Patient Engagement
Clip
Helping Patients Complete Advance Directives (04:56)

Nudging patients to fill out advance directives can dramatically increase their engagement with these documents, says Scott Halpern, Deputy Director of the University of Pennsylvania’s Center for Health Incentives and Behavioral Economics. However, because of laws that require witness or notary signatures, it’s difficult to get people to complete the final step. What can we do?

One thing that works in retirement savings, according to Harvard economist David Laibson, is to have people complete all paperwork in one place, at one time. For example, rather than sending patients home with an advance directive, you could encourage them to fill it out in the waiting room and have a notary available on site to sign and seal it. An appointment reminder could encourage them to bring their spouse, too, with a message such as, “We’re giving people advance directives and this would be a great time for the two of you to fill out this form together.” This streamlines the process and allows people to get everything completed in one sitting. If patients simply go home with the paperwork, not only do they have to go out of their way to get it notarized — a barrier in and of itself — but the document could also get misplaced or fall behind other priorities.

Research shows that while people prefer to combine negative decisions or losses, they prefer to separate positive decisions or gains, adds Dartmouth College marketing expert Punam Keller. They like savoring the idea of something positive happening to them, but they want to be done with negative things as quickly as possible. Keller’s group used this logic to encourage employees to complete a health and wellness assessment. Bundling this assessment with a health benefits initiative more than doubled, within three weeks, the number of employees who actually completed the assessment.

From the NEJM Catalyst event Patient Engagement: Behavioral Strategies for Better Health at the University of Pennsylvania, February 25, 2016.

More From Patient Engagement

Shared Decision-Making for Good Clinical Care: Better, but Not Easier

Active patient involvement and patient autonomy can be burdensome to patients, especially when they are faced with serious illness. The primary goal of shared decision-making is not autonomy, but good care that fits patients’ lives.

The Patient as Consumer and the Measurement of Bedside Manner

Many physicians do not believe patient satisfaction is a legitimate pursuit. Yet they must meet consumers of health care where they are — on Internet ratings sites.

Health Care — A Final Frontier for Design

Design must move beyond narrow projects and encompass complex systems.

Halpern02_clip_still: A/B Testing Health Behavior Interventions

A/B Testing Health Behavior

Health care can’t implement changes overnight like Silicon Valley, but we can still learn from their version of treatment and control.

Social Interventions Can Lower Costs and Improve Outcomes

We can better serve our under-resourced patients by helping them access treatments and social interventions we already know to be effective.

Better Communication Makes Better Physicians

How Adrienne Boissy and Cleveland Clinic are focusing on physician communication — and getting results.

Why Real-World Results Are So Challenging for Digital Health

User engagement outside of clinical trials is the critical factor.

Transparency and Trust — Online Patient Reviews of Physicians

Transparency of validated data about delivery-system performance has the power to change the culture of health care.

Patient Engagement Survey: Technology Tools Gain Support — But Cost Is a Hurdle

NEJM Catalyst Insights Council members say patient engagement technology tools must be patient-centric and are most useful for managing chronic disease.

Patient-Researchers and Physician-Consultants Confront Chronic Disease

Personal-use sensors and data applications allow patients with Type 1 diabetes and other chronic diseases to take charge of managing their health. This is the future of chronic disease management.

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

Topics

Patient Incentives

43 Articles

A/B Testing Health Behavior

Health care can’t implement changes overnight like Silicon Valley, but we can still learn from…

Patient-Centered Care

138 Articles

Shared Decision-Making for Good Clinical Care:…

Active patient involvement and patient autonomy can be burdensome to patients, especially when they are…

Patients As Customers

64 Articles

Shared Decision-Making for Good Clinical Care:…

Active patient involvement and patient autonomy can be burdensome to patients, especially when they are…

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now