Take a cursory look at the agenda for next month’s ASCO, and you’ll see oncology’s newest innovations—and promise—come with ever-increasing complexity of choices. The convention has many sessions focused on understanding the many novel choices available and on making decisions about when and with what types of patients to use these new treatments. Clearly, the objective is to help oncologists navigate a context of ambiguity and uncertainty.
Precision medicine, the field using genetic profiling to optimize and personalize treatments for individuals, promises to help reduce such complexity. In fact, studies show that progression-free survival (PFS) increases as a result of the molecular sequencing of precision-medicine. But such an approach is not standard yet. Currently, oncologists are left to wade through mountains of new data and learn what works best through experience (trial and error).
From a behavioral perspective, this often-muddled context has implications for decision-making. Needing to make decisions based on new information, with uncertain outcomes, puts strain on our already-limited cognitive resources. This makes it easy to overly rely on conclusions drawn from intuition, which in behavioral science is often referred to as System 1. But complex treatment decisions require the process of a different system, System 2: rational deliberation and conclusions. (More on System 1 and System 2 here.)
How oncologists cope with this challenge—override System 1 and keep System 2 engaged—is dependent on a few factors. Unsurprisingly, one factor is just baseline cognitive ability (i.e. the “smarts” to process and understand new evidence). The fact is, we can assume that oncologists have this is spades, as they wouldn’t have gotten this far in their careers without it.
But there’s another variable at play. Behavioral science tells us that there is a cognitive motivational style that reflects people’s natural tendency to problem-solve by seeking out and deeply deliberating about information, as opposed to using quicker strategies like heuristics and previously formed opinions. This spectrum is called “Need for Cognition” (NFC). People who have a high NFC tend to enjoy and may even look for opportunities to engage in high-effort cognitive activity. Think about a friend who does the exhaustive product research, rank-orders the options, and puts it all into an Excel worksheet. Those with higher NFC are likely to have more positive attitudes toward situations that require lots of reasoning and problem solving.
At the other extreme, people with low NFC, strongly prefer “cognitive closure,” which means that they’d rather make a quick decision from that friend’s spreadsheet and are not so interested in looking for new information or reconsidering the options. In fact, they may grow quickly distressed when they have to do it themselves.
Why this matters to us
Every day, oncologists make numerous decisions that have substantial consequences for their patients. Many factors influence these decisions: clinical experience, availability of research evidence, patient preferences and values, as well as practice frictions. We can help oncologists navigate through these variables and keep them focused on the product information that matters most—by taking into account the natural cognitive style of our audience.
For example, for high NFC specialists, we must satisfy their need to cognitively engage. We can make sure that all of the data and stats are up front in our communications, focus them on the quality of the data, and make recommendations for where to look for even more information. Framing messages in terms of the relative risks of action or inaction may also have more impact.
For those with low NFC, we need to first work hard to capture their attention with System 1 cues, like attractiveness or an influential messenger. Then we can make it easy for them to engage System 2 by chunking out information for them, repeating information in a variety of formats, and framing product messages in terms of gains or opportunities.
Many oncologists are being forced to adapt to increasingly complex circumstances at work. Their continued learning takes place at night, after patient hours; there are more complex treatment choices and reimbursement limitations; patient volume is rapidly growing, in part due to diagnoses delayed by the pandemic; and 40% of oncologists report experiencing burnout. Tailoring content to oncologists’ individual learning styles is a high-impact way to engage them in the face of these difficult barriers and support them throughout their ongoing journeys.
