Does hunger influence how patients make decisions about their rehabilitation?

Research tells us that time of day influences decision-making patterns, including decisions in audiology clinics.

After getting into my seat on a flight returning from AudiologyNow in 2014, I decided to tackle the long list of articles I had earmarked for later reading.

One particular article1 interested me because it tackled an area of research I have long been interested in – Decision Making. Plus, it was edited by one of my intellectual heroes, Nobel laureate, Daniel Kahneman who pioneered research exploring the biases of human decision making.

This article, well, it…blew…my…mind.

In it, Danziger et al. investigated the decision-making patterns of judges over the course of a day. Judges preside over numerous prisoner requests each day – parole requests, prisoner transfers, etc. We would assume that these highly trained decision makers would make their decision based on the merits of each case. Fascinatingly, what the data showed was a very different story.

Decisions to grant prisoner requests were more likely to be denied just before meal breaks – i.e., a prisoner was more likely to be refused if their request was considered before the judge broke for a meal. And this effect was not small – the decisions swung between an approval rate of roughly 65% down to an approval rate of roughly 10% depending on time of day. The researchers suggested that these time of day effects contribute to the willingness to make a decision for an outcome that involves risk.

Ideally, we should live in a world where decisions are made through a careful consideration of arguments which are free of bias, but in this work, the possibility was raised that, even in highly trained professionals such as judges, other factors may be exerting powerful influences on how we arrive at our conclusions.

Are we really so susceptible to extraneous factors like the time of day when we make our decisions? It was shortly after take-off that I wondered whether a similar pattern may be taking place in audiology clinics, because for many, the decision to adopt a hearing aid can also represent a risk proposition (changes to one’s identity, financial cost, etc.).

How does the hearing healthcare world compare?

I shared my idea with colleagues at Connect Hearing Canada, and they partnered with me and Stefan Launer (Sonova’s SVP of Science & Technology; Singh & Launer, in press, Trends in Hearing) to explore this question in our clinics. We looked at data from 24,842 first-time patients of audiology clinics, and we wanted to know if time of day was associated with the decision to obtain a hearing aid. Indeed, a similar pattern was observed with our participating patients.

At times of the day just before breaks take place (i.e., mid-day and the end of the day), hearing aid adoption rates were 8% lower than at any other time of the day. Seemingly, the course of a day not only influences the decisions made by judges, but also the decisions made by patients about their hearing rehabilitation.

Naturally, there is still so much to learn about this phenomenon. What is behind this pattern?…Would meals restore risk-taking tolerance for patients?…Does time of day influence hearing aid adoption because hearing-care professionals behave differently when they know they’re about to go for lunch/home for the day?

At a minimum, the findings suggest that non-audiological factors may be influencing how hearing-impaired patients make treatment decisions. Moving forward, we suggest that clinicians consider discussion of these findings with patients so that we can eliminate bias when planning hearing care.

To learn more, I welcome you to read our recently published article in Trends of Hearing journal.


  1. Danziger, S., Levav, J., & Avnaim-Pesso, L. (2011). Extraneous factors in judicial decisions. Proceedings of the National Academy of Sciences, 108(17), 6889–6892.