Encouraging HCPs to ‘stop and think’

Healthcare professionals (HCPs) strive to give their patients the best possible care and treatment, but it’s a tough job and, inadvertently, ingrained beliefs and behaviours can sometimes get in the way. As much as they work in an evidence-based world, they are, after all, also only human. Like all of us, it’s very easy for healthcare professionals to follow a certain path simply because it’s second nature, but there are times when this means patients may not benefit from new medical advances. Pharmaceutical companies can help by applying theories from behavioural science to encourage HCPs to ‘stop and think’ about how they approach new therapeutic options. Traditional pharma marketing focuses on raising awareness of unmet needs, educating about new therapeutic approaches, and positioning the brand to encourage product adoption. Those remain necessary, but awareness is not enough to disrupt entrenched beliefs and behaviours. It’s important for pharma to recognise, and address, the underlying factors that influence physician behaviour. One way to do this is through tackling cognitive bias and prescribing inertia.

Cognitive bias in healthcare We all rely on mental shortcuts in our day-to-day lives. They’re a protective mechanism and a way of simplifying the time and effort needed to make decisions on a daily basis. Every day our brains make thousands of decisions, most of which we’re not even aware of because pre-set mental shortcuts kick in to take them for us. The workday commute, for example, would require far more effort without them, if you had to consciously think about how to get to work each and every time you stepped outside your front door in the morning. Thankfully, your brain creates a mental shortcut to save you the time and energy of doing so, allowing you to focus on more important decisions. However, if you’re driving to work and find you’ve travelled the last few miles without consciously thinking about it because you’ve zoned out, that could have serious, negative consequences. It’s easy to do and happens because your brain is on autopilot, but that’s when mental shortcuts might not work in our favour. Cognitive biases for HCPs are a mental shortcut, but one that is prone to error and which can result in dogmatic thinking. They are not a character flaw – they’re just part of being human. In healthcare, cognitive biases can often be seen in HCPs that treat their patients in a certain way because that has always been their approach to a particular condition or symptom. Doctors and others can be so set in their own mental shortcuts that they’re not necessarily even aware that they’ve become a mental barricade against change. The mental shortcut becomes a habit. For example, when treating a patient with a certain condition, the HCP automatically prescribes the same medication time and time again. This has important ramifications for changing behaviour, particularly because biases very often exist at the subconscious level – hence the need for HCPs and others to ‘stop and think’. Prescribing inertia and its implications for pharma One of the prime things that needs some contemplation is prescribing inertia. It’s when an HCP falls into habits or shortcuts when making decisions about what they're going to prescribe. Specific examples of prescribing inertia are things like ‘I've been prescribing this medication for years, so I'm going to keep prescribing it’ or ‘I know how to manage the side effects that are associated with this treatment’. Oncology is a perfect example of a therapy area that’s particularly prone to prescribing inertia. Chemotherapy has been the standard-of-care for many patients for a number of years. From an HCP perspective, there may be an initial comfort level with prescribing chemo in the first-line setting, before offering some of the newer or more innovative options. What we’ve learned from our research is that some HCPs like to have these newer, more innovative treatments as a backup, in case a patient doesn't do well on the traditional first-line treatment. This is not to say that HCPs are not treating their patients appropriately, but it’s important to acknowledge their comfort level with certain medications and desire to have a strong Plan B. The theory of risk aversion, or risk tolerance, presents another side to this issue. Treatment options in oncology are changing so quickly that there may not necessarily be time to prescribe with confidence. HCPs may not understand how the latest immuno-oncology drug works or if it might be appropriate for a particular patient. Some HCPs may have a lower risk tolerance and want additional evidence before changing prescribing habits, while others may be more ready to try new therapies. The concern is that if these newer treatments are being kept in reserve, then patients may lose faith or confidence in their HCP. Patients often conduct their own research prior to speaking with their HCP. Patients may feel like they are more informed than their healthcare professional about the treatment options available. If this is the case, additional challenging dynamics will be introduced into the relationship. Disrupting habitual behaviours Simply introducing new clinical data often isn't enough to disrupt a cognitive bias because it is so entrenched and so much a part of a person’s daily routines and daily habits. Pharma has an opportunity to create experiences where HCPS are allowed to stop and think. This provides an opportunity to break the automatic prescribing inertia behaviour. It’s something we think about from an evidence-based perspective as an opportunity for debiasing, and there are some specific strategies that have been shown to really help and encourage HCPs to stop and think before they proceed.  How do you know that your pharma marketing will get providers to stop and think? One way is to create quick, disruptive experiences that allow them to reflect on their personal prescribing habits and biases. For example, instead of holding a traditional product theatre, create opportunities for interactive, hands-on role-play exercises where HCPs can try new things in a low risk setting, and then compare their current methods to desired approaches. The impact on pharmaceutical brands These are strategies pharmaceutical marketers need in their toolkits. The pharma brands that they are responsible for can always be negatively impacted by one or other form of cognitive bias, especially prescribing inertia, and it’s not something that traditional marketing approaches can rectify. If prescribing inertia and cognitive biases aren't addressed, they can truly limit the effectiveness of a marketing campaign and pharmaceutical brand. Addressing cognitive biases, prescribing inertia, and other specific challenges and drivers of HCP behaviour, can enable marketing campaigns to go further, help HCPs become more influential, and ultimately improve patient care. Improving patient outcomes It’s important to remember that addressing cognitive bias and prescribing inertia is never about a one-time interaction. Creating ongoing interactions and opportunities is helpful to your brand, the HCP, and the patient. Everything comes back to patient outcomes – it’s essential to meet patients’ needs. For example, preventable factors could negatively impact how a provider recommends a treatment to their patient, discusses potential side effects, or sets expectations on outcomes. Ultimately, these factors impact both the individual programme and also the brand that stands behind it. Simply stated, in order to truly meet the patient’s needs, we need to address the provider’s needs. About the author Kathy Moriarty is senior behaviourist at MicroMass. She implements and identifies behavioural change tactics and programs for the agency’s pharma clients. Kathy utilises her expertise to apply creative, out-of-the-box thinking to behavioural principles and develops curriculums to change patient and provider behaviours. Kathy’s therapeutic experience includes oncology, major depressive disorder, chronic kidney disease, type 2 diabetes, and cardiovascular disease. Prior to MicroMass, Kathy received her Master of Social Work from Loyola University in Chicago.