Exploring cognitive bias in destination therapy left ventricular assist device decision making: A retrospective qualitative framework analysis

Magid, Molly; McIlvennan, Colleen K.; Jones, Jacqueline; Nowels, Carolyn T.; Allen, Larry A.; Thompson, Jocelyn S.; Matlock, Daniel D.

doi:10.1016/j.ahj.2016.06.024

Cited by 8 publications

(8 citation statements)

References 24 publications

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“…9 It has been widely used to support development of patient decision aids in clinical situations where achieving a high-quality decision is challenging. [10][11][12][13][14]…”

Section: Methodsmentioning

confidence: 99%

Evaluating the Quality of Patient Decision-Making Regarding Post-Acute Care

et al. 2018

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“…9 It has been widely used to support development of patient decision aids in clinical situations where achieving a high-quality decision is challenging. [10][11][12][13][14]…”

Section: Methodsmentioning

confidence: 99%

Evaluating the Quality of Patient Decision-Making Regarding Post-Acute Care

et al. 2018

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“…Given the focused nature of our research question, we undertook a directed content analysis to identify instances of cognitive bias related to clinicians' HPV vaccine recommendations in the dataset (Hsieh & Shannon, 2005). This analytic approach was informed by prior qualitative studies that have explored cognitive bias as a potential influence on other aspects of medical decision making (Magid et al, 2016;Matlock et al, 2017). First, we developed a coding guide, based on cognitive biases that were previously reported in the scientific literature related to vaccination, that we hypothesized might be also be relevant to HPV vaccination.…”

Section: Discussionmentioning

confidence: 99%

Cognitive Bias in Clinicians’ Communication about Human Papillomavirus Vaccination

Hansen

North

Niccolai³

2019

Health Communication

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National guidelines recommend human papillomavirus (HPV) vaccination for all 11-12-year-olds, but uptake among United States adolescents remains low. A major barrier to greater uptake is the lack of effective recommendations for HPV vaccine from clinicians. One potential influence on clinicians' recommendations for HPV vaccine that has been relatively unexplored is that of cognitive biases, or errors in judgement that result from 'mental shortcuts' used to make decisions under uncertainty. Therefore, we analyzed qualitative data from interviews with 32 pediatric clinicians using a framework of nine cognitive biases relevant to HPV vaccination: omission bias, ambiguity aversion, present bias, availability bias, optimism bias, naturalness bias, protected values, anchoring bias, and confirmation bias. We used a directed content analysis approach to iteratively code and analyze all transcripts in the dataset. We found evidence for several cognitive biases that were related to weaker recommendations for HPV vaccine. Commonly identified biases included anchoring bias (perception that vaccination unnecessary due to age/pubertal status); present bias (perception of burdens related to discussing vaccination), and optimism bias (belief that patient at low risk for HPV acquisition). We found less frequent evidence for ambiguity aversion (perception of missing information regarding vaccination) and omission bias (deferring vaccination). Other biases were identified infrequently or not at all. Our findings suggest that several cognitive biases may be an influence on clinicians' communication about HPV vaccine. Raising awareness of cognitive biases related to making HPV vaccine recommendations could help to strengthen the recommendations that clinicians provide.

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“…We used a team-based approach to framework analysis, which has been used in other decision-making studies 14 , including those measuring cognitive bias. 20 A limitation in cognitive bias research is the lack of a standardized list or categorization of cognitive biases. We reviewed prior systematic 17,21 and narrative reviews 18,22 , as well as prior studies describing examples of cognitive biases playing a role in decision-making about therapy 20 to construct a list of possible cognitive biases to evaluate and narrow these a priori to potential biases relevant to the decision about postacute care based on our prior work (Table 2).…”

Section: Discussionmentioning

confidence: 99%

Cognitive Biases Influence Decision-Making Regarding Postacute Care in a Skilled Nursing Facility

et al. 2019

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BACKGROUND: Decisions about postacute care are increasingly important as the United States population ages, its use becomes increasingly common, and payment reforms target postacute care. However, little is known about how to improve these decisions. OBJECTIVE: To understand whether cognitive biases play an important role in patient and clinician decision-making regarding postacute care in skilled nursing facilities (SNFs) and identify the most impactful biases. DESIGN: Secondary analysis of 105 semistructured interviews with patients, caregivers, and clinicians. SETTING: Three hospitals and three SNFs in a single metropolitan area. PATIENTS: Adults over age 65 discharged to SNFs after hospitalization as well as patients, caregivers, and multidisciplinary frontline clinicians in both hospital and SNF settings. MEASUREMENTS: We identified potential cognitive biases from prior systematic and narrative reviews and conducted a team-based framework analysis of interview transcripts to identify potential biases. RESULTS: Authority bias/halo effect and framing bias were the most prevalent and seemed the most impactful, while default/status quo bias and anchoring bias were also present in decision-making about SNFs. CONCLUSIONS: Cognitive biases play an important role in decision-making about postacute care in SNFs. The combination of authority bias/halo effect and framing bias may synergistically increase the likelihood of patients accepting SNFs for postacute care. As postacute care undergoes a transformation spurred by payment reforms, it is increasingly important to ensure that patients understand their choices at hospital discharge and can make high-quality decisions consistent with their goals.

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Exploring cognitive bias in destination therapy left ventricular assist device decision making: A retrospective qualitative framework analysis

Cited by 8 publications

References 24 publications

Evaluating the Quality of Patient Decision-Making Regarding Post-Acute Care

Evaluating the Quality of Patient Decision-Making Regarding Post-Acute Care

Cognitive Bias in Clinicians’ Communication about Human Papillomavirus Vaccination

Cognitive Biases Influence Decision-Making Regarding Postacute Care in a Skilled Nursing Facility

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