Cognitive biases in diagnosis and decision making during anaesthesia and intensive care

BJA Education ◽  
2021 ◽  
Vol 21 (11) ◽  
pp. 420-425
Author(s):  
C.S. Webster ◽  
S. Taylor ◽  
J.M. Weller
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
Cognitive Biases

scholarly journals Intensive care decision-making: Identifying the challenges and generating solutions to improve inter-specialty referrals to critical care

2018 ◽  
Vol 19 (4) ◽  
pp. 287-298 ◽  
Author(s):  
Nicola Power ◽  
Nicholas R Plummer ◽  
Jacqueline Baldwin ◽  
Fiona R James ◽  
Shondipon Laha
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Intensive Care ◽  
Clinical Decision Making ◽  
Cognitive Biases ◽  
Clinical Decision ◽  
The Past ◽  
Admission Decision ◽  
Interviewing Technique ◽  
Care Decision

Introduction Decision-making regarding admission to UK intensive care units is challenging. Demand for beds exceeds capacity, yet the need to provide emergency cover creates pressure to build redundancy into the system. Guidelines to aid clinical decision-making are outdated, resulting in an over-reliance on professional judgement. Although clinicians are highly skilled, there is variability in intensive care unit decision-making, especially at the inter-specialty level wherein cognitive biases contribute to disagreement. Method This research is the first to explore intensive care unit referral and admission decision-making using the Critical Decision Method interviewing technique. We interviewed intensive care unit ( n = 9) and non-intensive care unit ( n = 6) consultants about a challenging referral they had dealt with in the past where there was disagreement about the patient’s suitability for intensive care unit. Results We present: (i) a description of the referral pathway; (ii) challenges that appear to derail referrals (i.e. process issues, decision biases, inherent stressors, post-decision consequences) and (iii) potential solutions to improve this process. Discussion This research provides a foundation upon which interventions to improve inter-specialty decision-making can be based.

Confirmation bias in decision making for fingerprints, DNA and eyewitness evidence cannot be explained by cognitive style or thinking dispositions.

2019 ◽  
Author(s):  
Daniel Edgcumbe
Keyword(s):  
Decision Making ◽  
Cognitive Style ◽  
Cognitive Biases ◽  
Confirmation Bias ◽  
Criminal Case ◽  
Court Cases ◽  
Legal Proceedings ◽  
Thinking Dispositions ◽  
Evaluation Of Evidence ◽  
Facial Composite

Pre-existing beliefs about the background or guilt of a suspect can bias the subsequent evaluation of evidence for forensic examiners and lay people alike. This biasing effect, called the confirmation bias, has influenced legal proceedings in prominent court cases such as that of Brandon Mayfield. Today many forensic providers attempt to train their examiners against these cognitive biases. Nine hundred and forty-two participants read a fictional criminal case and received either neutral, incriminating or exonerating evidence (fingerprint, eyewitness, or DNA) before providing an initial rating of guilt. Participants then viewed ambiguous evidence (alibi, facial composite, handwriting sample or informant statement) before providing a final rating of guilt. Final guilt ratings were higher for all evidence conditions (neutral, incriminating or exonerating) following exposure to the ambiguous evidence. This provides evidence that the confirmation bias influences the evaluation of evidence.

scholarly journals Cognitive biases, environmental, patient and personal factors associated with critical care decision making: A scoping review

2021 ◽  
Author(s):  
Iris E. Beldhuis ◽  
Ramesh S. Marapin ◽  
You Yuan Jiang ◽  
Nádia F. Simões de Souza ◽  
Artemis Georgiou ◽  
...  
Keyword(s):  
Decision Making ◽  
Critical Care ◽  
Scoping Review ◽  
Cognitive Biases ◽  
Personal Factors ◽  
Factors Associated ◽  
Care Decision

scholarly journals UK consultants’ experiences of the decision-making process around referral to intensive care: an interview study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044752
Author(s):  
Kaja Heidenreich ◽  
Anne-Marie Slowther ◽  
Frances Griffiths ◽  
Anders Bremer ◽  
Mia Svantesson
Keyword(s):  
Decision Making ◽  
Intensive Care ◽  
Moral Responsibility ◽  
Critically Ill ◽  
Interpersonal Relationships ◽  
Qualitative Interviews ◽  
Working Environment ◽  
Critically Ill Patient ◽  
Decision Making Process ◽  
Moral Duties

ObjectiveThe decision whether to initiate intensive care for the critically ill patient involves ethical questions regarding what is good and right for the patient. It is not clear how referring doctors negotiate these issues in practice. The aim of this study was to describe and understand consultants’ experiences of the decision-making process around referral to intensive care.DesignQualitative interviews were analysed according to a phenomenological hermeneutical method.Setting and participantsConsultant doctors (n=27) from departments regularly referring patients to intensive care in six UK hospitals.ResultsIn the precarious and uncertain situation of critical illness, trust in the decision-making process is needed and can be enhanced through the way in which the process unfolds. When there are no obvious right or wrong answers as to what ought to be done, how the decision is made and how the process unfolds is morally important. Through acknowledging the burdensome doubts in the process, contributing to an emerging, joint understanding of the patient’s situation, and responding to mutual moral duties of the doctors involved, trust in the decision-making process can be enhanced and a shared moral responsibility between the stake holding doctors can be assumed.ConclusionThe findings highlight the importance of trust in the decision-making process and how the relationships between the stakeholding doctors are crucial to support their moral responsibility for the patient. Poor interpersonal relationships can damage trust and negatively impact decisions made on behalf of a critically ill patient. For this reason, active attempts must be made to foster good relationships between doctors. This is not only important to create a positive working environment, but a mechanism to improve patient outcomes.

scholarly journals Age, Frailty, Resuscitation and Intensive Care: With Reference to COVID-19

Geriatrics ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 36
Author(s):  
David G Smithard ◽  
Nadir Abdelhameed ◽  
Thwe Han ◽  
Angelo Pieris
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Cardiopulmonary Resuscitation ◽  
Distributive Justice ◽  
Older Age ◽  
Distribution Of Resources ◽  
Utilitarian Approach ◽  
The Individual

Discussion regarding cardiopulmonary resuscitation and admission to an intensive care unit is frequently fraught in the context of older age. It is complicated by the fact that the presence of multiple comorbidities and frailty adversely impact on prognosis. Cardiopulmonary resuscitation and mechanical ventilation are not appropriate for all. Who decides and how? This paper discusses the issues, biases, and potential harms involved in decision-making. The basis of decision making requires fairness in the distribution of resources/healthcare (distributive justice), yet much of the printed guidance has taken a utilitarian approach (getting the most from the resource provided). The challenge is to provide a balance between justice for the individual and population justice.

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