IDENTIFY & REDUCE COGNITIVE BIASES OF DECISION AIDS

为了认识到患者价值在医疗决策中的重要性，研究人员已经开始开发决策辅助工具，告知患者与可用的治疗方案相关的各种伤害和好处的可能性。决策辅助工具在帮助患者做出明智的决定方面具有巨大的潜力。但它们也可能对患者的决定产生偏见。我们的总体目标是确定当患者使用决策辅助工具时可能发生的认知偏差，并测试减少这些偏差的方法。我们已经确定了四种与决策辅助设计特别相关的认知偏差：框架效应：人们的治疗选择取决于治疗益处是以存活率还是死亡率为框架的。患者证言的不当影响：患者关于一种治疗的可取性或不可取性的证言影响治疗选择，独立于有关治疗有效性的统计信息。增加第三个治疗选项后的偏好反转：在增加第三个治疗选项后，更喜欢治疗选项A而不是B的人可能更喜欢B。结果信息的不当影响：增加有关治疗结果的信息可能会不适当地影响患者的选择。我们将利用面向公众的书面和计算机化调查来开发决策辅助材料，其中三分之一的样本具有与癌症相关的经验。我们的目标不是在面临困难临床情况的患者身上测试决策辅助工具，而是开发可以产生此类决策辅助工具的方法-创建决策辅助工具的一般原则，将增加患者对其治疗选择的理解，而不会引入认知偏差。

In recognition of the importance of patient values in medical decisions, researchers have begun developing decision aids that inform patients about the probability of various harms and benefits associated with available treatment alternatives. Decision aids have great potential to help patients make informed decisions. But they could also bias patients' decisions. Our overall objective is to identify cognitive biases that are likely to occur when patients use decision aids and test ways to reduce these biases. We have identified four cognitive biases that are especially relevant to the design of decision aids: Framing effects: People's treatment choices depend on whether treatment benefits are framed in terms of survival or mortality. Undue influence of patient testimonials: Patient testimonials regarding the desirability or undesirability of a treatment influence treatment choices independent of statistical information about treatment effectiveness. Preference reversal after addition of a third treatment option: A person who prefers treatment option A over B may prefer B after the addition of a third option. Undue influence of outcome information: The addition of information about treatment outcomes may unduly influence patients' choices. We will develop decision aid materials using written and computerized surveys administered to the general public, with one-third of the sample having cancer-related experience. Our goal is not to test decision aids on patients facing difficult clinical situations but, instead, to develop methods by which such decision aids can be produced - general principles for the creation of decision aids that will increase patients' understanding of their treatment choices without introducing cognitive bias.