Association Between Obesity and Postmenopausal Breast Cancer Risk-Reply.

apply insights from behavioral theories to be better prepared for discussing patient preferences when a disease advances and irreversibly worsens. While multiple objective factors contribute to patients’ preferences, such as family needs, financial states, physical discomfort, and others, there are also subjective factors that might bias patients’ perception of a situation and shift their preferences, not only against statistical likelihoods, but also against patients’ true values and long-term goals.3 Subjective biases are often formed by patients’ anxiety, psychological defensive mechanisms (eg, denial), and misperception of provided information. We believe that it is essential for physicians to determine when a subjective reality guides medical choices that will potentially result in suboptimal outcomes and patients’ dissatisfaction. While we indeed propose simple techniques and decision-making “nudges” in our Viewpoint, it is because these techniques have been shown to have critical impact on decision-making biases.4(pp26,33,37) In discussions about patients’ preferences, physicians could use these techniques to ensure that patients’ choices are not misguided by subjective biases but, instead, that patients make a truly wellinformed decision consistent with their values and longterm goals. We understand the concern of Henselmans and colleagues that decision-making psychology could be misused to unduly shift patients’ preferences and convince patients to choose what just their physician thinks is best for them. Therefore, it is critically important to remember that the goal of physician-patient communication is to determine the patient’s true preference and arrive at a decision that matches these preferences. Proposing “influencing wisely,” we trust that physicians will always prioritize their patients’ interests, which should be determined by patients, not by physicians. The physician’s role is to ascertain these interests and help the patient to recognize them without bias to ensure that the patient’s choice is well considered and matches his or her true preference.