Beyond costs and benefits: understanding how patients make health care decisions.

Many medical decisions are "preference sensitive," where the best choice depends on the values a specific patient places on relevant outcomes. For example, a decision may require a patient to make a trade-off between a small increase in chance for survival and a large out-of-pocket expense. In such situations, patients need to understand the costs and benefits of the health care alternative, in order to decide the best course of action. However, findings from decision science research have demonstrated that people's decisions are often influenced not only by their perceptions of these costs and benefits, but also by subtle contextual factors that trigger intuitive and emotional decision processes. In this article, I describe some of these contextual factors, and lay out the challenges these factors raise for clinicians' efforts to help their patients make informed decisions.