David Geffen School of Medicine at UCLA, 911 Broxton Plaza, Los Angeles, CA 90095, USA.
J Gen Intern Med. 2013 May;28(5):711-8. doi: 10.1007/s11606-012-2261-8. Epub 2012 Nov 15.
Despite a revolution in therapeutics, the ability to control chronic diseases remains elusive. We present here a conceptual model of the potential role of behavioral tools in chronic disease control. Clinicians implicitly accept the assumption that patients will act rationally to maximize their self-interest. However, patients may not always be the rational actors that we imagine. Major behavioral barriers to optimal health behavior include patients' fear of threats to health, unwillingness to think about problems when risks are known or data are ambiguous, the discounting of risks that are far in the future, failure to act due to lack of motivation, insufficient confidence in the ability to overcome a health problem, and inattention due to pressures of everyday life. Financial incentives can stimulate initiation of health-promoting behaviors by reducing or eliminating financial barriers, but may not produce long-term behavior change without additional interventions. Strategies have been developed by behavioral economists and social psychologists to address each of these barriers to better decision-making. These include: labeling positive behaviors in ways consistent with patient life goals and priorities; greater focus on more immediate risks of chronic diseases; intermediate subgoals as steps to a large health goal; and implementation of specific plans as to when, where, and how an action will be taken. Such strategies hold promise for improving health behaviors and disease control, but most have not been studied in medical settings. The effectiveness of these approaches should be evaluated for their potential as tools for the clinician.
尽管治疗方法发生了革命性变化，但控制慢性病的能力仍然难以实现。我们在这里提出了一个行为工具在慢性病控制中潜在作用的概念模型。临床医生默认接受这样一种假设，即患者将理性行事，以最大限度地实现自身利益。然而，患者并不总是我们想象中的理性行为者。影响最佳健康行为的主要行为障碍包括患者对健康威胁的恐惧、对已知风险或数据不明确时不愿思考问题、对未来遥远风险的贴现、由于缺乏动力而无法采取行动、对克服健康问题的能力缺乏信心以及由于日常生活压力而注意力不集中。经济激励可以通过减少或消除经济障碍来刺激促进健康行为的启动，但如果没有额外的干预，可能不会产生长期的行为改变。行为经济学家和社会心理学家已经开发出了一些策略来应对这些决策障碍，包括：以符合患者生活目标和优先事项的方式标记积极行为；更加关注慢性疾病更直接的风险；将中间子目标作为实现大健康目标的步骤；以及实施具体计划，明确何时、何地以及如何采取行动。这些策略有望改善健康行为和疾病控制，但大多数策略尚未在医疗环境中进行研究。应该评估这些方法的有效性，以确定它们是否有可能成为临床医生的工具。
