Cognitive Biases and Diagnostic Errors
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The Status Quo Bias and Decisions to Withdraw Life-Sustaining Treatment
HUMANITIES | MEDICINE AND SOCIETY The status quo bias and decisions to withdraw life-sustaining treatment n Cite as: CMAJ 2018 March 5;190:E265-7. doi: 10.1503/cmaj.171005 t’s not uncommon for physicians and impasse. One factor that hasn’t been host of psychological phenomena that surrogate decision-makers to disagree studied yet is the role that cognitive cause people to make irrational deci- about life-sustaining treatment for biases might play in surrogate decision- sions, referred to as “cognitive biases.” Iincapacitated patients. Several studies making regarding withdrawal of life- One cognitive bias that is particularly show physicians perceive that nonbenefi- sustaining treatment. Understanding the worth exploring in the context of surrogate cial treatment is provided quite frequently role that these biases might play may decisions regarding life-sustaining treat- in their intensive care units. Palda and col- help improve communication between ment is the status quo bias. This bias, a leagues,1 for example, found that 87% of clinicians and surrogates when these con- decision-maker’s preference for the cur- physicians believed that futile treatment flicts arise. rent state of affairs,3 has been shown to had been provided in their ICU within the influence decision-making in a wide array previous year. (The authors in this study Status quo bias of contexts. For example, it has been cited equated “futile” with “nonbeneficial,” The classic model of human decision- as a mechanism to explain patient inertia defined as a treatment “that offers no rea- making is the rational choice or “rational (why patients have difficulty changing sonable hope of recovery or improvement, actor” model, the view that human beings their behaviour to improve their health), or because the patient is permanently will choose the option that has the best low organ-donation rates, low retirement- unable to experience any benefit.”) chance of satisfying their preferences. -
A Task-Based Taxonomy of Cognitive Biases for Information Visualization
A Task-based Taxonomy of Cognitive Biases for Information Visualization Evanthia Dimara, Steven Franconeri, Catherine Plaisant, Anastasia Bezerianos, and Pierre Dragicevic Three kinds of limitations The Computer The Display 2 Three kinds of limitations The Computer The Display The Human 3 Three kinds of limitations: humans • Human vision ️ has limitations • Human reasoning 易 has limitations The Human 4 ️Perceptual bias Magnitude estimation 5 ️Perceptual bias Magnitude estimation Color perception 6 易 Cognitive bias Behaviors when humans consistently behave irrationally Pohl’s criteria distilled: • Are predictable and consistent • People are unaware they’re doing them • Are not misunderstandings 7 Ambiguity effect, Anchoring or focalism, Anthropocentric thinking, Anthropomorphism or personification, Attentional bias, Attribute substitution, Automation bias, Availability heuristic, Availability cascade, Backfire effect, Bandwagon effect, Base rate fallacy or Base rate neglect, Belief bias, Ben Franklin effect, Berkson's paradox, Bias blind spot, Choice-supportive bias, Clustering illusion, Compassion fade, Confirmation bias, Congruence bias, Conjunction fallacy, Conservatism (belief revision), Continued influence effect, Contrast effect, Courtesy bias, Curse of knowledge, Declinism, Decoy effect, Default effect, Denomination effect, Disposition effect, Distinction bias, Dread aversion, Dunning–Kruger effect, Duration neglect, Empathy gap, End-of-history illusion, Endowment effect, Exaggerated expectation, Experimenter's or expectation bias, -
A Dissertation Entitled Exploring Common Antecedents of Three Related Decision Biases by Jonathan E. Westfall Submitted As Parti
A Dissertation Entitled Exploring Common Antecedents of Three Related Decision Biases by Jonathan E. Westfall Submitted as partial fulfillment of the requirements for the Doctor of Philosophy in Psychology __________________________ Advisor: Dr. J. D. Jasper __________________________ Dr. S. D. Christman __________________________ Dr. R. E. Heffner __________________________ Dr. K. L. London __________________________ Dr. M. E. Doherty __________________________ Graduate School The University of Toledo August 2009 Exploring Common Antecedents ii Copyright © 2009 – Jonathan E. Westfall This document is copyrighted material. Under copyright law, no parts of this document may be reproduced in any manner without the expressed written permission of the author. Exploring Common Antecedents iii An Abstract of Exploring Common Antecedents of Three Related Decision Biases Jonathan E. Westfall Submitted as partial fulfillment of the requirements for The Doctor of Philosophy in Psychology The University of Toledo August 2009 “Decision making inertia” is a term loosely used to describe the similar nature of a variety of decision making biases that predominantly favor a decision to maintain one course of action over switching to a new course. Three of these biases, the sunk cost effect, status-quo bias, and inaction inertia are discussed here. Combining earlier work on strength of handedness and the sunk cost effect along with new findings regarding counterfactual thought, this work principally seeks to determine if counterfactual thought may drive the three decision biases of note while also analyzing common relationships between the biases, strength of handedness, and the variables of regret and loss aversion. Over a series of experiments, it was found that handedness differences did exist in the three biases discussed, that amount and type of counterfactuals generated did not predict choice within the status-quo bias, and that the remaining variables potentially thought to drive the biases presented did not link causally to them. -
1. Service Evaluations and Qualitative Research
EAHP Academy Seminars 20 - 21 September 2019 Brussels #ACASEM2019 EAHP Academy Seminars 20-21 September 2019 Introduction to service evaluation and qualitative research Jonathan Underhill, NICE and Keele University, UK Ulrika Gillespie Uppsala University Hospital, Sweden Conflicts of interest • No conflicts of interest to declare Introduction • Understanding how humans make decisions and its impact on: – Communicating findings – Conducting research • Answering questions using qualitative and quantitative studies Introduction • Understanding how humans make decisions and its impact on: – Communicating findings – Conducting research • Answering questions using qualitative and quantitative studies What do we know about how people make decisions? • Behavioural economics and cognitive psychology: – Bounded rationality (Herbert Simon 1978) – Dual process theory (Daniel Kahneman 2002) – Most decisions are informed by brief reading and talking to other people - please find a piece of paper and a pen - a list of words follows look at them once, do not re-read them - when you have read the list close your eyes Flange Routemaster Laggard Sausages Automaton Approach Antichrist Research Slipper Haggle Fridge Locomotive Bracket Confused Telesales Professor Stool pigeon Hale Banquet Irrelevance Write down as many words as you can remember Flange How many words Routemaster A that you remembered Laggard are in each group? Sausages Automaton Approach B Antichrist Research Slipper Haggle C Fridge Locomotive Bracket Confused D Telesales Professor Stool pigeon Hale E Banquet Irrelevance Herbert Simon 1978 Economics Bounded rationality Satisfycing Please list all the medicines which have a potential interaction with warfarin – both increasing and decreasing its effect Drug interactions with warfarin – decreased effect • Amobarbital • Primidone Butabarbital Ribavirin Carbamazepine Rifabutin Cholestyramine Rifampin Dicloxacillin Secobarbital Griseofulvin Sucralfate Mercaptopurine Vitamin K Mesalamine Coenzyme Q10 Nafcillin Ginseng Phenobarbital St. -
Immersive High Fidelity Simulation of Critically Ill Patients to Study Cognitive Errors
Prakash et al. BMC Medical Education (2017) 17:36 DOI 10.1186/s12909-017-0871-x RESEARCHARTICLE Open Access Immersive high fidelity simulation of critically ill patients to study cognitive errors: a pilot study Shivesh Prakash1,2*, Shailesh Bihari2, Penelope Need3, Cyle Sprick4 and Lambert Schuwirth1,5 Abstract Background: The majority of human errors in healthcare originate from cognitive errors or biases. There is dearth of evidence around relative prevalence and significance of various cognitive errors amongst doctors in their first post-graduate year. This study was conducted with the objective of using high fidelity clinical simulation as a tool to study the relative occurrence of selected cognitive errors amongst doctors in their first post-graduate year. Methods: Intern simulation sessions on acute clinical problems, conducted in year 2014, were reviewed by two independent assessors with expertise in critical care. The occurrence of cognitive errors was identified using Likert scale based questionnaire and think-aloud technique. Teamwork and leadership skills were assessed using Ottawa Global Rating Scale. Results: The most prevalent cognitive errors included search satisfying (90%), followed by premature closure (PC) (78.6%), and anchoring (75.7%). The odds of occurrence of various cognitive errors did not change with time during internship, in contrast to teamwork and leadership skills (x2 = 11.9, P = 0.01). Anchoring appeared to be significantly associated with delay in diagnoses (P = 0.007) and occurrence of PC (P = 0.005). There was a negative association between occurrence of confirmation bias and the ability to make correct diagnosis (P = 0.05). Conclusions: Our study demonstrated a high prevalence of anchoring, premature closure, and search satisfying amongst doctors in their first post-graduate year, using high fidelity simulation as a tool. -
Communication Science to the Public
David M. Berube North Carolina State University ▪ HOW WE COMMUNICATE. In The Age of American Unreason, Jacoby posited that it trickled down from the top, fueled by faux-populist politicians striving to make themselves sound approachable rather than smart. (Jacoby, 2008). EX: The average length of a sound bite by a presidential candidate in 1968 was 42.3 seconds. Two decades later, it was 9.8 seconds. Today, it’s just a touch over seven seconds and well on its way to being supplanted by 140/280- character Twitter bursts. ▪ DATA FRAMING. ▪ When asked if they truly believe what scientists tell them, NEW ANTI- only 36 percent of respondents said yes. Just 12 percent expressed strong confidence in the press to accurately INTELLECTUALISM: report scientific findings. ▪ ROLE OF THE PUBLIC. A study by two Princeton University researchers, Martin TRENDS Gilens and Benjamin Page, released Fall 2014, tracked 1,800 U.S. policy changes between 1981 and 2002, and compared the outcome with the expressed preferences of median- income Americans, the affluent, business interests and powerful lobbies. They concluded that average citizens “have little or no independent influence” on policy in the U.S., while the rich and their hired mouthpieces routinely get their way. “The majority does not rule,” they wrote. ▪ Anti-intellectualism and suspicion (trends). ▪ Trump world – outsiders/insiders. ▪ Erasing/re-writing history – damnatio memoriae. ▪ False news. ▪ Infoxication (CC) and infobesity. ▪ Aggregators and managed reality. ▪ Affirmation and confirmation bias. ▪ Negotiating reality. ▪ New tribalism is mostly ideational not political. ▪ Unspoken – guns, birth control, sexual harassment, race… “The amount of technical information is doubling every two years. -
Understanding Outcome Bias ∗
Understanding Outcome Bias ∗ Andy Brownbacky Michael A. Kuhnz University of Arkansas University of Oregon January 31, 2019 Abstract Disentangling effort and luck is critical when judging performance. In a principal-agent experiment, we demonstrate that principals' judgments of agent effort are biased by luck, despite perfectly observing the agent's effort. This bias can erode the power of incentives to stimulate effort when there is noise in the outcome process. As such, we explore two potential solutions to this \outcome bias" { control over irrelevant information about luck, and outsourcing judgment to independent third parties. We find that both are ineffective. When principals have control over information about luck, they do not avoid the information that biases their judgment. In contrast, when agents have control over the principal's information about luck, agents strategically manipulate principals' outcome bias to minimize their punishments. We also find that independent third parties are just as biased as principals. These findings indicate that outcome bias may be more widespread and pernicious than previously understood. They also suggest that outcome bias cannot be driven solely by disappointment nor by distributional preferences. Instead, we hypothesize that luck directly affects beliefs about agents even though effort is perfectly observed. We elicit the beliefs of third parties and principals and find that lucky agents are believed to exert more effort in general than identical, unlucky agents. JEL Classification: C92, D63, D83 Keywords: Experiment, Reciprocity, Outcome Bias, Attribution Bias, Blame ∗We wish to thank Gary Charness, Ryan Oprea, Peter Kuhn, Joshua Miller, Justin Rao, and James Andreoni for valuable feedback. -
Moral Hindsight
Special Issue: Moral Agency Research Article Moral Hindsight Nadine Fleischhut,1 Björn Meder,2 and Gerd Gigerenzer2,3 1Center for Adaptive Rationality, Max Planck Institute for Human Development, Berlin, Germany 2Center for Adaptive Behavior and Cognition, Max Planck Institute for Human Development, Berlin, Germany 3Center for Adaptive Behavior and Cognition, Harding Center for Risk Literacy, Max Planck Institute for Human Development, Berlin, Germany Abstract: How are judgments in moral dilemmas affected by uncertainty, as opposed to certainty? We tested the predictions of a consequentialist and deontological account using a hindsight paradigm. The key result is a hindsight effect in moral judgment. Participants in foresight, for whom the occurrence of negative side effects was uncertain, judged actions to be morally more permissible than participants in hindsight, who knew that negative side effects occurred. Conversely, when hindsight participants knew that no negative side effects occurred, they judged actions to be more permissible than participants in foresight. The second finding was a classical hindsight effect in probability estimates and a systematic relation between moral judgments and probability estimates. Importantly, while the hindsight effect in probability estimates was always present, a corresponding hindsight effect in moral judgments was only observed among “consequentialist” participants who indicated a cost-benefit trade-off as most important for their moral evaluation. Keywords: moral judgment, hindsight effect, moral dilemma, uncertainty, consequentialism, deontological theories Despite ongoing efforts, hunger crises still regularly occur all deliberately in these dilemmas, where all consequences are over the world. From 2014 to 2016,about795 million people presented as certain (Gigerenzer, 2010). Moreover, using worldwide were undernourished, almost all of them in dilemmas with certainty can result in a mismatch with developing countries (FAO, IFAD, & WFP, 2015). -
Infographic I.10
The Digital Health Revolution: Leaving No One Behind The global AI in healthcare market is growing fast, with an expected increase from $4.9 billion in 2020 to $45.2 billion by 2026. There are new solutions introduced every day that address all areas: from clinical care and diagnosis, to remote patient monitoring to EHR support, and beyond. But, AI is still relatively new to the industry, and it can be difficult to determine which solutions can actually make a difference in care delivery and business operations. 59 Jan 2021 % of Americans believe returning Jan-June 2019 to pre-coronavirus life poses a risk to health and well being. 11 41 % % ...expect it will take at least 6 The pandemic has greatly increased the 65 months before things get number of US adults reporting depression % back to normal (updated April and/or anxiety.5 2021).4 Up to of consumers now interested in telehealth going forward. $250B 76 57% of providers view telehealth more of current US healthcare spend % favorably than they did before COVID-19.7 could potentially be virtualized.6 The dramatic increase in of Medicare primary care visits the conducted through 90% $3.5T telehealth has shown longevity, with rates in annual U.S. health expenditures are for people with chronic and mental health conditions. since April 2020 0.1 43.5 leveling off % % Most of these can be prevented by simple around 30%.8 lifestyle changes and regular health screenings9 Feb. 2020 Apr. 2020 OCCAM’S RAZOR • CONJUNCTION FALLACY • DELMORE EFFECT • LAW OF TRIVIALITY • COGNITIVE FLUENCY • BELIEF BIAS • INFORMATION BIAS Digital health ecosystems are transforming• AMBIGUITY BIAS • STATUS medicineQUO BIAS • SOCIAL COMPARISONfrom BIASa rea• DECOYctive EFFECT • REACTANCEdiscipline, • REVERSE PSYCHOLOGY • SYSTEM JUSTIFICATION • BACKFIRE EFFECT • ENDOWMENT EFFECT • PROCESSING DIFFICULTY EFFECT • PSEUDOCERTAINTY EFFECT • DISPOSITION becoming precise, preventive,EFFECT • ZERO-RISK personalized, BIAS • UNIT BIAS • IKEA EFFECT and • LOSS AVERSION participatory. -
Hindsight Bias and Outcome Bias in Judging Directors' Liability and The
Received: 7 June 2020 | Revised: 12 September 2020 | Accepted: 18 October 2020 DOI: 10.1111/jasp.12722 ORIGINAL ARTICLE Hindsight bias and outcome bias in judging directors’ liability and the role of free will beliefs Niek Strohmaier1 | Helen Pluut1 | Kees van den Bos2 | Jan Adriaanse1 | Reinout Vriesendorp3 1Department of Business Studies, Leiden University, Leiden, the Netherlands Abstract 2Department of Psychology and School Following a corporate disaster such as bankruptcy, people in general and dam- of Law, Utrecht University, Utrecht, the aged parties, in particular, want to know what happened and whether the com- Netherlands 3Department of Company Law and pany's directors are to blame. The accurate assessment of directors’ liability can Department of Business Studies, Leiden be jeopardized by having to judge in hindsight with full knowledge of the adverse University, Leiden, the Netherlands outcome. The present study investigates whether professional legal investiga- Correspondence tors such as judges and lawyers are affected by hindsight bias and outcome Niek Strohmaier, Department of Business Studies, Leiden University, Steenschuur 25, bias when evaluating directors’ conduct in a bankruptcy case. Additionally, to 2311 ES Leiden, the Netherlands. advance our understanding of the mechanisms underlying these biases, we also Email: [email protected] examine whether free will beliefs can predict susceptibility to hindsight bias and outcome bias in this context. In two studies (total N = 1,729), we demonstrate that legal professionals tend to judge a director's actions more negatively and perceive bankruptcy as more foreseeable in hindsight than in foresight and that these effects are significantly stronger for those who endorse the notion that humans have free will. -
The Comprehensive Assessment of Rational Thinking
EDUCATIONAL PSYCHOLOGIST, 51(1), 23–34, 2016 Copyright Ó Division 15, American Psychological Association ISSN: 0046-1520 print / 1532-6985 online DOI: 10.1080/00461520.2015.1125787 2013 THORNDIKE AWARD ADDRESS The Comprehensive Assessment of Rational Thinking Keith E. Stanovich Department of Applied Psychology and Human Development University of Toronto, Canada The Nobel Prize in Economics was awarded in 2002 for work on judgment and decision- making tasks that are the operational measures of rational thought in cognitive science. Because assessments of intelligence (and similar tests of cognitive ability) are taken to be the quintessence of good thinking, it might be thought that such measures would serve as proxies for the assessment of rational thought. It is important to understand why such an assumption would be misplaced. It is often not recognized that rationality and intelligence (as traditionally defined) are two different things conceptually and empirically. Distinguishing between rationality and intelligence helps explain how people can be, at the same time, intelligent and irrational. Thus, individual differences in the cognitive skills that underlie rational thinking must be studied in their own right because intelligence tests do not explicitly assess rational thinking. In this article, I describe how my research group has worked to develop the first prototype of a comprehensive test of rational thought (the Comprehensive Assessment of Rational Thinking). It was truly a remarkable honor to receive the E. L. Thorn- Cunningham, of the University of California, Berkeley. To dike Career Achievement Award for 2012. The list of previ- commemorate this award, Anne bought me a 1923 ous winners is truly awe inspiring and humbling. -
Thinking and Reasoning
Thinking and Reasoning Thinking and Reasoning ■ An introduction to the psychology of reason, judgment and decision making Ken Manktelow First published 2012 British Library Cataloguing in Publication by Psychology Press Data 27 Church Road, Hove, East Sussex BN3 2FA A catalogue record for this book is available from the British Library Simultaneously published in the USA and Canada Library of Congress Cataloging in Publication by Psychology Press Data 711 Third Avenue, New York, NY 10017 Manktelow, K. I., 1952– Thinking and reasoning : an introduction [www.psypress.com] to the psychology of reason, Psychology Press is an imprint of the Taylor & judgment and decision making / Ken Francis Group, an informa business Manktelow. p. cm. © 2012 Psychology Press Includes bibliographical references and Typeset in Century Old Style and Futura by index. Refi neCatch Ltd, Bungay, Suffolk 1. Reasoning (Psychology) Cover design by Andrew Ward 2. Thought and thinking. 3. Cognition. 4. Decision making. All rights reserved. No part of this book may I. Title. be reprinted or reproduced or utilised in any BF442.M354 2012 form or by any electronic, mechanical, or 153.4'2--dc23 other means, now known or hereafter invented, including photocopying and 2011031284 recording, or in any information storage or retrieval system, without permission in writing ISBN: 978-1-84169-740-6 (hbk) from the publishers. ISBN: 978-1-84169-741-3 (pbk) Trademark notice : Product or corporate ISBN: 978-0-203-11546-6 (ebk) names may be trademarks or registered trademarks, and are used