Exploiting order effects to improve the quality of decisions

Objective: To examine the effect of ordering information in a patient decision aid (PtDA) about treatments for obstructive sleep apnea (OSA).

Methods: We recruited 643 individuals to imagine that they had been diagnosed with OSA and to choose between treatment options. A value clarification exercise was used to determine which attributes of treatment mattered most to each individual. Before deciding on their preferred treatment option, we randomly assigned participants to view information with attributes in: a pre-specified order (Group 1), order of what mattered most last (Group 2), and first (Group 3).

Results: Of the 510 participants who provided usable results, viewing information that mattered most first was associated with choosing the treatment option most concordant with their informed values. The order effect was most pronounced in younger individuals.

Conclusions: In this study of hypothetical patients, order effects were found to improve the information patients focussed on, potentially improving the quality of their decisions.

Practice implications: The order of information presented in a PtDA can inadvertently influence patients' choices. By tailoring information order for each patient, developers cannot only overcome this dilemma, but also make it simpler for patients to choose the option that is best for them.