FAITH IN DELIBERATION: ON THE IMPACT OF DELIBERATIVE VERSUS INTUITIVE STRATEGIES ON PATIENT DECISIONS

Purpose:  It is often assumed that deliberative decisions are better than intuitive ones, and this assumption has guided the development of patient decision aids. However, the psychological literature suggests that deliberation is not always superior to intuition. Hence, it is unclear how to best support patient decisions, and the topic has generated considerable debate. The purpose of the present research is to clarify the impact of these decision strategies in the context of patient decision-making. 

Method: In Study 1, 1470 participants were recruited online and made one of two hypothetical cancer treatment choices. The choice involved either a trade-off between the quantity and quality of their lives, or a choice between watchful waiting with a 5% chance of death, and surgery with a 10% chance of death. Participants were randomly assigned to make their decision (a) intuitively, (b) deliberatively, by writing about which decision is objectively best, (c) deliberatively, by writing about one’s feelings, or (d) without instructions. In Study 2, 326 men (40-87 years) were recruited from the University of Michigan and Ann Arbor VA hospitals. They read an abbreviated prostate cancer decision aid, and were randomly assigned to make a hypothetical treatment decision (a) intuitively, (b) deliberatively, by writing about pros and cons, or (c) deliberatively, using a checklist exercise. Outcomes included choice, satisfaction, decision conflict, and attitudes toward the decision strategy. In Study 2, knowledge was also measured.

Result: In both studies, the decision strategies had no impact on treatment choice, however deliberators liked their decision strategy significantly more than intuitors, both p<.01.  In Study 1, deliberators reported greater satisfaction (F(3,1463)=26.30, p<.001) and less conflict (F(3,1466)=21.51, p<.001) than intuitors. In Study 2 there were no effects involving satisfaction and conflict, and the deliberative writing condition reduced knowledge (M=5.36) compared to the intuition and checklist conditions (Ms=6.00 and 6.02), F(2,289)=5.05, p<.01.

Conclusion: Regardless of the specific decision or how deliberation was evoked, participants liked using deliberation better than intuition. However, there was no evidence that deliberation changed participants’ decisions, and only partial evidence that it improved satisfaction and conflict. There was also some evidence that deliberation can reduce knowledge. These results indicate that deliberation may help people to feel better about their decision process, even if it does not change or improve decisions.