6 In their experiment, when confronted with the positive frame (eg, number of people saved), participants were more likely to choose the risk-averse option (a program that saves 200 of 600 people with certainty), and when confronted with the negative frame (eg, the number of people who will die), participants were more likely to choose the risk-seeking option (a program with a one-third probability that no one will die and a two-thirds probability that all will die). Risky choice framing was first illustrated in the seminal paper by Tversky and Kahneman. 16 Risky choice framing refers to the comparison of choices between a more- and less-risky option where the value of the options are described in positive terms or negative terms. Positive-negative framing effects can be grouped into two categories: risky choice framing and attribute framing. The two most studied framing effects in the health literature are positive-negative framing effects and effects of absolute versus relative risk presentation. We conclude that there is no way to eliminate these biases, but we provide some recommendations for how they might be mitigated. We then argue that direct input from physicians and family caregivers is likely to lead to overtreatment. We argue that these biases are likely to be so pervasive that they call into question patients’ ability to truly make informed choices. We present cancer-specific examples of how these biases influence treatment choice, and where cancer-specific studies are not available, we share examples from other health fields ( Table 2). We classify these biases on the basis of how and when information is presented to patients ( Fig 1 ) because this typology can be easily conveyed to patients, clinicians, and policymakers. We present descriptions of common cognitive biases that are highly relevant to patients with cancer ( Table 1) and provide applicable examples. The goal of this narrative review is to present theoretical and empirical evidence that suggest that such an assumption is unlikely to hold. Shared decision making, however, inherently assumes that patients are capable of taking in complex information from health care providers at a most vulnerable time in their lives and then synthesizing that information to make rational treatment choices. However, many countries now emphasize shared decision making, which involves mutual information sharing between patients and providers in an effort to come to a consensus about an appropriate treatment path that is evidence based and aligned with patient preferences. 4 In decades past, the clinician typically made this determination unilaterally. However, the availability of these treatments also puts patients in a challenging position as they wrestle with which treatment option is best for them. 3 Many patients have benefited greatly from access to these new treatments. 1, 2 The good news is that despite the growing incidence of cancer, patients are living longer and with a better quality of life partly because of advances in treatment, including new immunotherapies and precision medicines. Cancer is the second leading cause of death worldwide, and cancer incidence is expected to grow in the coming decades.
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