Using nudges to promote clinical decision making of healthcare professionals: A scoping review

Nudging has been discussed in the context of policy and public health, but not so much within healthcare and how it can be applied to change the behavior of healthcare professionals (HCPs). This scoping review aimed to assess the empirical evidence on how nudging techniques can be used to affect the behavior of HCPs in clinical settings. A systematic database search was conducted for the period January 2010-December 2020 using the PRISMA extension for Scoping Review checklist. Two reviewers independently screened each article for inclusion. Included articles were reviewed to extract key information about each intervention, including purpose, target behavior, measured outcomes, key findings, nudging strategies used, and their theoretical underpinnings. Two independent dimensions were used to describe nudging strategies according to action and timing where each of the identified nudging strategies and objectives was characterized as active, passive, synchronous, or asynchronous. Of the included 51 articles, 40 reported statistically positive results, six reported no success and two reported mixed results. Thirteen different nudging strategies were identified aimed at modifying four types of HPCs behavior:prescriptions/orders, procedure, hand hygiene, and vaccination. The most common nudging strategy used involved default/pre-order nudges, followed by alerts/reminders and active choice. Both passive and active nudges showed positive results, highlighting the importance of long-term studies that evaluate if the desired outcome is maintained. Careful ethical consideration should however be given to passive strategies where the user might not be aware of the nudge