19 - Decision Making and Treatment Choices Flashcards
How do people make decisions?
Limited capacity for conscious attention, makes unconscious judgements about what to attend to
Only the info processed will form the person’s representation of the world out there
Decision making = complex process, put together a lot of components – goals, options, attributes, values, risks, outcome
What is attention focused by?
Cues - external and internal (experience, value, sensation, other people).
What is a decision?
Decision = choice of action between option
What can decision outcomes be?
- Satisfactory (good/happy)
- Unsatisfactory (bad/regret)
What are the different types of decisions?
- Certain - get an outcome (riskless)
- Uncertain - chance get/not get the outcome (risk unknown)
- Risky - chance get/not get the outcome (risk known)
What is the classical decision theory?
Subjective expected utility theory (sEUT)
What is the purpose of sEUT?
Normative theory - how people should make decisions
- Links choice with values, probability of each option.
- Based on mathematical axioms/ rules of logic
Who came up with sEUT?
von Neumann and Morgenstern
How is a rational decision made?
- Choice based on evaluating all options’ expected utility (EU)
- You choose the option with greatest or max value
MEU = EUa - EUb
The MEU option is the ‘correct’, ‘accurate’ or ‘rational’ choice.
What are the outcomes for not testing for Down Syndrome?
- Miscarriage
- Baby with DS
- Baby without DS
(Usual care)
What are the outcomes for testing for Down Syndrome?
- Miscarriage
- Baby with DS
- Baby without DS
(Choice-termination)
What are the assumptions for rational decision making?
- People are motivated to follow rules or axioms.
- People have complete knowledge of all options.
- People’s representations of options, risk and benefits are accurate.
- People’s know what their values are.
- People’s values are stable.
What conclusion did Simon draw about rational decision making?
‘Satisficing’
People don’t have processing capacity to calculate EUT.
People use simpler, less effortful strategies: choose ‘satisfactory’ criterion, and first matching option, e.g. need 5 rooms, choose 1st house with 5 rooms.
What is ‘elimination by aspects’ and who came up with it?
Tversky
Choose an attribute and make trade-offs between options, e.g. compare all houses with 5 rooms.
What is ‘heuristic’ and who came up with it?
Chaiken
Use a rule of thumb, not option information, e.g. friend said X, I’ve done it before.
What are the information processing strategies?
System 1 and System 2
What is the system 1 information processing strategy?
Intuitive-experience strategy, fast
- Attend to part of the decision problem or decision context (e.g. who gave the information).
- Choice made on a rule of thumb triggered by ‘bit’ of information (heuristic) (e.g. trust the person).
- Informed by experience or beliefs (e.g. trust ‘mum’).
How is system 1 decision made?
Sub-conscious, quick, little effort or emotion.
What is the likely outcome of a system 1 decision?
Satisfactory: more likely to regret or make ‘wrong’ choice
What is the system 2 information processing strategy?
Deliberative-analytic strategy, slow:
- Attend to the details of the decision problem.
- Evaluate the pros and cons of all options.
- Make choice based on trade-offs between evaluations
How is system 2 decision made?
Conscious, time-consuming, emotionally demanding.
What is likely outcome of a system 2 decision?
Results in more stable values (changes cognition).
Happier with choice made, less likely to regret choice.
What can affect decision making?
- Presentation of information biases how we make choices.
- The context ‘leaks information’, cues.
- People pick up on cues and it affects their decision representation, and judgment
How does patient, not professional, story influence choice?
- Reasoning story (how they made decision) –> no effect
- Choice story –> increases uptake treatment described
- Reasoning + Choice story –> augments increasing effect
Can end up biasing decision
What is the Gambler’s fallacy?
The erroneous belief that if a particular event occurs more frequently than normal during the past it is less likely to happen in the future (or vice versa)
What is the Availability Heuristic/Bias?
A mental shortcut that relies on immediate examples that come to a given person’s mind when evaluating a specific topic, concept, method or decision.
What is anchoring and adjustment?
A person starts off with an initial idea and adjusts their beliefs based off of this starting point. Anchoring and adjustment has been shown to produce erroneous results when the initial anchor deviates from the true value.
How is decision making influenced by availability?
- Perceptions influenced by media reports.
- Media reports influenced by what sells papers.
E.g. Tornado is more likely to kill than asthma (not true)
What are decision aids?
Help support people making decisions fairly
- Patient decision aids – reasoned/informed decisions
- Clinical decision aids – accurate choices
- Shared decision aids – more effective communication process between patients and professionals
Help people make better health decisions
How can decision making go wrong?
- We miss information in our search and/or are over-confident after a limited search of information
- Our judgments or inferences are biased
- We think too much and find counter-evidence that does not add more to the decision representation.
What is ‘Doctor Error’? Who came up with it?
Graber et al
Notes three types of errors in diagnosis
What are the 3 types of error noted in diagnosis in ‘Doctor Error’?
- No fault: silent disease, mimics, not known, poor quality data from the patient, etc.
- System: culture left too long, missed appointment, unsupervised junior, delays in x-rays, etc.
- Cognitive: misdiagnosis from poor data collection, interpretation, flawed reasoning, incomplete knowledge – BEING A HUMAN
What was Croskerry’s Dual Model of Diagnostic Reasoning?
Combination of system 1 and 2
What is benefit of open mindedness in decision making?
o Search for more options, don’t be overconfident of one option
o Look for counter-evidence (pros and cons of each option)
o Balance effort of information searching with appeal of cognitive miser/ thriftiness
What does EUT provide?
Provides ideal of how we make decisions under risk.
