EP204: Overcoming Decision Paralysis with Dr. Mary Steffel

Overcoming Decision Paralysis: Insights from Dr. Mary Steffel

In this episode of The Girl Doc Survival Guide, we welcome Dr. Mary Steffel, an Associate Professor of Marketing at Northeastern University. Dr. Steffel delves into the phenomenon of decision paralysis, drawing from her extensive research on consumer judgment and decision making. She shares personal anecdotes, including her illustrative experience playing Cinderella, and discusses practical strategies for managing complex decisions. Key solutions include delegating decision-making to others and simplifying choices. Dr. Steffel also offers advice for healthcare providers to help patients navigate medical decisions. The conversation covers the importance of recognizing decision fatigue and planning decision-making for optimal times.

00:00 Introduction and Guest Welcome

00:56 Personal Anecdote: Cinderella and Decision Paralysis

02:15 Understanding Decision Paralysis

03:54 Real-World Example: Medicare Drug Plans

05:25 Delegating Decisions: A Practical Approach

09:58 Medical Decision Making: Simplifying Choices

14:07 Overcoming Decision Fatigue

15:49 Conclusion and Farewell

Transcript

Christine Ko: [00:00:00] Welcome back to The Girl Doc Survival Guide. Today, I'm very happy to be with Dr. Mary Steffel. Dr. Mary Steffel is an Associate Professor of Marketing at Northeastern University's D'Amore-McKim School of Business with affiliated appointments in Public Policy and Urban Affairs. She holds PhDs in Marketing and Psychology from the University of Florida and Princeton University, respectively, and studies consumer judgment and decision making with a focus on how people seek help, decide for others, and how institutions can support better decisions. Her research has been published in leading journals across marketing, management and psychology, and she directs the Choice and Thought Lab while teaching undergraduate and MBA courses. Mary has advised the White House and federal agencies, received multiple teaching honors, and regularly shares her work through major media outlets and public talks. Welcome to Mary. 

Mary Steffel: Thank you so much for having me. 

Christine Ko: To start off with, can you first share a personal [00:01:00] anecdote? 

Mary Steffel: Absolutely. Back in grad school when I was studying to be a decision scientist, I spent a lot of time doing research on how people react when they're faced with difficult decisions. But funny enough, one of the best lessons I had about the experience of facing difficult decisions came outside of my research. I actually had the opportunity to play Cinderella in a university production of Into the Woods. In this version of the story, Cinderella actually embodies what it's like to be paralyzed with indecision. She's so indecisive about whether to pursue a life with a prince or go back home where things are safe that night after night, she attends the prince's ball, but flees before he can learn who she really is. Now he eventually catches onto this and ends up spreading thick, sticky tar to the steps of the palace to keep her from running away. And this time when she flees, she actually ends up getting stuck to the steps and is confronted with how her indecision is quite literally keeping her from moving forward. [00:02:00] This moment perfectly captures what it feels like to be stuck in decision paralysis and frozen in indecision. You wanna move forward, but the fear of making the wrong choice keeps you frozen in place. When choices feel complex, emotionally loaded, or consequential, people often cope by delaying, avoiding, or walking away from decisions altogether. This response isn't limited just to big life shaping decisions. It shows up just as much in everyday decisions, like what to order at a restaurant, what product to buy, or whether to move forward at all. Decision paralysis is widespread. It's familiar, and it's just deeply human.

A core insight from decision research is that when decisions, whether big or small, feel difficult, people often respond by opting out of choosing altogether.

Christine Ko: Yes, I read about your work in the Princeton Alumni Weekly, and I was fascinated because in daily life, I [00:03:00] have decision making paralysis or just decision making fatigue. In my family, my husband, me, and my daughter, we tend to be more paralyzed by decision making. But my son, who's actually the youngest of the three of us is not, ever, so we'll be like, Oh, well, you make the decision, like dinner on the weekend. He'll always have an opinion. 

Mary Steffel: I love that. That actually foreshadows what I hope to get into as a potential solution to overcoming decision paralysis. Utilizing people in your social network to help you navigate these decisions and to even delegate those decisions altogether.

Doing nothing is still a decision, and it's often a costly one. When choices are hard, especially when there are many options or real trade-offs, people tell themselves, Well, I'll just wait, or I'll come back to this later. But waiting isn't neutral. Opportunities expire, defaults take over. Stress accumulates, and the decision rarely gets easier with time.

When I was a fellow for the White House, I worked with the Centers for Medicare and Medicaid Services to help people [00:04:00] navigate choices about their prescription drug plans. Every year, CMS sends notices to over a million people with Medicare drug plans. The notice informs 'em that their premiums are going up and that they can qualify for alternative plans, sometimes with a $0 premium. Obviously that would save them some money, and people can switch plans if they want to avoid paying more, but switching requires comparing options, understanding coverage differences, and making a new commitment. So despite the potential changes, only a fraction of recipients actually ever switch. And in many states, people are grappling with as many as 10 different plans to choose from, each with different networks, drug coverages, and special rules. So it's easy to see why this decision is just so overwhelming to people and why so many people just avoid dealing with it all together. The cost here doesn't come from necessarily choosing the wrong plan, it comes from choosing nothing at all. We get stuck with that default and end up paying more even when other better options [00:05:00] are available. Not making the decision at all can have real financial, practical, and personal consequences. 

Christine Ko: That's a great point. Everyone would benefit from realizing that when we don't make a decision, we are still making a decision of not making that decision. So when something gets so complicated that it can be completely overwhelming, is delegating to someone else, or asking for help, the main thing to do?

Mary Steffel: One of the common misconceptions about decision making is that it happens entirely inside of our heads. It's a solitary, rational exercise. We weigh the options and act independently. In reality decisions happen in a social context. We can seek support and advice from people around us. We can even delegate those decisions to 'em entirely. Delegating decisions can be a really practical way to manage complexity, share responsibility, and reduce the overall emotional burden of difficult choices. It helps people move forward. In the example that we just discussed with choosing healthcare plans, we actually [00:06:00] simplify that and encourage 'em to call one number, 1-800-MEDICARE, for guidance on how to make a decision about which healthcare plan was best for them. In promoting that solution, we were really trying to help people realize you don't have to navigate this on your own. There's one simple step you can take to get someone to help you navigate or even delegate this decision to someone else. So that's the more serious example.

Coming back to Cinderella, when she was faced with this daunting choice of whether she wanted to be with the prince or go back home where things were safe, she couldn't figure out what she wanted to do. She kept waffling back and forth and ended up stuck. And so ultimately what she ended up doing is leaving a shoe for the prince to find and leaving it up to him, putting the ball in his court to ultimately make the decision: is he gonna come pursue her or not. Delegation became her key to overcoming her decision paralysis and moving forward.

More scientifically, I am a decision scientist [00:07:00] by training. I conducted a series of research studies where we looked at how people react to difficult decisions and whether giving people the opportunity to delegate those difficult decisions to someone might make people more likely to walk away with something rather than nothing from a difficult decision. We presented people with a choice between a small handful or a large array of loose leaf gourmet teas to choose between. And what we found is that in our control conditions where people had to make this decision on their own of which one to choose, they actually were much less likely to choose at all when they had many options to choose from than few. Research over time has shown about choice overload that the more options that you have available to you, oftentimes the less likely you are to choose anything 'cause it just gets overwhelming. But we found that in another set of conditions, if we simply had a salesperson say, Hey, I'm happy to help you make a decision. If you [00:08:00] tell me which options you're considering, I'm happy to recommend a tea on your behalf. We found that people are actually almost twice as likely to choose something when people were explicitly offered the opportunity to delegate the decision. In this situation, people were much more likely to walk away with something rather than nothing, when there were many options; in part because these people then opted to delegate the decision to the salesperson.

To me, this is powerful evidence that giving people the opportunity to have access to someone who can help them navigate a difficult choice can be a really powerful way to make sure that they don't leave the table empty handed. 

Christine Ko: In that study, when they have so many choices and they can't make a decision, but you offer someone like a sales person who can help, did the participants then choose a couple out of the many and then delegate to the salesperson, or did they sometimes just delegate the whole thing [00:09:00] to the salesperson? 

Mary Steffel: They had the opportunity to do either if they wished. Most of the time, the most common response was for people to choose two or three options that they were considering and share those. 

Christine Ko: The reason I asked that is because the article that I read about you in the Princeton Alumni Weekly, you said, in medical context or really for any complex decision, people are more likely to delegate the decision making. So I wanted to talk to you specifically about that because in my role as a physician, a lot of times I'm talking to the patient about different decisions, you know, different options that they might have, whether it's an option to get this treatment or that treatment or surgery or not, et cetera. And it can be complex. And so I was trying to figure out if it's better, if they seem overwhelmed, for me to narrow it down. How best to present that to the patient as a doctor? 

Mary Steffel: One key [00:10:00] strategy that I think is so important in medical context is to think about how to make the decision feel easier to process. Medical decisions in particular can be especially difficult for people who don't have medical background because they're often complex. They often have really important consequences associated with them, and they often involve a lot of specific knowledge and jargon that they may not be familiar with. And, in many encounters, a doctor or nurse or other healthcare professional might not always have the luxury of all of the time and thought in the world to be able to break that down, in simple terms. And so what I want to highlight to the medical community is how important it is actually to think carefully about how to present these choices to people clearly, breaking them into manageable steps, avoiding medical jargon, using [00:11:00] conversational terminology that is gonna be accessible to anyone. Describing something using more complex terminology versus simpler terminology can actually make the difference between whether somebody participates in the decision at all or not. So I think remembering to make choices feel fluent and understandable is really, really important. There's a lot of different ways of doing that. One is just being mindful of your language, your handwriting when instructions are being written out. It can also carry over into bigger things like decision aids and other kinds of more structured guides that can be provided to patients to help them navigate these decisions and sort through their options. You also highlighted honing in on a few options.

It's tricky, right? With federal government, they didn't ne necessarily want to only present people a subset of options that were available to them or show favoritism to one plan over another. And so they were hesitant to necessarily [00:12:00] recommend a particular option to somebody. But I think as a healthcare provider, it can certainly be an option to help narrow the field by presenting a recommended option alongside additional options that somebody might favor and help them understand the reasons why an option might be a better fit for them than others. What are the kinds of things that would make the option better for them than another? What are the risks and benefits associated with these different choices?

Christine Ko: That's great. When you broadly think about making a decision, whether it's small, like what to have for dinner or bigger, like what to do in a medical context for a serious medical problem, how do you recommend approaching that decision and avoiding decision paralysis? 

Mary Steffel: I really encourage people to recognize that you don't have to make every decision entirely on your own. When choices feel overwhelming, it can really help to recruit decision support, [00:13:00] whether that be from experts like your doctor, friends or family members, but even people that you don't know personally. Somebody who you know, might have experience with this particular condition or somebody who just might be less encumbered by all of the thoughts and anxieties that are plaguing you as you're trying to think about how to move forward. This can look really different depending on the context. Family and friends can offer input or advice when you're stuck. When you're out in the world, retailers and service providers, even the waiter, can help offer guidance on which options to consider or how to choose when things are confusing. And of course, especially in healthcare, support services can help people understand complex plans and complex decisions so that they can make informed choices. Providing or seeking out decision support doesn't mean that you're giving up control. It doesn't mean that you're being lazy. It's a way to move forward with more confidence, reduce stress, and make sure that you're walking away with something rather than nothing. [00:14:00] We can overcome decision paralysis and make better use of the choices available to us.

Christine Ko: Nice. Great. Do you have any ideas about what to do about decision fatigue? Towards the end of the day, you just get tired. You get tired of making the decision. Do you have any thoughts about that kind of thing? 

Mary Steffel: The first step is being self-aware enough to realize when you're feeling that decision fatigue, because it's not just you. There's actual scientific research showing that both in the medical profession, judges in judicial settings often will make different decisions at the end of the day when they're feeling fatigued than they do when they're fresh and bringing everything to the table to make those decisions. Recognizing when you're feeling fatigued, might be good to ask yourself a question, Can this decision be made tomorrow? Can I carve out [00:15:00] a designated time to revisit this decision when I am feeling fresh? Give yourself the opportunity to make that decision more fully without all of the biases that might enter in when you're feeling tired and otherwise maxed out. It's not procrastinating forever. Really coming up with a clear plan for when you are going to revisit this and make sure that that indeed happens. It can be a way to make sure that you don't fall into some of those patterns of making decisions that are not ideal because you are tired and might go with the easiest default response rather than necessarily the best informed response. 

Christine Ko: Yes. Just take time and create a plan for when to make the decision. 

Mary Steffel: Absolutely. 

Christine Ko: Well, thank you so much, Mary. It was such pleasure to talk to you. 

Mary Steffel: It was so lovely to talk to you as well. Thank you so much for letting me be a part of this.