Understanding Decision Making in Critical Care

Lighthall, Geoffrey K.; Guillamet, M Cristina Vazquez

doi:10.3121/cmr.2015.1289

Cited by 70 publications

(81 citation statements)

References 79 publications

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“…The majority of patients admitted to an ICU lack capacity for medical decision making themselves. 21 Thus, most medical decisions in ICUs that involve value judgments (ie, changing a patient's code status or deciding to limit life support for a patient with poor prognosis) put families and surrogate decision makers in the difficult position of attempting to respect a patient's perceived wishes, when such wishes may not have been previously discussed. 22 In this sense, PCPs may play a more important role for patients admitted to the ICU than in other hospital units because their longitudinal relationships with their patients can give them unique perspectives regarding patient values and preferences when uncertainty exists in critical situations (especially when patients themselves lack decision making capacity).…”

Section: Discussionmentioning

confidence: 99%

Primary Care Physician Involvement in Shared Decision Making for Critically Ill Patients and Family Satisfaction with Care

et al. 2018

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Purpose: An intensive care unit (ICU) patient's primary care physician (PCP) may be able to assist family with certain ICU shared medical decisions. We explored whether families of patients in nonopen ICUs who nevertheless report involvement of a patient's PCP in medical decision making are more satisfied with ICU shared decision making than families who do not.Methods The roles that US primary care physicians (PCPs) play when their patients are admitted to intensive care units (ICUs) have evolved as most ICUs have moved from "open" to "nonopen" staffing models.1,2 "Nonopen" models include "closed" models, where all admitted patients have an intensivist as the official attending of record, and "semiclosed" models, where patients may still have official attendings of record who are outside of the ICU butThis article was externally peer reviewed.

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Section: Discussionmentioning

confidence: 99%

Primary Care Physician Involvement in Shared Decision Making for Critically Ill Patients and Family Satisfaction with Care

et al. 2018

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“…dmf-s, decayed, missing, or filled surfaces. a higher caries experience was influenced by confirmation bias [Elstein and Schwartz, 2002], a type of cognitive bias which occurs when the examiner does a selective search for evidence to confirm a preexisting hypothesis or idea [Pines, 2006;Lighthall and Vazquez-Guillamet, 2015]. Thus, when performing the visual examination to detect noncavitated caries lesions, examiners may have attached their thoughts to the initial impression regarding the oral health condition of children with a higher caries experience.…”

Section: Discussionmentioning

confidence: 99%

“…Clinicians consider more information and different possibilities to reach a diagnosis and the respective treatment decision [Gowda and Lamster, 2011]. Although diagnostic inaccuracies are more likely to arise from unchecked heuristics [Lighthall and Vazquez-Guillamet, 2015], both processes of diagnostic reasoning are prone to errors influenced by external factors [Elstein and Schwartz, 2002].…”

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confidence: 99%

The Influence of Cognitive Bias on Caries Lesion Detection in Preschool Children

et al. 2018

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We aimed to evaluate whether children’s caries experience exerts an influence on the performance of visual and radiographic methods in detecting nonevident proximal caries lesions in primary molars. Eighty children (3–6 years old) were selected and classified as having a lower (≤3 decayed, missing, or filled surfaces; dmf-s) or higher (> 3 dmf-s) caries experience. Two calibrated examiners then assessed 526 proximal surfaces for caries lesions using visual and radiographic methods. As a reference standard, 2 other examiners checked the surfaces after temporary separation. Noncavitated and cavitated lesion thresholds were considered and Poisson multilevel regression analyses were conducted to evaluate the influence of caries experience on the performance of diagnostic strategies. Accuracy parameters stratified by caries experience were also derived. A statistically significant influence of caries experience was observed only for visual inspection, with more false-positive results in children with a higher caries experience at the noncavitated lesion threshold, and more false results at the cavitated threshold. The detection of noncavitated caries lesions in children with a higher caries experience was overestimated (specificity = 0.696), compared to children with a lower caries experience (specificity = 0.918), probably due to confirmation bias. However, the examiners underestimated the detection of cavitated lesions in children with a higher caries experience (sensitivity = 0.143) compared to lower-caries-experience children (sensitivity = 0.222), possibly because of representativeness bias. The radiographic method was not influenced by children’s caries experience. In conclusion, children’s caries experience influences the performance of visual inspection in detecting proximal caries lesions in primary teeth, evidencing the occurrence of cognitive biases.

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“…I medisinsk sammenheng er det foreslått at slik opplaering kan bestå av undervisning i teoretisk kunnskap, kombinert med simulering og, viktigst, implementering i daglig virksomhet (3,4).…”

Section: Kan Beslutningskompetanse øVes?unclassified

“…, diskusjon med kolleger og/eller ulike former undervisning -gjerne allerede under medisinstudiene (3,4). Dette vil gi et felles rammeverk av begreper og definisjoner.…”

Section: Kan Beslutningskompetanse øVes?unclassified

Om vanskelige luftveier og nødlandinger

Antonsen¹

2017

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Er medisinske beslutninger kun basert på fakta? Bør vi fortsette jakten på prosedyrer og algoritmer, eller stole mer på egen erfaring og kompetanse? Beslutningsteoretisk innsikt kan bidra med svar på disse spørsmålene. Illustrasjon: Ørjan Jensen/SuperpopAnsvaret for å ta beslutninger er en sentral del av legeyrket. Alle leger har kjent på usikkerheten knyttet til krevende avgjørelser. Slik bør det vaere. Det er et ansvar vi må ønske å ha.Noen fagfelt -som anestesi og traumatologi -er preget av tidskritiske ja/nei-beslutninger som må tas hurtig og på sviktende informasjonsgrunnlag. I andre fagfelt, for eksempel rehabilitering, er usikkerheten knyttet til komplekse og langvarige beslutningsprosesser over uker og måneder.Tradisjonelt har vi vaert flinke til å vektlegge oppdatert faglig kunnskap om diagnostikk og behandling. Når vi opplever feil og avvik, er løsningen ofte å søke mer kunnskap og/eller utarbeide nye retningslinjer og prosedyrer. Dette er viktige og riktige forutsetninger for god medisinsk praksis, men bare en del av løsningen.Her vil jeg belyse temaet fra en annen vinkel: Hvordan kan innsikt i beslutningsteori gjøre oss til bedre beslutningstagere? To forskere har vaert -og er fortsatt -sentrale innen feltet: Nobelprisvinner og psykolog Daniel Kahneman er for mange best kjent som forfatter av boken Thinking, fast and slow (1). Han har vaert viktig for utviklingen av modellen Heuristics and biases approach. Psykolog og forsker Gary Klein har vaert ledende i arbeidet med

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Understanding Decision Making in Critical Care

Cited by 70 publications

References 79 publications

Primary Care Physician Involvement in Shared Decision Making for Critically Ill Patients and Family Satisfaction with Care

Primary Care Physician Involvement in Shared Decision Making for Critically Ill Patients and Family Satisfaction with Care

The Influence of Cognitive Bias on Caries Lesion Detection in Preschool Children

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