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Unformatted text preview: Judgment and Decision Making , vol. 3, no. 2, February 2008, pp. 174-180 Prospect theory, reference points, and health decisions Alan Schwartz * Department of Medical Education University of Illinois at Chicago Julie Goldberg Department of Medical Education University of Illinois at Chicago Gordon Hazen IEMS Department Northwestern University In preventative health decisions, such as the decision to undergo an invasive screening test or treatment, people may be deterred from selecting the test because its perceived disutility relative to not testing is greater than the utility associated with prevention of possible disease. The prospect theory editing operation, by which a decision maker's reference point is determined, can have important effects on the disutility of the test. On the basis of the prospect theory value function, this paper develops two approaches to reducing disutility by directing the decision maker's attention to either (actual) past or (expected) future losses that result in shifted reference points. After providing a graphical description of the approaches and a mathematical proof of the direction of their effect on judgment, we briefly illustrate the potential value of these approaches with examples from qualitative research on prostate cancer treatment decisions. Keywords: prospect theory, medical decision making, reference points 1 Introduction In preventative health decisions, such as the decision to undergo an invasive screening test or treatment, people may be deterred from selecting the test because its disutility relative to not testing is greater than the utility associated with prevention of possible disease. For example, people may feel that the anticipated disutility of a colonoscopy for colorectal cancer screening is great enough relative to the expected utilty of prevention of possible colorectal cancer to dissuade them from seeking colonoscopy. 1 The prospect theory editing operation (Kahneman & Tversky, 1979; Tversky & Kahneman, 1992), by which a decision maker's reference point is determined, can have important impacts on the perceived disutility of the test. The work of Rothman, Salovey, and colleagues 21/2/2011 Prospect theory, reference points, and… journal.sjdm.org/7823/jdm7823.html 1/11 on message framing has tested prospect theory predictions of how the description of test outcomes as gains or losses (as well as the conceptualization of the purpose of the test as preventative vs. diagnostic and the consequent perception of whether the test is "safe" or "risky") can affect test rates (Rothman & Salovey, 1997; Rothman, Bartels, Wlaschin, et al., 2006). Specifically, message framing theories predict that when a procedure is perceived as risky (e.g., cancer screening tests may cause a patient to find out that they have cancer), loss- framed messages will promote testing more strongly than gain-framed messages, because people favor risky prospects over sure prospects in the domain of losses. On the other hand,people favor risky prospects over sure prospects in the domain of losses....
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