SynthesisBMJ open2021
Systematic review of clinician-directed nudges in healthcare contexts.
Synthesis in BMJ open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 88 papers, 8 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
88 citing papers in PubMed, 8 syntheses or guidelines pooled it.
- Enhancing goals of care discussions: a systematic review and meta-analysis of clinician-directed behavioural nudges.Age and ageing · 2026Pooled it
- Using nudges with electronic health records systems to improve advance care planning: a systematic review.BMC palliative care · 2025Pooled it
- Evaluating the role of clinical decision support systems in medication safety for older people: a systematic review.Age and ageing · 2025Pooled it
- Preventative behavioural interventions that reduce health inequities: a systematic review using the theoretical domains framework.BMC public health · 2025Pooled it
- Electronic Health Record Nudges and Health Care Quality and Outcomes in Primary Care: A Systematic Review.JAMA network open · 2024Pooled it
- Pooled it
- Effectiveness of non-interruptive nudge interventions in electronic health records to improve the delivery of care in hospitals: a systematic review.Journal of the American Medical Informatics Association : JAMIA · 2023Pooled it
- Nudge interventions to reduce unnecessary antibiotic prescribing in primary care: a systematic review.BMJ open · 2023Pooled it
- Trial
- Pilot Trial of a Behavioral Economics-Informed Clinical Decision Support Alert to Improve Inpatient Tobacco Use Treatment Rates.Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2025Trial
- A qualitative analysis on the implementation of a nudge intervention to reduce post-surgical opioid prescribing.BMC health services research · 2025Trial
- Strategies to Limit Benzodiazepine Use in Anesthesia for Older Adults: A Randomized Clinical Trial.JAMA network open · 2024Trial
- Clinician- and Patient-Directed Communication Strategies for Patients With Cancer at High Mortality Risk: A Cluster Randomized Trial.JAMA network open · 2024Trial
- Process evaluation of a tailored nudge intervention to promote appropriate care and treatment of older patients at the end-of-life.BMC geriatrics · 2024Trial
- Assessing a behavioral nudge on healthcare leaders' intentions to implement evidence-based practices.PloS one · 2024Trial
- Cluster Randomized Pragmatic Clinical Trial Testing Behavioral Economic Implementation Strategies to Improve Tobacco Treatment for Patients With Cancer Who Smoke.Journal of clinical oncology : official journal of the American Society of Clinical Oncology · 2023Trial
- Nudging attitudes toward IT innovations by information provision that serves as a reminder of familial support.PloS one · 2023Trial
- Impact of a prospective feedback loop on care review activities in older patients at the end of life. A stepped-wedge randomised trial.BMC geriatrics · 2022Trial
- Effect of Pharmacist Email Alerts on Concurrent Prescribing of Opioids and Benzodiazepines by Prescribers and Primary Care Managers: A Randomized Clinical Trial.JAMA health forum · 2022Trial
- Effect of Different Interventions to Help Primary Care Clinicians Avoid Unsafe Opioid Prescribing in Opioid-Naive Patients With Acute Noncancer Pain: A Cluster Randomized Clinical Trial.JAMA health forum · 2022Trial
28 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
Abstract
objectiveNudges are interventions that alter the way options are presented, enabling individuals to more easily select the best option. Health systems and researchers have tested nudges to shape clinician decision-making with the aim of improving healthcare service delivery. We aimed to systematically study the use and effectiveness of nudges designed to improve clinicians' decisions in healthcare settings.
designA systematic review was conducted to collect and consolidate results from studies testing nudges and to determine whether nudges directed at improving clinical decisions in healthcare settings across clinician types were effective. We systematically searched seven databases (EBSCO MegaFILE, EconLit, Embase, PsycINFO, PubMed, Scopus and Web of Science) and used a snowball sampling technique to identify peer-reviewed published studies available between 1 January 1984 and 22 April 2020. Eligible studies were critically appraised and narratively synthesised. We categorised nudges according to a taxonomy derived from the Nuffield Council on Bioethics. Included studies were appraised using the Cochrane Risk of Bias Assessment Tool.
resultsWe screened 3608 studies and 39 studies met our criteria. The majority of the studies (90%) were conducted in the USA and 36% were randomised controlled trials. The most commonly studied nudge intervention (46%) framed information for clinicians, often through peer comparison feedback. Nudges that guided clinical decisions through default options or by enabling choice were also frequently studied (31%). Information framing, default and enabling choice nudges showed promise, whereas the effectiveness of other nudge types was mixed. Given the inclusion of non-experimental designs, only a small portion of studies were at minimal risk of bias (33%) across all Cochrane criteria.
conclusionsNudges that frame information, change default options or enable choice are frequently studied and show promise in improving clinical decision-making. Future work should examine how nudges compare to non-nudge interventions (eg, policy interventions) in improving healthcare.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.