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Value of High-Cost Cancer Care: A Behavioral Science Perspective

Kevin P. Weinfurt

From the Center for Clinical and Genetic Econimics, Duke Clinical Research Institute; the Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine; and the Department of Psychology and Neuroscience, Duke University, Durham, NC

Address reprint requests to Kevin P. Weinfurt, PhD, Duke Clinical Research Institute, PO Box 17969, Durham, NC 27715; e-mail: kevin.weinfurt{at}duke.edu

Concerns about the high costs of cancer care have led to a renewed interest in understanding how patients value the outcomes of care. Psychologists, economists, and others have highlighted some of the ways in which patients and caregivers perceive and make treatment decisions. Prospect theory is the predominant framework for understanding decisions made in situations where the outcomes of each choice are uncertain. Prospect theory assumes that a patient values the outcomes of care not in absolute terms, such as years of life saved, but as deviations from the patient's point of reference. This article discusses some of the implications of this notion, along with discussing differences among people in their reference points. These and other considerations from the psychology of decision making help to clarify why some patients might be inclined to seek expensive or risky treatments in the hopes of achieving benefits that others might consider not worthwhile. An appreciation of these psychological issues might improve the quality of debates concerning the rising costs of cancer care.

Supported by funding from the Duke Interdisciplinary Medical Decision Making Initiative, a National Cancer Institute (NCI) supplement to National Institute of Arthritis and Musculoskeletal and Skin Diseases Grant No. 5U02AR052186-03 (NIH PROMIS Network), and Grant No. R01CA100771-01A2 from the NCI.

Author's disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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