New York, NY  Making decisions is tough. Maybe we’re buying a new home, choosing which pants to wear, picking a salad dressing or what song to listen to next. It seems like possibilities are endless and there is always a better option out there.

Enter algorithms. Algorithms increasingly help us make decisions amid a sea of endless choice. Want a new home? Casamatic will algorithmically connect you with properties that match your profile. Need new music to listen to? Spotify’s Discover Weekly Playlist will algorithmically curate a personalized playlist based on the songs you already listen to. Need to figure out how best to navigate a complex range of treatment options for prostate cancer? Well guess what, there’s an algorithm for that too.

The Feinstein Institute for Medical Research is working on an app to guide people living with prostate cancer through the treatment decision process. People diagnosed with prostate cancer face a variety of treatments, from immediate surgery, radiation or ongoing observation until risk increases. These treatment options have potential side effects that can have big lifestyle consequences, such as incontinence or impotence.

“Making treatment decisions can be daunting with any type of cancer, but it can be particularly difficult for men dealing with prostate cancer as it has a big impact on very basic everyday physical functions”
-Dr. Michael Diefenbach, Northwell Health Department of Medicine and Urology

The app first helps patients navigate through the initial decision process of treatment vs. no treatment. Patients then rate their agreement or disagreement with various statements related to treatment requirements and outcomes. The software matches their preferences to a treatment option with the help of a unique algorithm. They can then email the results to their doctor and discuss their potential plans.


Why This Matters

In medicine, there has been a movement toward shared decision-makingwhere patients play a role in medical decisions that affect their health. The thinking is that empowering patients to have agency over healthcare decisions which reflect their personal preferences often leads to better health outcomes such as decreased anxiety, quicker recovery and increased compliance with treatment regimens.

Agency Over Decisions = Better Health Outcomes

However, choice is sometimes anti-initiative. In a world of ever increasing options, it isn’t freedom of choice that makes us happy… its freedom fromchoice. Research has shown that all this choice has had two negative effectson people:

  1. Too much choice leads to paralysis, not liberation. With so many options to choose from, we don’t want to make a choice at all.
  2. Too much choice makes us less satisfied. The more choices we have to choose from, the more we fantasize about other options and less satisfied we are about the choices we make.

Choice * More Options = Paralysis and Unhappiness

In addition, other research has shown that when faced with a choice whose decision leads to a situation with immediate, negative and concrete outputs, we start dwelling on the other options and question the validity of our decision. This increases doubt, decreases confidence and reduces our ability and willingness to fight through the adversity. This is the situation when choosing a treatment option for cancer, where choices lead to some level of adversity, regardless of the decision.

Choice + Hard Path Forward = Less Fight

Decreasing Choice While Maintaining Agency

What does this have to do with prostate cancer and Dr. Diefenbach’s app? By strongly recommending a treatment option using patients’ provided preferences, the software gets the best of both worlds. It gives patients agency over the decision by incorporating their preferences and reduces the amount of choices they have to make by providing a firm recommend treatment plan.

Agency Over Decision + Reduced Choice = Increased Motivation

Algorithmic apps like this can give patients both the freedom of and freedom from choice. We can get to more patient-centric solutions, without running the risk of pitfalls associated with choice like paralysis, unhappiness or the reduced willingness to deal with adversity. Armed with algorithms and a relentless campaign against uncertainty, we can help patients win the fight vs. cancer.

About the Author:

Zach Friedman