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Dual processing model of medical decision-making

BACKGROUND: Dual processing theory of human cognition postulates that reasoning and decision-making can be described as a function of both an intuitive, experiential, affective system (system I) and/or an analytical, deliberative (system II) processing system. To date no formal descriptive model of...

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Autores principales: Djulbegovic, Benjamin, Hozo, Iztok, Beckstead, Jason, Tsalatsanis, Athanasios, Pauker, Stephen G
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3471048/
https://www.ncbi.nlm.nih.gov/pubmed/22943520
http://dx.doi.org/10.1186/1472-6947-12-94
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author Djulbegovic, Benjamin
Hozo, Iztok
Beckstead, Jason
Tsalatsanis, Athanasios
Pauker, Stephen G
author_facet Djulbegovic, Benjamin
Hozo, Iztok
Beckstead, Jason
Tsalatsanis, Athanasios
Pauker, Stephen G
author_sort Djulbegovic, Benjamin
collection PubMed
description BACKGROUND: Dual processing theory of human cognition postulates that reasoning and decision-making can be described as a function of both an intuitive, experiential, affective system (system I) and/or an analytical, deliberative (system II) processing system. To date no formal descriptive model of medical decision-making based on dual processing theory has been developed. Here we postulate such a model and apply it to a common clinical situation: whether treatment should be administered to the patient who may or may not have a disease. METHODS: We developed a mathematical model in which we linked a recently proposed descriptive psychological model of cognition with the threshold model of medical decision-making and show how this approach can be used to better understand decision-making at the bedside and explain the widespread variation in treatments observed in clinical practice. RESULTS: We show that physician’s beliefs about whether to treat at higher (lower) probability levels compared to the prescriptive therapeutic thresholds obtained via system II processing is moderated by system I and the ratio of benefit and harms as evaluated by both system I and II. Under some conditions, the system I decision maker’s threshold may dramatically drop below the expected utility threshold derived by system II. This can explain the overtreatment often seen in the contemporary practice. The opposite can also occur as in the situations where empirical evidence is considered unreliable, or when cognitive processes of decision-makers are biased through recent experience: the threshold will increase relative to the normative threshold value derived via system II using expected utility threshold. This inclination for the higher diagnostic certainty may, in turn, explain undertreatment that is also documented in the current medical practice. CONCLUSIONS: We have developed the first dual processing model of medical decision-making that has potential to enrich the current medical decision-making field, which is still to the large extent dominated by expected utility theory. The model also provides a platform for reconciling two groups of competing dual processing theories (parallel competitive with default-interventionalist theories).
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spelling pubmed-34710482012-10-18 Dual processing model of medical decision-making Djulbegovic, Benjamin Hozo, Iztok Beckstead, Jason Tsalatsanis, Athanasios Pauker, Stephen G BMC Med Inform Decis Mak Research Article BACKGROUND: Dual processing theory of human cognition postulates that reasoning and decision-making can be described as a function of both an intuitive, experiential, affective system (system I) and/or an analytical, deliberative (system II) processing system. To date no formal descriptive model of medical decision-making based on dual processing theory has been developed. Here we postulate such a model and apply it to a common clinical situation: whether treatment should be administered to the patient who may or may not have a disease. METHODS: We developed a mathematical model in which we linked a recently proposed descriptive psychological model of cognition with the threshold model of medical decision-making and show how this approach can be used to better understand decision-making at the bedside and explain the widespread variation in treatments observed in clinical practice. RESULTS: We show that physician’s beliefs about whether to treat at higher (lower) probability levels compared to the prescriptive therapeutic thresholds obtained via system II processing is moderated by system I and the ratio of benefit and harms as evaluated by both system I and II. Under some conditions, the system I decision maker’s threshold may dramatically drop below the expected utility threshold derived by system II. This can explain the overtreatment often seen in the contemporary practice. The opposite can also occur as in the situations where empirical evidence is considered unreliable, or when cognitive processes of decision-makers are biased through recent experience: the threshold will increase relative to the normative threshold value derived via system II using expected utility threshold. This inclination for the higher diagnostic certainty may, in turn, explain undertreatment that is also documented in the current medical practice. CONCLUSIONS: We have developed the first dual processing model of medical decision-making that has potential to enrich the current medical decision-making field, which is still to the large extent dominated by expected utility theory. The model also provides a platform for reconciling two groups of competing dual processing theories (parallel competitive with default-interventionalist theories). BioMed Central 2012-09-03 /pmc/articles/PMC3471048/ /pubmed/22943520 http://dx.doi.org/10.1186/1472-6947-12-94 Text en Copyright ©2012 Djulbegovic et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Djulbegovic, Benjamin
Hozo, Iztok
Beckstead, Jason
Tsalatsanis, Athanasios
Pauker, Stephen G
Dual processing model of medical decision-making
title Dual processing model of medical decision-making
title_full Dual processing model of medical decision-making
title_fullStr Dual processing model of medical decision-making
title_full_unstemmed Dual processing model of medical decision-making
title_short Dual processing model of medical decision-making
title_sort dual processing model of medical decision-making
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3471048/
https://www.ncbi.nlm.nih.gov/pubmed/22943520
http://dx.doi.org/10.1186/1472-6947-12-94
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