• Senlin Lin, Yingyan Ma, and Haidong Zou.
• Department of Eye Disease Prevention, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai 200010, People's Republic of China.
• Patient Prefer Adher. 2020 Jan 1; 14: 371-381.

PurposeThis study tried to establish a metric framework of patient adherence to doctor's advice based on the expected utility and prospect theories, and it explained why the key to patient adherence to doctor's advice is patients' perceptions.MethodsOur framework is primarily based on two mature theories: expected utility theory and prospect theory. We started with a basic assumption: the doctor is rational and cares for patient's health utility. We analyzed the expected utility of therapy with a definite diagnosis. Then, we considered the impacts of the accuracy of diagnostic techniques. After that, we explored the patient's response to the doctors' advices based on behavioral economics. In addition, we launched a discrete choice experiment to test our main point: perception is the key to patients' adherence. A total of 200 undergraduate students participated in the discrete choice experiment.ResultsThree main factors might impact a rational clinical decision: the therapeutic and side effects of the treatment, patient's true disease risk, and diagnostic accuracy. However, another factor, patient's individual percepion, was crucial for patient's adherence since it may bias the patient's estimations regarding the above three factors. As a result, doctors and patients would have a cognitive gap in the estimation of the disease and the treatment.ConclusionThe results indicate that without the necessary information, better clinical techniques may not help to improve patient adherence, which support our theoretical reasoning forcefully. Therefore, improving patient adherence should be more of a process of empathy and communication rather than a promotion of medical technology.© 2020 Lin et al.

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