华人生死学
认知偏差、行为助推与路径优化:预立医疗照护计划三阶段困境的应对策略分析
DOI: 10.12209/j.hrssx.2026060205
基金项目:
Nudging Through Barriers: A Behavioral Bias Perspective on Decision-making in Advance Care Planning
摘要
预立医疗照护计划(ACP)是提升临终生命质量的关键工具,但其推广面临认知偏差引致的阶段性困境。本研究采用文献综述与理论分析法,旨在分析ACP在“引入-执行-持续”三阶段中的核心困境,并构建基于助推理论的干预框架以优化实施路径。研究识别出各阶段的关键偏差:前期因可得性偏差导致对话回避,中期因锚定效应等致使决策偏离,后期因禀赋效应造成计划难续。据此,提出了一个多维助推策略框架:通过默认选项与简化流程(实用性与激励性)降低启动门槛,利用框架效应与规范指引(规范性与警示性)纠正认知偏差,借助情景模拟与路径比较(预测性与比较性)促进长期共识。未来ACP推广需注重策略与认知机制的精准匹配,并加强相关制度保障。
Abstract
dvance Care Planning (ACP) serves as a critical tool for improving end-of-life quality, yet its implementation faces stage-specific challenges driven by cognitive biases. This study aims to analyze the core dilemmas encountered across the three phases of ACP—initiation, execution, and sustainability—and to develop a nudge-based intervention framework to optimize its implementation pathway. Using literature review and theoretical analysis, the study identifies key biases at each stage: avoidance of dialogue due to availability bias in the initial phase, deviation in decision-making caused by anchoring effects in the mid-term phase, and difficulties in sustainability resulting from endowment effects in the later phase. Correspondingly, a multidimensional nudge strategy framework is proposed: applying default options and process simplification (practicality and incentivization) to lower initiation barriers; utilizing framing effects and normative guidance (standardization and warning) to correct cognitive deviations; and leveraging scenario simulation and pathway comparison (predictability and comparability) to foster long-term consensus. Future ACP promotion should emphasize precise alignment between strategies and cognitive mechanisms, supported by enhanced institutional safeguards.

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1主要系统原理图1
Fig.1Main system schematic diagram