Heuristics, Biases, and Decisions in Resource Allocation for Home Care Packages under Consumer Directed Care: A Systematic Review and Thematic Synthesis

Abstract

Consumer-directed care (CDC) is a policy solution for quality deficiencies in aged care where seniors accessing care services are empowered with full choice and flexibility over their service packages. Various programs have been developed using this policy approach around the world, and implementation has invoked a mixture of responses. While consumer organisations welcome a policy direction providing additional choice, there is a concern that this policy complicates the decision-making process, leading people to rely on “rules of thumb” (heuristics) that may not reflect their best interests. Behavioural science provides a lens for looking at heuristics and biases that may occur during complex decision making, particularly as people age. Objective. To explore the presence and influence of heuristics and biases on the decision-making processes of older people receiving home care services under a CDC model. Method. Qualitative systematic review involving systematic searching of PubMed, MEDLINE via Ovid, Embase via Elsevier, CINAHL via Ebsco, PsycINFO via Ovid, Web of Science, Scopus, and EconLit, from inception until 14th April 2022 was undertaken. Identified articles were deduplicated, screened, and extracted for information relevant to the research question using PRISMA guidelines. Data extraction considered descriptive data and metadata including study type, participants, overall objectives, chosen methodologies, and their relationship to the research question. The variety of study types prompted a thematic synthesis to achieve greater comprehension of the existing knowledge base. Results. Descriptive categories were analysed to reveal five themes relevant to the presence and influence of heuristics and biases in decisions made by older people when allocating home care resources. Principally, CDC is implemented to afford autonomy but is complicated by the decision-making environment. Choice and decision making are both specific to the individual, and the processes employed for decision making vary over the life-course. Decision quality can be improved through the identification and mitigation of complicating factors. More research is needed to understand how modifications can assist decision making and improve health outcomes.