Exploring cognitive bias in destination therapy left ventricular assist device decision making: A retrospective qualitative framework analysis.
Exploring cognitive bias in destination therapy left ventricular assist device decision making: A retrospective qualitative framework analysis.
复制标题
探索目的地治疗左心室辅助装置决策中的认知偏差：回顾性定性框架分析。
DOI：
10.1016/j.ahj.2016.06.024
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发表时间：
2016
影响因子：
4.8
通讯作者：
Matlock,Dan
中科院分区：
文献类型：
--
作者：
Magid,Molly;McIlvennan,ColleenK;Jones,Jaqueline;Nowels,CarolynT;Allen,LarryA;Thompson,JocelynS;Matlock,Dan
认知偏见是一种心理影响，它导致人类做出看似没有最大化效用的决定。对于心力衰竭患者，左心室辅助装置（LVAD）是一种具有复杂权衡的外科植入式装置。因此，它代表了一个很好的模型，在其中探索现实世界决策中的认知偏见。我们进行了一项框架分析，以检查人们在决定是否获得LVAD时存在认知偏差的证据。目的探讨认知偏差对LVAD决策过程的影响。方法：我们使用演绎法，预先确定的认知偏差框架分析了先前接受或拒绝LVAD的患者访谈。我们使用归纳演绎框架方法对访谈进行编码和分析，这也允许其他主题出现。结果我们共采访了22例经过LVAD目的地治疗决策的心力衰竭患者（15例接受LVAD， 7例拒绝）。所有患者都受到状态依赖的影响，两组都描述了高电流状态的痛苦，但两组在是否相信LVAD会减轻痛苦方面存在差异。我们发现认知偏差的证据似乎影响了两组患者的决策，但两组患者在存在认知偏差方面有所不同。在接受者中，我们发现了锚定偏见、可得性偏见、乐观偏见和情感预测的证据。在衰退者中，我们发现了情感预测错误的证据。结论医疗决策是一个复杂的、多方面的过程，包括认知偏差和其他因素的影响。对于临床医生来说，认识到患者可能受到认知偏见的影响是很重要的，这样他们就可以更好地理解和改进决策过程，以确保患者得到充分的信息。
BackgroundCognitive biases are psychological influences, which cause humans to make decisions, which do not seemingly maximize utility. For people with heart failure, the left ventricular assist device (LVAD) is a surgically implantable device with complex tradeoffs. As such, it represents an excellent model within which to explore cognitive bias in a real-world decision. We conducted a framework analysis to examine for evidence of cognitive bias among people deciding whether or not to get an LVAD.ObjectivesThe aim of this study was to explore the influence of cognitive bias on the LVAD decision-making process.MethodsWe analyzed previously conducted interviews of patients who had either accepted or declined an LVAD using a deductive, predetermined framework of cognitive biases. We coded and analyzed the interviews using an inductive-deductive framework approach, which also allowed for other themes to emerge.ResultsWe interviewed a total of 22 heart failure patients who had gone through destination therapy LVAD decision making (15 who had accepted the LVAD and 7 who had declined). All patients appeared influenced by state dependence, where both groups described high current state of suffering, but the groups differed in whether they believed LVAD would relieve suffering or not. We found evidence of cognitive bias that appeared to influence decision making in both patient groups, but groups differed in terms of which cognitive biases were present. Among accepters, we found evidence of anchoring bias, availability bias, optimism bias, and affective forecasting. Among decliners, we found evidence of errors in affective forecasting.ConclusionsMedical decision making is often a complicated and multifaceted process that includes cognitive bias as well as other influences. It is important for clinicians to recognize that patients can be affected by cognitive bias, so they can better understand and improve the decision-making process to ensure that patients are fully informed.