Emotional Influences on Diagnostic Error in Emergency Medicine: An Experimental Approach to Understand Diagnostic Failure and Facilitate Improvement for Patients with and without Mental Illness

项目摘要 诊断错误在医学中普遍存在，通常是由于临床推理失败造成的。然而， 关于如何改善临床推理，甚至更少的是关于情感体验如何可能 导致诊断失败。知识上的这一重大差距对所有人口都很重要，但特别是 这对容易引起负面情绪的高度脆弱和被污名化的人群很重要。个人 患有精神疾病的人占美国人口的近20%，代表了这样一个群体。主 这项研究的目的是确定情绪因素可能导致错误的具体方式， 诊断在急诊医学（EM）的实践，并制定和测试认知干预， 减少这些错误。具体目标是：1）确定作为诊断障碍和促进因素的因素 在诊断过程中，从关键利益相关者（医生，护士和患者）中进行EM推理; 2）确定 情绪因素的影响（例如，愤怒）对评估患者的提供者之间的临床推理过程的影响 在紧急情况下有身体健康投诉，无论是否患有精神疾病;以及3） 评估认知干预的影响，这些干预可能会减轻情感诱发的错误并提高可靠性 诊断过程。为达致这些目的，我们会先与教育统筹局的成员进行质性访谈， 医生、护士和病人，告知接下来的实验研究。采用严谨、高度可靠、 和完善的方法，从社会心理学，EM医生和护士将参与高度- 控制实验，旨在检查实验操纵的因果关系的影响（a）情绪 经验和（B）认知干预。在这些实验中，参与者将评估和诊断患者 案例（以多媒体格式呈现），以确定这些操纵对供应商的 临床推理这种方法在理论和方法上都是创新的，因为它采用了最先进的 社会认知和情感科学的理论、研究和方法，以调查关键的知识差距 这还没有被系统地研究过。这项研究很重要，因为它将扩大 我们对情绪如何影响诊断推理的理解， 不良影响，提高诊断准确性。这些知识有可能提高患者的 安全不仅是对脆弱的、被污名化的人群，如精神疾病患者，而且对所有患者， 人口。

PROJECT SUMMARY Diagnostic errors are pervasive in medicine and often result from failures in clinical reasoning. Yet, little is known about how to improve clinical reasoning, and even less is known about how emotional experiences may contribute to diagnostic failure. This significant gap in knowledge is important for all populations, but is especially important for highly vulnerable and stigmatized populations who tend to evoke negative emotions. Individuals with mental illnesses comprise nearly 20% of the U.S. population and represent one such group. The primary objective of this research is to identify specific ways in which emotional factors may contribute to errors in diagnosis in the practice of emergency medicine (EM), and to develop and test cognitive interventions that may reduce these errors. Specific aims are to: 1) identify factors that serve as barriers to and facilitators of diagnostic reasoning in EM from key stakeholders (physicians, nurses, and patients) in the diagnostic process; 2) determine the impact of emotional factors (e.g., anger) on clinical reasoning processes among providers assessing patients with physical health complaints either with or without comorbid mental illnesses in emergency contexts; and 3) assess the influence of cognitive interventions that may mitigate affect-induced errors and improve the reliability of the diagnostic process. To achieve these objectives, qualitative interviews will first be conducted with EM physicians, nurses, and patients to inform the experimental studies that follow. Using rigorous, highly-reliable, and well-established methods from social psychology, EM physicians and nurses will participate in highly- controlled experiments designed to examine the causal influences of experimentally-manipulated (a) emotional experiences and (b) cognitive interventions. In these experiments, participants will assess and diagnose patient cases (presented in multimedia formats) to determine the causal effects of these manipulations on providers’ clinical reasoning. This approach is theoretically and methodologically innovative in that it employs cutting-edge theory, research, and methods from social cognitive and affective science to investigate a critical knowledge gap that has not yet been systematically investigated. The proposed research is significant because it will expand our understanding of how emotions influence diagnostic reasoning and investigate possible ways to reduce adverse influences and promote diagnostic accuracy. Such knowledge has the potential to enhance patient safety not only for vulnerable, stigmatized populations such as those with mental illness, but for all patient populations.