“The Role of Information and Nudges on Advance Directives and End-of-Life Planning: Evidence from a Randomized Trial” with Allyson B. Root and Benjamin Handel
My job market paper involves a randomized control trial in partnership with a large Northwest U.S. health care system to improve advance directive completion in older adults through written reminders and gentle nudges in a behavioral economics framework.
Abstract: Despite the substantial personal and economic implications of end-of-life decisions, many individuals fail to document their wishes, which often leads to patient dissatisfaction and unnecessary medical spending. We conducted a randomized trial of 1,200 patients aged 55 and older to facilitate advance directive (AD) completion and better understand why patients fail to engage in high-value planning. We found that including a physical AD form with paper letters as a nudge to decrease hassle costs increased AD completion by 9.0 pp (95% CI = 4.2-13.9 pp). Our intervention was especially effective for individuals age 70 and older, as AD completion increased 17.5 pp (95% CI = 5.7-9.4 pp). When compared to the impact of costless electronic reminders, each additional AD completion from the letter interventions cost as little as $37. Our findings suggest that simple, inexpensive interventions with paper communication as behavioral nudges can be effective, especially in older populations.
- Initial study trial registration: https://doi.org/10.1257/rct.3038-1.0
- Subsequent study trial registration: https://doi.org/10.1257/rct.4212-1.0
- J-PAL initiative
“Employer Risk-Adjustment Transitions with Inertial Consumers: Evidence from CalPERS” with Benjamin Handel, Lynn M. Hua, and Yuki Ito
“Spending and Enrollment Effects of the Pandemic Maintenance of Eligibility Policy on Medicaid” with Noelia Duchovny and Ru Ding
“Early Impact of the State Innovation Models Initiative on Diagnosed Diabetes Prevalence Among Adults and Hospitalizations Among Diagnosed Adults” with Brent Fulton and Hector Rodriguez in Medical Care