Imagine going to the doctor for your annual physical, including the usual battery of screening tests your physician recommends each year. You think nothing of it all – it’s familiar territory – and when you leave the office your mind is onto other matters of the day.
But a week later, you receive an unexpected phone call: your results have come back, and they reveal something suspicious. Anxious and full of questions, you return to the hospital for another round of testing, and once again wait for your results. After a week of worrying, the doctor calls to tell you that everything appears to be normal after all, and suggests you simply return next again year for the same routine testing.
Crisis averted, no harm, no foul? Or do you now feel more – or less – vulnerable? Will you respond the same way, quickly dashing in for follow-up testing, the next time you get an unexpected phone call from your doctor?
Wharton’s Mary Frances Luce explores these questions and others that probe the psychology of consumer decision making. Luce, associate professor of marketing, has broken new ground in her examination of a previously ignored area of consumer behavior: how decisions – from pursuing medical testing to buying a car – are affected by emotion, especially negative emotion.
Luce, 32, earned her PhD at Duke University, noted for its research on the behavioral aspects of decision making. The implications of such investigation are obvious: predicting consumer action and choice. But most research on decision making has taken a somewhat clinical view of how and why people pick one item or course of action over another, looking at decisions as little more than problem-solving exercises or herd mentality.
Luce has taken a different view, however, and her research has borne out her hunches. In a variety of contexts and through a number of experiments, Luce has demonstrated that our choices change – sometimes dramatically – if we are faced with aspects of a decision that frighten or upset us.
Her research on how people respond to medical test results, co-authored with Wharton’s Barbara Kahn and published last year in the Journal of Consumer Research , revealed that initially suspicious test results that ultimately show no disease – often called false positives – increase a patient’s feeling of vulnerability and can influence later decisions to get re-tested.
In their paper, Luce and Kahn note that a focus on saving lives through early diagnosis has resulted in a proliferation of medical tests today, from pap smears to mammograms, blood tests for prostate cancer and sexually transmitted disease screening. Thus, today’s consumers are faced with a barrage of suggested screening tests and frequently must decide whether to engage in repeated screening tests after a suspicious test result.
And there’s little doubt that not finding a malady ultimately costs more than follow-up tests. As a result, most medical screening tests are hyper-sensitive by design, flagging suspicious results roughly 15 to 20 percent of the time for mammograms, for instance, when only 2 to 6 percent of those ultimately lead to a breast cancer diagnosis.
Luce and Kahn write that the costs of not diagnosing an illness are obvious: a disease cannot be treated if it is not detected. But what about the psychological costs to patients who are informed of a suspicious test result and undergo follow-up testing, only to be told that they are healthy, after all? In a variety of research writings, physicians have for years expressed worry about the emotional trauma to patients and subsequent effects on their decisions to seek further medical testing. But prior to Luce and Kahn’s paper, no experimental research on the subject had taken place.
Funded by a grant from the National Science Foundation, Kahn and Luce looked for answers through a series of four experiments using human subjects who were put in a variety of settings and circumstances, and then were observed. The study’s findings?
While there’s concern in the medical literature that excessive follow-up tests may reduce a healthy patient’s tendency to be retested because it will shake the patient’s faith in the test, we actually found the opposite,” Luce says. “Our studies concluded that patients feel more vulnerable, and this increases the propensity to retest. But it appears to be true only in situations where patients feel there is no good alternative to testing. So one implication of our findings is that giving patients alternatives – such as suggesting ways to cure the disease directly – could reverse the motivational effects of the suspicious test result.”
“The two researchers also suspect that test-generated feelings of vulnerability may dwindle over time, and are now engaged in additional studies to gauge patient response to repeated suspicious test results. As an extension of their first study, Luce and Kahn are interviewing mammogram recipients at the Hospital of the University of Pennsylvania and also plan a broad survey that examines women’s reactions to one or several suspicious mammograms. “We want to examine their feelings of perceived vulnerability, their perceptions of how accurate or useful the tests are, and finally their actions,” Luce says.
Ultimately, Luce and Kahn hope their research will lead to policy implications for medical professionals. “If doctors could make mammograms more accurate they would. But equivocal results are a frequent and unfortunate reality, and that’s not likely to change in the near future. Our goal, then, is to provide medical professionals with the information they need to predict a patient’s reaction to testing errors so that negative patient reactions can be minimized by finding better ways to communicate test results.”
A Station Wagon, Or A Roadster?
We’ve all seen the ads: a family sits incubated in the cozy expanse of a Volvo, winding down a beautiful country road, snugly buckled in, wife and children smiling calmly with the knowledge that they are safe – safer than in nearly any other car – in this Swedish fortress of steel and airbags.
Even in the absence of data demonstrating its effects on consumer decision making, advertising agencies have played on emotional themes such as safety for years. Michelin’s baby-centered ads communicate a link between tire brand and protecting one’s family; life insurance companies routinely stress the potential catastrophe to loved-ones that can come with under-coverage. Even seemingly mundane consumer decisions have emotional implications: Was that shampoo tested on animals? Do those diapers biodegrade?
For marketers, decision making is perhaps the key to understanding consumer behavior. Another area of Luce’s work investigates the often difficult trade-offs that consumers face and how those trade-offs ultimately affect their purchases: price versus safety in buying a car, quality of life versus longevity in making a health care choice, or risk versus return in choosing investments for a child’s college fund or retirement.
“There’s a huge body of academic research that describes decision behavior,” Luce says. “And that research has been integrated into marketing practice to predict and explain why people makes the choices they do – for instance, to ultimately predict market share. But I think that research misses a lot of what people are actually trying to do when they make a choice.”
Most research explains decisions as an attempt to save time and be accurate – a somewhat clinical interpretation of an action that Luce believes is also fraught with emotion. “I believe that people are also trying to cope with their decisions,” Luce says. “People want to feel good about their choices and not feel threatened, to feel like they are responsible decision makers and that they can justify their actions to others. And if you are trying to predict what people will do and you ignore this motivation, you’ll miss a lot of the picture.”
What specifically have her various studies found?
A 1998 research paper published in the Journal of Consumer Research, “Choosing to Avoid: Coping with Negatively Emotion-Laden Consumer Decisions,” addresses the conflicting feelings consumers face when making significant purchases, such as an automobile, and studies how those feelings ultimately affect actions.
In particular, Luce zeros in on something called the “status quo bias,” a long-cited finding in marketing research that argues, quite simply, that people tend to prefer the ease of maintaining the status quo. Luce’s research doesn’t dispute this argument, but adds to it: maintaining the status quo when making choices is a way to cope with your choice. “If you maintain the status quo, you don’t have to make any difficult tradeoffs,” she says. “If I trade in my Volvo station wagon for a convertible sports car, I might have to confront the trade off between my family’s safety and the enjoyment of the sports car. But if I just keep driving my Volvo or maybe trade it in for an identical model, I don’t have to think about those things and experience the negative emotions that come as a result.”
She finds that when people are put in a position of making an emotionally charged decision – such as considering car safety over sport – they tend to cling to the status quo more. “One goal of this research is ultimately to predict and explain marketplace behavior better,” Luce says. “And what it tells us is that Volvo and other companies playing on the strong emotions people feel about issues like safety are very likely on the right track where consumers are concerned. Of course, this means that as consumers, we should be aware of how our feelings about decisions influence our actions. If not, we might respond to marketers’ emotional appeals without really understanding whether these responses make sense.
