Physiological Plausibility and Boundary Conditions of Theories of Risk Sensitivity

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Rational decision-making in medicine: implications for overuse and underuse

open access articleIn spite of substantial spending and resource utilization, today's health care remains characterized by poor outcomes, largely due to overuse (over-testing/treatment) or underuse (under-testing/treatment) of services. To a significant extent, this is a consequence of low-quality decision-making that appears to violate various rationality criteria. Such sub-optimal decision-making is considered a leading cause of death and is responsible for more than 80% of health expenses. In this paper, we address the issue of overuse or underuse of healthcare interventions from the perspective of rational choice theory. We show that what is considered rational under one decision theory may not be considered rational under a different theory. We posit that the questions and concerns regarding both underuse and overuse have to be addressed within a specific theoretical framework. The applicable rationality criterion, and thus the “appropriateness” of health care delivery choices, depends on theory selection that is appropriate to specific clinical situations. We provide a number of illustrations showing how the choice of theoretical framework influences both our policy and individual decision-making. We also highlight the practical implications of our analysis for the current efforts to measure the quality of care and link such measurements to the financing of healthcare services

Editorial: From Is to Ought: The Place of Normative Models in the Study of Human Thought

Editorial for a Research Topic in Frontiers in Cognitive Science This Document is Protected by copyright and was first published by Frontiers. All rights reserved. it is reproduced with permission

Similarity-based reasoning in conceptual spaces

Whereas the validity of deductive inferences can be characterized in terms of their logical form, this is not true for all inferences that appear pre-theoretically valid. Nonetheless, philosophers have argued that at least some of those inferences—sometimes called “similarity-based inferences” —can be given a formal treatment with the help of similarity spaces, which are mathematical spaces purporting to represent human similarity judgments. In these inferences, we conclude that a given property pertains to a category of items on the grounds that the same property pertains to a similar category of items. We look at a specific proposal according to which the strength of such inferences is a function of the distance, as measured in the appropriate similarity space, between the category referenced in the premise and the category referenced in the conclusion. We report the outcomes of three studies that all support the said proposal

Counterfactual conditionals and normative rules

The funding was awarded to the second, third and fourth authorsCounterfactual thinking is the consideration of how things could have turned out differently, usually taking the form of counterfactual conditionals. This experiment examined the psychological mechanisms that transform counterfactuals into deontic guidance rules for the future. We examined how counterfactual thinking translates into deontic guidance rules by asking participants to infer these deontic conclusions from the counterfactual premises. Participants were presented with a vignette and a counterfactual conditional, and assigned to either a control condition or a suppression condition in which they were additionally presented with conflicting normative rules. The presence of conflicting norms reduced the likelihood of positive deontic conclusions being endorsed and increased the likelihood of negative deontic conclusions being endorsed. Future intentionality and regret intensity ratings were reduced in the suppression condition. The same conditions that affect normative inference also affect regret and future planning, suggesting similar cognitive mechanisms underlie these processes

Thinking styles and regret in physicians

Background Decision-making relies on both analytical and emotional thinking. Cognitive reasoning styles (e.g. maximizing and satisficing tendencies) heavily influence analytical processes, while affective processes are often dependent on regret. The relationship between regret and cognitive reasoning styles has not been well studied in physicians, and is the focus of this paper. Methods A regret questionnaire and 6 scales measuring individual differences in cognitive styles (maximizing-satisficing tendencies; analytical vs. intuitive reasoning; need for cognition; intolerance toward ambiguity; objectivism; and cognitive reflection) were administered through a web-based survey to physicians of the University of South Florida. Bonferroni’s adjustment was applied to the overall correlation analysis. The correlation analysis was also performed without Bonferroni’s correction, given the strong theoretical rationale indicating the need for a separate hypothesis. We also conducted a multivariate regression analysis to identify the unique influence of predictors on regret. Results 165 trainees and 56 attending physicians (age range 25 to 69) participated in the survey. After bivariate analysis we found that maximizing tendency positively correlated with regret with respect to both decision difficulty (r=0.673; p<0.001) and alternate search strategy (r=0.239; p=0.002). When Bonferroni’s correction was not applied, we also found a negative relationship between satisficing tendency and regret (r=-0.156; p=0.021). In trainees, but not faculty, regret negatively correlated with rational-analytical thinking (r=-0.422; p<0.001), need for cognition (r=-0.340; p<0.001), and objectivism (r=-0.309; p=0.003) and positively correlated with ambiguity intolerance (r=0.285; p=0.012). However, after conducting a multivariate regression analysis, we found that regret was positively associated with maximizing only with respect to decision difficulty (r=0.791; p<0.001), while it was negatively associated with satisficing (r=-0.257; p=0.020) and objectivism (r=-0.267; p=0.034). We found no statistically significant relationship between regret and overall accuracy on conditional inferential tasks. Conclusion Regret in physicians is strongly associated with their tendency to maximize; i.e. the tendency to consider more choices among abundant options leads to more regret. However, physicians who exhibit satisficing tendency – the inclination to accept a “good enough” solution – feel less regret. Our observation that objectivism is a negative predictor of regret indicates that the tendency to seek and use empirical data in decision-making leads to less regret. Therefore, promotion of evidence-based reasoning may lead to lower regret

How (not) to argue about is/ought inferences in the cognitive sciences

How (not) to argue about is/ought inferences in the cognitive sciences Quintelier, K.J.P.; Zijlstra, L

Structured decision-making drives guidelines panels’ recommendations ‘for’ but not ‘against’ health interventions

Background: The determinants of guideline panels’ recommendations remain uncertain. Objective: To investigate factors considered by members of 8 panels convened by the American Society of Hematology (ASH) to develop guidelines using GRADE system. Study Design and Setting: web-based survey of the participants in the ASH guidelines panels. Analysis: two level hierarchical, random-effect, multivariable regression analysis to explore the relation between GRADE and non-GRADE factors and strength of recommendations (SOR). Results: In the primary analysis, certainty in evidence [OR=1.83; (95CI% 1.45 to 2.31)], balance of benefits and harms [OR=1.49 (95CI% 1.30 to 1.69)] and variability in patients’ values and preferences [OR=1.47 (95CI% 1.15 to 1.88)] proved the strongest predictors of SOR. In a secondary analysis, certainty of evidence was associated with a strong recommendation [OR=3.60 (95% CI 2.16 to 6.00)] when panel members recommended “for” interventions but not when they made recommendations “against” [OR=0.98 (95%CI: 0.57 to 1.8)] consistent with “yes” bias. Agreement between individual members and the group in rating SOR varied (kappa ranged from -0.01 to 0.64). Conclusion: GRADE’s conceptual framework proved, in general, highly associated with SOR. Failure of certainty of evidence to be associated with SOR against an intervention, suggest the need for improvements in the process