'We Have Guidelines, but We Can Also Be Artists': Neurologists Discuss Prognostic Uncertainty, Cognitive Biases, and Scoring Tools.

Details

Ressource 1Request a copy Under indefinite embargo.
UNIL restricted access
State: Public
Version: author
License: CC BY 4.0
Serval ID
serval:BIB_3EC989771C44
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
'We Have Guidelines, but We Can Also Be Artists': Neurologists Discuss Prognostic Uncertainty, Cognitive Biases, and Scoring Tools.
Journal
Brain sciences
Author(s)
Tolsa L., Jones L., Michel P., Borasio G.D., Jox R.J., Rutz Voumard R.
ISSN
2076-3425 (Print)
ISSN-L
2076-3425
Publication state
Published
Issued date
21/11/2022
Peer-reviewed
Oui
Volume
12
Number
11
Pages
1591
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Abstract
Ischemic stroke is a leading cause of disability and mortality worldwide. As acute stroke patients often lose decision-making capacity, acute management is fraught with complicated decisions regarding life-sustaining treatment (LST). We aimed to explore (1) the perspectives and experiences of clinicians regarding the use of predictive scores for LST decision making in severe acute stroke, and (2) clinicians' awareness of their own cognitive biases in this context.
Four focus groups (FGs) were conducted with 21 physicians (13 residents and 8 attending physicians); two FGs in a university hospital and two in a regional hospital in French-speaking Switzerland. Discussions were audio-recorded and transcribed verbatim. Transcripts were analyzed thematically. Two of the four transcripts were double coded to establish coding framework consistency.
Participants reported that predictive tools were not routinely used after severe stroke, although most knew about such scores. Scores were reported as being useful in quantifying prognosis, advancing scientific evidence, and minimizing potential biases in decisions. Their use is, however, limited by the following barriers: perception of inaccuracy, general disbelief in scoring, fear of self-fulfilling prophecy, and preference for clinical judgement. Emotional and cognitive biases were common. Emotional biases distort clinicians' knowledge and are notably: bias of personal values, negative experience, and cultural bias. Cognitive biases, such as availability, confirmation, and anchoring biases, that produce systematic deviations from rational thinking, were also identified.
The results highlight opportunities to improve decision making in severe stroke through the promotion of predictive tools, strategies for communicating prognostic uncertainty, and minimizing cognitive biases among clinicians, in order to promote goal-concordant care.
Keywords
cognitive biases, decision making, prognostic uncertainty, severe stroke
Pubmed
Open Access
Yes
Create date
06/12/2022 14:25
Last modification date
09/12/2022 6:48
Usage data