 Number of genes 5 40 Time to result 1 month 2 weeks Time to result 1 month 1 month Cost $ $ Chance of a VUS 5%.5% Cost $ $ Chance of a VUS 2.5%.5% 9

10 Acknowledgements Faculty Members Debra Roter Barbara Bowles Biesecker William Klein Lori Erby Gillian Hooker Chris Anderson My Classmates Christy Haakonsen Gregory Schwartz Funding for my work is from the NHGRI Intramural Research Program, National Institutes of Health. Recommended Reading Johnson, E. J., Shu, S. B., Dellaert, B. G. C., Fox, C., Goldstein, D. G., Häubl, G., Weber, E. U. (2012). Beyond nudges: Tools of a choice architecture. Marketing Letters, 23(2),