Decision aids to assist patients and professionals in choosing the right treatment for kidney failure

Background

Kidney services vary in the way they involve people with kidney failure (PwKF) in treatment decisions as management needs change. We discuss how decision-science applications support proactively PwKF to make informed decisions between treatment options with kidney professionals.

Methods

A conceptual review of findings about decision making and use of decision aids in kidney services, synthesized with reference to: the Making Informed Decisions-Individually and Together (MIND-IT) multiple stakeholder decision makers framework; and the Medical Research Council-Complex Intervention Development and Evaluation research framework.

Results

This schema represents the different types of decision aids that support PwKF and professional reasoning as they manage kidney disease individually and together; adjustments at micro, meso and macro levels supports integration in practice.

Conclusion

Innovating services to meet clinical guidelines on enhancing shared decision making processes means enabling all stakeholders to use decision aids to meet their goals within kidney pathways at individual, service and organizational levels.

How you choose is as important as what you choose: Subjective quality of choice predicts well-being and academic performance

The paper proposes a new approach to measuring key parameters of choice as intentional activity. We developed and validated a 23-item questionnaire called the Subjective Quality of Choice (SQC) which measures four qualitative dimensions of choice: elaboration, emotional valence, autonomy, and satisfaction with the outcome. Three validation studies are presented. In the first study respondents from a large online sample evaluated the quality of important choices they made in life. Using structural equation modeling, we confirmed the structure of the SQC and investigated the associations of its scales with other measures. In the second study using a longitudinal design we replicated the structure of the SQC in a university choice context and investigated the criterion validity of its scales against well-being and academic outcome variables. In the third study we investigated the predictive validity of the SQC in a university applicant sample against an objective real-life outcome. The findings support the validity of the choice quality model.

The framing of decisions “leaks” into the experiencing of decisions

We connect Bermúdez's arguments to previous theorizing about “leaky” rationality, emphasizing that the decision process (including decision frames) “leaks” into the experience of decision outcomes. We suggest that the implications of Bermúdez's analysis are broadly applicable to the study of virtually all real-world decision making, and that the field needs a substantive and not just a formal theory of rationality.

Reconciling scientific and commonsense values to improve reasoning

Scientific reasoning is characterized by commitments to evidence and objectivity. New research suggests that under some conditions, people are prone to reject these commitments, and instead sanction motivated reasoning and bias. Moreover, people's tendency to devalue scientific reasoning likely explains the emergence and persistence of many biased beliefs. However, recent work in epistemology has identified ways in which bias might be legitimately incorporated into belief formation. Researchers can leverage these insights to evaluate when commonsense affirmation of bias is justified and when it is unjustified and therefore a good target for intervention. Making reasoning more scientific may require more than merely teaching people what constitutes scientific reasoning; it may require affirming the value of such reasoning in the first place.

The association between decision-making skills and subjective decision outcomes among administrative officers in the Swedish Social Insurance Agency

Social insurance administrative officers' decision-making skills influence their efficiency at work and their general well-being. At work their tasks are characterised by complexity and a need for order and accountability. Moreover, cases should usually be handled and finalised within the imposed time frames. We investigated skills related to decision-making success among social insurance officers. In total, 118 administrative officers at the Swedish Social Insurance Agency (66% response rate) responded to questions on scales and measures relating to cognitive-rational, socio-emotional and time approach features of decision-making skill. In addition, they responded to questions on three scales pertaining to outcomes of everyday decisions in terms of subjective everyday difficulties, tendencies to burnout and depressive symptoms. The results showed that cognitive-rational competence was associated with lower reports of subjective everyday difficulties and depressive symptoms and thereby contributed to the explained variance in decision outcomes. Furthermore, socio-emotional and time approach features of decision-making skills contributed to the explanation for subjective everyday difficulties, tendencies to burnout and depressive symptoms. The results corroborate the basic assumption and usefulness of a broad approach in the definition and assessment of decision-making skills in human service professions in general, and of administrative officers in social insurance agencies in particular. Recommendations for future research and the implications of the results are discussed.

Positive emotion induction improves cardiovascular coping with a cognitive task

Feeling positive emotions seems to favour an adaptive cardiovascular response (greater heart rate variability, HRV), associated with improved cognitive performance. This study aims to test whether the induction of a positive emotional state produce such cardiovascular response and therefore, enhance coping and performance in Tower of Hanoi (ToH). Forty-two Participants were randomly distributed into two groups (Experimental and Control). Experimental group was subjected to the evocation of a memory of success, while control group was subjected to an attentional task before performing ToH. Heart Rate Variability (HRV), activity of the zygomatic major muscle (ZEMG) and emotions were measured. Emotional induction increased ZEMG activity, feelings of emotional valence and HRV, but the performance in ToH was not different from control. Experiencing positive emotions seems to favour an adaptive psychophysiological response when faced with a complex cognitive task. These results are discussed in relation to clinical practice and health.

Resisting knowledge, realizing values, and reasoning in complex contexts: Ecological reflections

In this article I explore the social, pragmatic, ecological contexts within which reasoning occurs, and without which it cannot function properly. A diverse set of perspectives are used to guide this exploration: (a) pragmatic critiques of studies showing failures to reason logically, (b) theoretical claims that reasoning is fundamentally social and argumentative, (c) a values-realizing account of resistance and truthfulness in social reasoning dilemmas, and (d) arguments related to the nature of rationality and resistance to scientific claims. Implications emerging from the integration of these sources point to improved prospects for a more ecological, values-realizing approach to theory, method, and application with respect to reasoning.

At Least Bias Is Bipartisan: A Meta-Analytic Comparison of Partisan Bias in Liberals and Conservatives

Both liberals and conservatives accuse their political opponents of partisan bias, but is there empirical evidence that one side of the political aisle is indeed more biased than the other? To address this question, we meta-analyzed the results of 51 experimental studies, involving over 18,000 participants, that examined one form of partisan bias-the tendency to evaluate otherwise identical information more favorably when it supports one's political beliefs or allegiances than when it challenges those beliefs or allegiances. Two hypotheses based on previous literature were tested: an asymmetry hypothesis (predicting greater partisan bias in conservatives than in liberals) and a symmetry hypothesis (predicting equal levels of partisan bias in liberals and conservatives). Mean overall partisan bias was robust ( r = .245), and there was strong support for the symmetry hypothesis: Liberals ( r = .235) and conservatives ( r = .255) showed no difference in mean levels of bias across studies. Moderator analyses reveal this pattern to be consistent across a number of different methodological variations and political topics. Implications of the current findings for the ongoing ideological symmetry debate and the role of partisan bias in scientific discourse and political conflict are discussed.

Decision-Making Competence, Social Orientation, Time Style, and Perceived Stress

Peoples' decision-making competence, defined as tendency to follow normative rational principles in their decision making, is important as it may influence the extent that requirements are met and levels of perceived stress. In addition, perceived stress could be influenced by social orientation and time style; for example, decisions need to comply with given deadlines and the expectations of others. In two studies, with students (n = 118) and professionals (police investigators, n = 90), we examined how the three individual difference features: decision-making competence, social orientation, and time approach relate to perceived stress. Results showed that social orientation and time approach were related to levels of perceived stress, but decision-making competence was not. These results indicate that social orientation and time approach are important to consider in relation to perceived stress, but the role of decision-making competence may be less important for perceived stress. However, the role of decision-making competence for perceived stress needs to be further researched.

Intuitive Choices Lead to Intensified Positive Emotions: An Overlooked Reason for "Intuition Bias"?

People have, for many well-documented reasons, a tendency to overemphasize their intuitions and to follow them, even when they should not. This “intuition bias” leads to several kinds of specific intuitive biases in judgments and decision making. Previous studies have shown that characteristics of the decision process have a tendency to “leak” into the experience of the choice outcome. We explore whether intuitive choices influence the experience of the choice outcomes differently from “non-intuitive,” analytic choices. Since intuition is feeling based, we examine in particular if intuitive choices have stronger affective consequences than non-intuitive ones. Participants in two scenario studies (N = 90; N = 126) rated the feelings of decision makers who experienced a conflict between two options, one intuitively appealing and another that appeared preferable on analytic grounds. Choosing the intuitive alternative was anticipated to lead to somewhat more regret after negative outcomes and, in particular, much more satisfaction with positive outcomes. In two autobiographical studies, one with psychology students (N = 88) and the other with experienced engineers (N = 99), participants were asked to provide examples of choice conflicts between an intuitive and a non-intuitive option from their own private or professional lives. Both groups showed a tendency to report stronger emotions, in particular positive, after intuitive choices. One well-established explanation for intuition bias focuses on the nature of people’s anticipated negative counterfactual thoughts if their decisions were to turn out badly. The present data indicate that intuitive choices intensify positive emotions, anticipated and real, after successful outcomes much more than negative emotions after failures. Positive outcomes are also more commonly expected than negative ones, when we make choices. We argue that markedly amplified emotions, mediated by stronger personal involvement, in the positive outcomes of intuitive versus non-intuitive choices, is an overlooked reason for intuition bias.

Biases and Heuristics in Decision Making and Their Impact on Autonomy

Cognitive scientists have identified a wide range of biases and heuristics in human decision making over the past few decades. Only recently have bioethicists begun to think seriously about the implications of these findings for topics such as agency, autonomy, and consent. This article aims to provide an overview of biases and heuristics that have been identified and a framework in which to think comprehensively about the impact of them on the exercise of autonomous decision making. I analyze the impact that these biases and heuristics have on the following dimensions of autonomy: understanding, intentionality, absence of alienating or controlling influence, and match between formally autonomous preferences or decisions and actual choices or actions.

Competence and Quality in Real-Life Decision Making

What distinguishes a competent decision maker and how should the issue of decision quality be approached in a real-life context? These questions were explored in three studies. In Study 1, using a web-based questionnaire and targeting a community sample, we investigated the relationships between objective and subjective indicators of real-life decision-making success. In Study 2 and 3, targeting two different samples of professionals, we explored if the prevalent cognitively oriented definition of decision-making competence could be beneficially expanded by adding aspects of competence in terms of social skills and time-approach. The predictive power for each of these three aspects of decision-making competence was explored for different indicators of real-life decision-making success. Overall, our results suggest that research on decision-making competence would benefit by expanding the definition of competence, by including decision-related abilities in terms of social skills and time-approach. Finally, the results also indicate that individual differences in real-life decision-making success profitably can be approached and measured by different criteria.

Reappraising abstract paintings after exposure to background information

Can knowledge help viewers when they appreciate an artwork? Experts’ judgments of the aesthetic value of a painting often differ from the estimates of naïve viewers, and this phenomenon is especially pronounced in the aesthetic judgment of abstract paintings. We compared the changes in aesthetic judgments of naïve viewers while they were progressively exposed to five pieces of background information. The participants were asked to report their aesthetic judgments of a given painting after each piece of information was presented. We found that commentaries by the artist and a critic significantly increased the subjective aesthetic ratings. Does knowledge enable experts to attend to the visual features in a painting and to link it to the evaluative conventions, thus potentially causing different aesthetic judgments? To investigate whether a specific pattern of attention is essential for the knowledge-based appreciation, we tracked the eye movements of subjects while viewing a painting with a commentary by the artist and with a commentary by a critic. We observed that critics’ commentaries directed the viewers’ attention to the visual components that were highly relevant to the presented commentary. However, attention to specific features of a painting was not necessary for increasing the subjective aesthetic judgment when the artists’ commentary was presented. Our results suggest that at least two different cognitive mechanisms may be involved in knowledge- guided aesthetic judgments while viewers reappraise a painting.

Cognitive biases and heuristics in medical decision making: a critical review using a systematic search strategy

BACKGROUND

The role of cognitive biases and heuristics in medical decision making is of growing interest. The purpose of this study was to determine whether studies on cognitive biases and heuristics in medical decision making are based on actual or hypothetical decisions and are conducted with populations that are representative of those who typically make the medical decision; to categorize the types of cognitive biases and heuristics found and whether they are found in patients or in medical personnel; and to critically review the studies based on standard methodological quality criteria.

METHOD

Data sources were original, peer-reviewed, empirical studies on cognitive biases and heuristics in medical decision making found in Ovid Medline, PsycINFO, and the CINAHL databases published in 1980-2013. Predefined exclusion criteria were used to identify 213 studies. During data extraction, information was collected on type of bias or heuristic studied, respondent population, decision type, study type (actual or hypothetical), study method, and study conclusion.

RESULTS

Of the 213 studies analyzed, 164 (77%) were based on hypothetical vignettes, and 175 (82%) were conducted with representative populations. Nineteen types of cognitive biases and heuristics were found. Only 34% of studies (n = 73) investigated medical personnel, and 68% (n = 145) confirmed the presence of a bias or heuristic. Each methodological quality criterion was satisfied by more than 50% of the studies, except for sample size and validated instruments/questions. Limitations are that existing terms were used to inform search terms, and study inclusion criteria focused strictly on decision making.

CONCLUSIONS

Most of the studies on biases and heuristics in medical decision making are based on hypothetical vignettes, raising concerns about applicability of these findings to actual decision making. Biases and heuristics have been underinvestigated in medical personnel compared with patients.

A peace treaty for the rationality wars? External validity and its relation to normative and descriptive theories of rationality

If we know that certain ways of making decisions are associated with real-life success, is this then how we should decide? In this paper the relationship between normative and descriptive theories of decision-making is examined. First, it is shown that the history of the decision sciences ensures that it is impossible to separate descriptive theories from normative ones. Second, recent psychological research implies new ways of arguing from the descriptive to the normative. The paper ends with an evaluation of how this might affect normative theories of decision-making.

Assessment of the sunk-cost effect in clinical decision-making

Despite the current push toward the practice of evidence-based medicine and comparative effectiveness research, clinicians' decisions may be influenced not only by evidence, but also by cognitive biases. A cognitive bias describes a tendency to make systematic errors in certain circumstances based on cognitive factors rather than evidence. Though health care providers have been shown in several studies to be susceptible to a variety of types of cognitive biases, research on the role of the sunk-cost bias in clinical decision-making is extremely limited. The sunk-cost bias is the tendency to pursue a course of action, even after it has proved to be suboptimal, because resources have been invested in that course of action. This study explores whether health care providers' medical treatment recommendations are affected by prior investments in a course of treatment. Specifically, we surveyed 389 health care providers in a large urban medical center in the United States during August 2009. We asked participants to make a treatment recommendation based on one of four hypothetical clinical scenarios that varied in the source and type of prior investment described. By comparing recommendations across scenarios, we found that providers did not demonstrate a sunk-cost effect; rather, they demonstrated a significant tendency to over-compensate for the effect. In addition, we found that more than one in ten health care providers recommended continuation of an ineffective treatment.

If only I had taken my usual route…: age-related differences in counter-factual thinking

Previous research suggests that young adults can shift between rational and experiential modes of thinking when forming social judgments. The present study examines whether older adults demonstrate this flexibility in thinking. Young and older adults completed an If-only task adapted from Epstein, Lipson, and Huh's (1992 , Journal of Personality and Social Psychology, 62, 328) examination of individuals' ability to adopt rational or experiential modes of thought while making a judgment about characters who experience a negative event that could have been avoided. Consistent with our expectations for their judgments of the characters, young adults shifted between experiential and rational modes of thought when instructed to do so. Conversely, regardless of the mode of thought being used or the order with which they adopted the different modes of thought (i.e., shifting from experiential to rational in Study 1 and from rational to experiential in Study 2), older adults consistently offered judgments and justifications that reflected a preference for experiential-based thought.

The Limits of Cost-Benefit Calculation: Commentary on Bennis, Medin, & Bartels (2010)

Bennis, Medin, and Bartels (2010, this issue) correctly identify real limits to the efficacy of cost-benefit analysis in comparison to moral rules. In this commentary, I suggest that those very same limits apply to decision making in general. Cost-benefit analysis may be the best way to arrive at decisions under a set of "closed-world assumptions" like those described by Bennis et al. But those assumptions virtually never hold, and in the absence of those assumptions, cost-benefit analysis often substitutes counting for thinking.

A short form of the Maximization Scale: Factor structure, reliability and validity studies

We conducted an analysis of the 13-item Maximization Scale (Schwartz et al., 2002) with the goal of establishing its factor structure, reliability and validity. We also investigated the psychometric properties of several proposed refined versions of the scale. Four sets of analyses are reported. The first analysis confirms the 3-part factor structure of the scale and assesses its reliability. The second analysis identifies those items that do not perform well on the basis of internal, external, and judgmental criteria, and develops three shorter versions of the scale. In the third analysis, the three refined versions of the scale are cross-validated to confirm dimensionality, reliability, and validity. The fourth analysis uses an experiment in an investment decision making context to assess the reliability and nomological validity of the refined scales. These analyses lead us to conclude that a shorter, 6-item Maximization Scale performs best and should be used by future researchers. It is hoped that clarification of the conceptual underpinnings of the maximization construct and development of a refined scale will enhance its use among researchers across several of the social science disciplines.