Randomised controlled trial of information leaflet on preference for endoscopy sedation: Impact of a ‘nudge’ on patient behaviour
Karen Boland, Jennifer McGrath, Gavin Harewood
Department of Gastroenterology and Hepatology, Beaumont Hospital.
Behavioural economists have used the term ‘nudge’ to describe an attempt to influence an individual’s behaviour using a subtle intervention while preserving freedom of choice. There is growing awareness of the potential of ‘nudges’ to modify human behaviour. In our endoscopy unit, approximately 60% of outpatients undergoing oesophagogastroscopy (OGD) opt to receive conscious sedation. For the majority of patients, an unsedated procedure would be safer, more efficient and less costly.
We aimed to assess the impact of a ‘nudge’ intervention –an information leaflet explaining details of a sedated/unsedated procedure – on patients’ choices for procedure sedation.
Consecutive outpatients scheduled to undergo OGD were randomised: a) to receive an information leaflet prior to their procedure (study group) or b) no leaflet (control group) on alternate weeks over 10 weeks. Within the study group, patients either received the leaflet during registration (self informed group) or received personalised procedure information by a physician (physician informed group). The leaflet detailed practical considerations of conscious sedation while personalised information comprised a brief 1 to 2 minute review by a physician. All patients were free to opt for sedation/no sedation (anaesthetic throat spray) for their procedure. The endoscopist had the discretion to administer or withhold sedation if medically necessary regardless of patient preference. Patients scheduled for an anticipated endoscopic intervention or for combined colonoscopy were excluded. Written, informed consent was obtained from each patient.
354 consecutive patients were enrolled of whom 209 received a pre-procedure information leaflet. Within the study group, 175 patients reviewed the leaflet independently (selfinformed group) while 34 patients reviewed the leaflet with a physician (physician informed group). Overall, the proportion of patients opting for sedation within the physician informed group (47%) was lower than either the self informed group (61%) or the control group (60%). One patient required reversal of their sedation in the control group. All groups were similar in terms of age and gender; age and gender did not influence selection of sedation.
The study findings illustrate the potential of a ‘nudge’ strategy to modify patient behaviour. Interestingly, provision of an information leaflet alone does not appear to influence patient preference for sedation; however, personalised review of the procedure with a physician carries greater impact on patient behaviour while still respecting patient autonomy. Reduction in utilisation of sedation for OGD results in a safer and more efficient procedure while saving on costs. Further study is required to evalua