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I & P Year 1 > Decision Making & Treatment Choices > Flashcards

Decision Making & Treatment Choices Flashcards

1
Q

How do people make decisions?

What is the decision making complex made up from?

A

People have little awareness of how they make decisions

Mental representations are made up from conscious and unconscious processes

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2
Q

How does the brain judge what information it should attend to?

A

The brain has limited capacity for conscious attention

It makes unconscious judgements about what to attend to

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3
Q

What focuses attention of the brain?

A

Attention is focused through external and internal cues

e.g. other people, experience, sensation, value

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4
Q

How do people choose what to pay attention to?

A

People have very little insight into what influences attention

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5
Q

What is significant about whether someone believes they have made a good choice?

A

How they think they made the decision bears no relation to how the decision was actually made

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6
Q

What are multi-attribute decisions?

What types of decision tend to be made this way?

A

There are many factors which influence the final decision

Many health decisions are made this way

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7
Q

How does whether the outcome of a decision is ‘good’ relate to how well the decision was made?

A

If the outcome of a decision is good, this does not mean the decision was made well

A decision may be made well, even if the outcome is not what was wanted

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8
Q

How are goals achieved?

A

To achieve goals, we make decisions and act

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9
Q

What is a decision?

A

It is a choice of action between options

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10
Q

Why is decision making a complex process?

A

It involves many attributes including:

  1. goals
  2. options
  3. attributes
  4. values
  5. risk
  6. outcome
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11
Q

What are the 2 possible decision outcomes?

A
  1. satisfactory (good/happy)

2. unsatisfactory (bad/regret)

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12
Q

What are the 3 different types of decision?

A
  1. certain
  2. uncertain
  3. risky
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13
Q

What is a certain decision?

A

There is no risk and a guarantee of an outcome

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14
Q

What is an uncertain decision?

A

There is a chance that you may or may not get the outcome

The risk is unknown

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15
Q

What is a risky decision?

A

There is a chance that you may or may not get the outcome

The risk is known

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16
Q

What is the Expected Utility Theory (EUT)?

What is it based on?

A

It links choice with values and the probability of each option happening

It is based on mathematic axioms/rules of logic

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17
Q

Why is the EUT described as a ‘normative theory’?

A

A normative theory describes how people SHOULD make decisions

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18
Q

What is meant by expectations and utility in the EUT?

A

Expectations are the risks

Utility describes the values

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19
Q

What equation is used to calculate the expected utility of an option?

A

EU = [ p(i) - u(i) ] / i

i = all the expected outcomes of an option

p(i) = probability of the ith outcome

u(i) = utility (non-money value) of the ith outcome

p(i) - u(i) = product of the probabilty x utility of the ith outcome

EU = expected utility

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20
Q

What is the maximum expected utility choice?

A

A choice based on evaluating the expected utility of all the options

You choose the option with the greatest/maximum value for EU

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21
Q

What is the equation for maximum expected utility?

A

MEU = EU of a - EU of b

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22
Q

What is significant about the MEU choice?

A

The MEU option is the ‘correct’ or ‘rational’ choice

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23
Q

Why are decision trees sometimes used in clinical circumstances?

A

For some people, visually seeing the decision helps them to make it

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24
Q

What is meant by a ‘lumped decision’?

A

Two factors which are closely linked

e.g. choose to have a diagnostic test for Down’s syndrome

THEN

choose whether to continue with the pregnancy or not

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25
Q

What is the problem with the Expected Utility Theory?

A

People do not always make decisions rationally

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26
Q

What assumptions are made for rational decision making?

A
  1. people are motivated to follow rules or axioms
  2. people have complete knowledge of all options
  3. people’s representations of options, risk and benefits are accurate
  4. people know what their values are
  5. people’s values are stable
27
Q

Realistically, how do people tend to make decisions?

A

Sometimes they think hard about a decision, but sometimes it is a gut reaction

Decisions are made in different ways and sometimes they don’t know why they made a choice

28
Q

What is meant by ‘Bounded Rationality’?

Simon, 1955

A

People do not have the processing capacity to calculate EUT

They use simpler, less effortful strategies

29
Q

What are the 3 less effortful strategies in bounded rationality?

A
  1. satisficing (Simon)
  2. elimination by aspects (Tversky)
  3. Heuristic (Chaiken)
30
Q

What is involved in the satisficing strategy?

A

Choosing a satisfactory criterion and the first matching option

e.g. need 5 rooms, choose 1st house with 5 rooms

31
Q

What is involved in the elimination by aspects strategy?

A

Choosing an attribute, and making ‘trade-offs’

e.g. comparing all houses with 5 rooms

32
Q

What is involved in the heuristic strategy?

A

using ‘rule of thumb’ and not option/attribute facts

e.g. friend’s advice

33
Q

What is ‘System 1’ as an information processing strategy?

A

This is an intuitive-experience strategy and it is fast

34
Q

What type of information is focused on when using System 1?

A

You attend to a small part of the decision problem

This depends on the context of the decision problem

35
Q

How is a choice made when using System 1?

What type of strategy is this?

A

The choice is made on a rule of thumb triggered by a ‘bit’ of information

This is heuristic

36
Q

How are decisions using System 1 informed?

A

They are informed by experience or beliefs

e.g. trusting someone who gave advice

37
Q

What kind of effort and emotion is involved in System 1?

A

It is sub-conscious and quick

It involves very little effort or emotion

38
Q

What is the usual outcome of a System 1 decision?

A

Satisfactory

You are more likely to regret or make the ‘wrong’ choice

39
Q

What is ‘System 2’ as an information processing strategy?

A

It is a deliberative-analytic strategy and is slow

40
Q

What type of information is attended to when using system 2?

A

All of the details of the decision problem are attended to

41
Q

What forms a major part of the decision making process in System 2?

A

Evaluating the pros and cons of all options

42
Q

How is the final decision made using System 2?

A

The choice is made based on trade-offs between evaluations of the risks and outcomes

43
Q

What is the usual outcome of a System 2 decision?

A

People are happier with the choice made and less likely to regret it

It results in more stable values

44
Q

What are the emotions involved in making a System 2 decision?

A

It is conscious, time-consuming and emotionally demanding

45
Q

How are biases in decision making presented?

A

The way in which facts are presented biases how a decision is made

46
Q

How does context lead to biases and affect decision making?

A

Context ‘leaks information; and provides cues-to-action

People pick up on cues, and this impacts decision representation and judgement

47
Q

What are the two ways in which cues can impact decision representation and judgement?

A
  1. framing (direct)
  2. perceptions of risk and values (indirect)

Judgements are always changing and are not stable

48
Q

If people are given the options to:

take part in a trial (opt-in)

opt out of a trial (opt-out)

the standard treatment of take part in the trial (choice)

How many people will choose the trial?

A

Opt-in: 45% opt to have trial

Opt-out: 61% opt to have trial

Choice: 38% opt to have trial

49
Q

Based on the trial example, what is this an example of?

What does it show?

A

It is a nudge

The way in which information is presented influences the way in which decisions are made

50
Q

How do people give meaning to risk?

What do perceptions of risk influence?

A

People are ‘hardwired’ to use context to give meaning to risk

Perceptions of risk influence choice, not actual figures

51
Q

If humans saw a fair coin being tossed:

H H H H H

What would they bet to be the next outcome?

A

H

Even though the probability of H or T is the same

Humans like to see patterns in things, so will think the outcome of H is more likely

52
Q

What is the anchoring hypothesis relating to risk?

A

Decisions are not influenced by the risk figure presented, it depends on the information surrounding it

53
Q

What is meant by ‘availability’ in decision making?

A

Perceptions may be influenced by media, which may not be accurate

e.g. people think tornedoes are more likely to kill than asthma, but this is not true

54
Q

How do people make informed/reasoned decisions?

What are the 3 steps?

A
  1. looking at the disadvantages and advantages of all options and consequences
  2. evaluating options with their own values
  3. trade-off their evaluations to make a choice and act on it
55
Q

What are patient decision aids and what are they used for?

A

They present information in a fair, balanced way to help patients make informed decisions well

e.g. leaflets, decision guidance

56
Q

What is the main reason why decision making goes wrong?

A

Information is missed in our search as we are over-confident after a limited search of information

57
Q

What other 2 reasons mean that decision making goes wrong?

A
  1. our judgements or inferences are biased

2. we think too much and find counter-evidence that does not add more to the decision representation

58
Q

What are the three types of errors in diagnosis, described by Graber et al?

A
  1. No fault
  2. System
  3. Cognitive
59
Q

What are examples of ‘no fault’ errors in diagnosis?

A
  1. silent disease/not known

2. poor quality data from the patient, e.g. did not talk about all the symptoms

60
Q

What are examples of ‘system’ errors in diagnosis?

A
  1. culture left too long
  2. patient missed an appointment
  3. delays in x-rays
  4. unsupervised junior doctor
61
Q

How can system errors be fixed?

A

By identifying weaknesses in the system and making sure it doesn’t happen again

62
Q

What are examples of ‘cognitive’ errors in diagnosis?

A
  1. misdiagnosis from poor data collection
  2. interpretation
  3. flawed reasoning
  4. incompetent knowledge

The doctor’s errors due to being human

63
Q

What are ways to minimise cognitive errors?

A
  1. asking questions and gathering evidence
  2. looking at pattern recognition
  3. decision making
  4. appraisal
  5. integration of prior clinical expertise
  6. judgement and evaluation
64
Q

What was the name of Croskerry’s model?

A

The Dual Process Model of Diagnostic Reasoning

I & P Year 1 (21 decks)

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