From: Cognitive biases associated with medical decisions: a systematic review
Author | Type of participants | Number of vignettes or medical cases | Number of attributes | Based on Guidelines | Outcome measure | Type of outcomea | Type of analysis | Data qualityb | Main findings |
---|---|---|---|---|---|---|---|---|---|
Redelmeier | GPs and Neurologist | 4 | 10-11 | yes | Treatment recommendations | 4 | unadjusted | 5 | Multiple options decreased the likelihood of medication prescription for pain and carotid endarterectomy by 26Â % and 35Â %, respectively |
Ross | GPs | 3 | NA | No | Descriptive | 5 | adjusted | 6 | GPs were less likely to arrange a further consultation for female patients than for male patients (OR = 0.55). GPs with a pessimistic belief about depression were less likely to discuss non-physical symptoms or social factors; More experienced GPs were less likely to conduct a physical examination (OR = 0.60). |
Graber | GPs | 2 | 8-9 | No | Descriptive | 1 | adjusted | 4 | GPs were less likely to believe a serious medical condition among patients with history of depression or somatic symptoms |
Sorum | GPs | 32 | 5 | yes | Probability of ordering a test | 4 | adjusted | 4 | PSA were more likely ordered among GPs with discomfort for uncertainty and those who expressed regret. |
Baldwin | Pediatric ED physicians | 397 | NA | No | Admission rates | 4 | adjusted | 5 | Risk aversion scores higher for physicians with >15 years of experience. Admissions rates did not differ between high and low risk adverse physicians (31.1 vs 30.1; p = 0.91). Adjusted admission rates did not different between high and low discomfort with uncertainty (32.3 vs 29.7; p = 0.84) |
Friedmann | Medical students (72), residents (72), physicians (72) | 36 (9) | >20 | No | Diagnostic accuracy | 5 | adjusted | 4 | Overconfident found in 41Â % of residents and in 36Â % faculty. |
Reyna | GPs and specialists | 9 | NA | Yes | Diagnostic accuracy and management | 6 | adjusted | 5 | Physicians deviated from Guidelines in terms of discharge. GP were more risk averse and less likely to discharge patients. Experts achieved better case-risk discrimination by processing less information |
Bytzer | Specialists | 5 | NA | No | Diagnostic accuracy | 6 | unadjusted | 4 | Only 23Â % endoscopists gave the same diagnosis for the two identical video-cases. The great majority were affected by prior information bias. |
Dibonaventura | Physicians | 2 | 11--12 | No | Descriptive | 4 | unadjusted | 4 | Naturalness bias present in 40Â %, omission bias in 60Â % of participants |
Mamede | Residents | 8 | NA | No, confirmed diagnosis | Diagnostic accuracy | 5 | unadjusted | 5 | Availability bias increased with years of training. Clinical reasoning ameliorate this bias |
Mamade | internal medicine residents (34) and medical students (50) | 12 | >20 | No | Diagnostic accuracy | 6 | unadjusted | 3 | Conscious deliberation improved the likelihood of correct diagnosis in physicians, but not in medical students problems were complex, whereas reasoning mode did not matter in simple problems. In contrast, deliberation without attention improved novices’ decisions. |
Gupta | ED Physicians | 6 | >20 | No | Descriptive | 1 | adjusted | 6 | Outcome bias tends to inflate ratings in the presence of a positive outcome more than it penalizes scenarios with negative ones. |
Perneger | GPs and specialists, and patients (1121) | 1 | 5 | No | Rating of new drug | 6 | adjusted | 4 | Physicians and patients provided higher value to the hypothetical new medication when presented in relative terms. Compared to descriptive information, relative mortality reduction (OR 4.40; 3.05 – 6.34), Number needed to treat (OR 1.79; 1.21 – 2.66), and relative survival extension (OR 4.55; 2.74 – 7.55) had a more positive perception. |
Stiegler | Residents (32), Faculty (32) | 20 | NA | Catalogue of common cases | Management | 1 | unadjusted | 4 | 1. Developed a cognitive factor/bias catalogue, 2. Top 10 cognitive biases and personality traits: anchoring, availability bias, omission bias, commission bias, premature closure, confirmation bias, framing effect, overconfidence, feedback bias, and sunk cost. 3. Errors perceived by faculty to be important to anesthesiology were indeed observed frequently among trainees in a simulated environment. |
Ogdie | Residents | 41 | NA | No | Descriptive | 6 | unadjusted | 3 | Most common biases: anchoring (88Â %), availability (76Â %), framing effect (56Â %), overconfidence (46Â %) |
Meyer | Physicians | 4 | 6-11 | No | Diagnostic accuracy | 2 | unadjusted | 4 | Higher confidence was related to decreased requests for additional diagnostic tests (P = .01); higher case difficulty was related to more requests for additional reference materials (P = .01). |
Crowley | pathology residents, fellows and staff pathologists | 40 | NA | No | Diagnostic accuracy | 6 | unadjusted | 4 | Overall, biases occurred in 52Â % of incorrect cases compared to 21Â % correct. Most common biases-Availability (20Â %) and satisfying biases (22.5Â %) the two most common. All the rest, less than 10Â %. |
Saposnik | Residents, internists, emergency physicians and Neurologist | 10 | 5-7 | No | Probability of death or disability | 6 | adjusted | 5 | Higher confidence was not associated with better outcome predictions. 70Â % of underestimated the risk of the death or disability, 38Â % overestimated death at 30Â days. |
Msaouel | Residents | 2 | 4, 5 | No | Descriptive | 1 | adjusted | 5 | Gambler’s fallacy in 46 %, conjunction bias 69 % |
Yee | Specialists (Obstetricians) | 3488 | NA | No | Management | 6 | adjusted | 7 | Physicians with a higher tolerance of ambiguity were less likely to deliver patients by operative vaginal delivery (11.8 % vs 16.4 %; p = 0.006). The effect disappeared in the adjusted analysis (OR 0.77, 95 % CI 0.53-1.1) |