Managing the risk of ‘availability bias’
By Agata Zadrożna, Research Manager and Joanna Skrzyńska, Research Manager - Kantar Public, Poland
1 Source: European Cancer Organisation, May 2021
On 4 March 2020, the first COVID-19 case was confirmed in Poland. Initially, the mortality rate was low and oscillated around 10,000 cases per month (2.5–3 cases per 10,000 inhabitants). By October, the number of COVID-19 cases had increased sharply, with a peak in November, and again in March 2021 with an excess of 600,000 new cases per month (over 150 cases per 10,000 inhabitants).
COVID-19 new cases in Poland
Source: COVID-19 w Polsce, June 2021
While the mortality rate shows that there were (unsurprisingly) significantly more deaths in 2020 and 2021 than in 2019, more than 120,000 ‘excess deaths’ were recorded throughout the pandemic – with approximately 70,000 officially attributed to COVID-19. 2 Opinions are divided as to whether the remaining 50,000 deaths were indeed unrelated to the Coronavirus, or whether they were actually due to COVID 19 but ended up being otherwise categorised (for example, as heart failure).
2 As of 1 June 2021, 73,856 COVID-19 related deaths in Poland had been reported to the WHO. Source: WHO
Excess deaths and COVID-19 deaths in Poland
Source: Otwarte Dane, 8 June 2021 and COVID-19 w Polsce, June 2021.
Many commentators point out that these deaths may be related to illnesses that were not detected in time, or ones that were not adequately treated since all healthcare efforts focused on fighting the pandemic.
At the time, the first lockdown in the Spring of 2020 was viewed as a temporary situation. It seemed that the restrictions would soon be lifted, alongside the limitations on access to healthcare services. However, even though medical staff were prioritised for COVID 19 vaccination, most consultations continued to be conducted by telephone.
Hosts of patients were still unable to receive diagnoses and adequate treatment. Multiple hospitals and wards were converted into ‘COVID facilities’, with beds reserved for potential COVID-19 patients, and insufficient capacity for other patients.
A study conducted in early May 2021 by Kantar Public in Poland, indicates that the biggest problem during the pandemic consisted of the lack of availability of face-to-face consultations with a doctor. A total of 59%, or around 19 million Poles, reported that they were offered remote (telephone) consultations instead. Access to healthcare in general became more difficult too, as reported by one in three Poles (33%).
Many of the previously scheduled appointments with specialists (25%) and medical procedures (10%) were cancelled. Diagnostic tests also proved a challenge: 21% of Poles experienced the cancellation of routine tests (e.g. ECG, mammography, or gynaecological ultrasound scans), and 20% faced difficulties in getting these tests done.
In addition, a large group of people (36%) opted not to consult a doctor despite experiencing health problems.
Virtual consultations, delays and cancellations in health services
Source: COVID-19 w Polsce, June 2021.
From the perspective of critically ill patients, and specifically those with cancer, access to medical treatment during the pandemic has been even more problematic . Cancer is the second most common cause of death in Poland, after cardiovascular disease. Cancer patients in Poland are offered fast-track diagnosis and treatment. Yet, the pandemic has hit these patients particularly hard, limiting their treatment options. This is reflected, for instance, in the number of fast-track treatment entitlements issued in 2020, falling by 10% third in comparison with previous years.
There are important information gaps in the public healthcare system, notably in relation to cancer. Non-governmental organisations are doing their best to bridge the gap, drawing on their own resources.
Agata Polińska, Vice-President of the Alivia Cancer Foundation, describes the situation facing many critically-ill patients:
“During the first and second waves of the pandemic, we conducted in-depth consultations among cancer patients to better understand the main problems facing those patients. We came up with recommendations, and presented them to the Ministry of Health together with other organisations from the Polish Oncology Federation.
After the first wave, the Ministry ensured better access to personal protective equipment in cancer units, but some of our other recommendations were not implemented and the continuity of cancer diagnosis and treatment was not well coordinated in cases where a healthcare facility was converted into a COVID unit, or when staff members got infected. The affected cancer patients who had their health services cancelled for this reason were often left without any information as to where and when their treatment could resume.
As a result, they desperately sought help on their own. Now, in partnership with Kantar Public, we are conducting a study on cancer patients’ experiences throughout the outbreak. We will report the survey results and conclusions to the Ministry of Health in the coming weeks.”
The state of cancer care during the pandemic is currently being widely discussed in the Polish media. In May 2021, as part of a broader initiative undertaken by the European Cancer Organisation, Alivia launched a campaign entitled: ‘Time To Act! Don’t let Covid-19 stop you from tackling cancer’, to urge the public, cancer patients, policymakers and healthcare professionals to ensure COVID-19 does not continue to undermine the fight against cancer.
According to a study commissioned by the European Cancer Organisation, the COVID-19 pandemic has resulted in an estimated one million cancer cases being left undiagnosed in Europe, and an estimated 100 million cancer screening tests not being performed, leading to later stage diagnoses and decreased overall survival rates.
Today, COVID-19 is the most visible and inescapable factor in healthcare, and beyond. However, while the pandemic undeniably presents a real and enormous threat, behavioural science shows us that the prevalence and impact of COVID-19 in our thinking can sometimes lead to poor decision making.
Humans are irrational beings. Fortunately for researchers, this irrationality is predictable and, whether we like it or not, we are all prone to fall victim to cognitive biases. In Kantar Public’s Behavioural Insights work, we help clients to understand citizen behaviour and deconstruct the complex range of levers that influence it. As part of this, we apply our proprietary Behaviour Change Diagnostic Framework to help clients to understand the role of behavioural biases, otherwise known as ‘heuristics’.
Amongst these, is the availability heuristic which shows us that when making decisions about the future, we may rely too heavily on things that come quickly and easily to our minds. We form impressions and judgements based on the information that is available to us, as Daniel Kahneman explained via the acronym WYSIATI, which stands for “What You See Is All There Is.”
In a pandemic, as at all other times, a great deal depends on how we all behave. Success in the battle against the virus will be driven at the institutional level where regulations are drafted and public policies are formulated, as much as at the public level. At this level, decisions are also made by people, and behavioural biases apply here too.
Obviously, the pandemic is not the only cause of problems in healthcare systems. While it has exacerbated pre-existing problems, it has also pushed them to the back burner, thus rendering them less visible.
As we examine the excess deaths over the past 15 months and the challenges facing non-COVID patients, one must consider that while the decision-making environment in healthcare has focused on tackling the COVID-19 emergency, the de-prioritisation of other healthcare services carries enormous risks for public health.
How can decision makers deal with the plethora of information and news about coronavirus, and counteract the availability heuristic that may unduly influence their decisions?
Recent events and our studies have shown us once again the importance of gathering data beyond what is already available, to ensure that policy decision making is truly evidence-based. The collection of appropriate and sufficient data and statistics, alongside effective analysis to better understand the problem and context, increases the chances of finding the optimal solution.
It may be unrealistic to eliminate entirely the availability heuristic and other distorting heuristics in decision making. Nevertheless, simply being aware of and noticing the risks implicit in various heuristics can make a huge difference. For example, if everyone is focusing on the same thing, something important may be missed.
To counteract this risk of ‘group think’, it can be useful to bring in people who have a different perspective and to encourage the consideration of new points of view. Since these biases are even more likely to occur in pressurised situations – such as the current pandemic where the stakes are so high - organisations and institutions, both public and private, will benefit from exploring cognitive biases, and understanding how these might affect decision-making processes.
