Highlights
- •Cognitive biases can influence decisions in a non-normative way.
- •Implantable cardioverter-defibrillators (ICDs) are a challenging decision.
- •Retrospectively, we found indications of cognitive bias in ICD decision making.
- •On the whole, the biases appeared to encourage ICD treatment.
Abstract
Background
Studies have demonstrated that patients with primary prevention implantable cardioverter-defibrillators
(ICDs) often misunderstand the ICD. Advances in behavioral economics demonstrate that
some misunderstandings may be due to cognitive biases. We aimed to explore the influence
of cognitive bias on ICD decision making.
Methods and Results
We used a qualitative framework analysis including 9 cognitive biases: affect heuristic,
affective forecasting, anchoring, availability, default effects, halo effects, optimism
bias, framing effects, and state dependence. We interviewed 48 patients from 4 settings
in Denver. The majority were male (n = 32). Overall median age was 61 years. We found
frequent evidence for framing, default, and halo effects; some evidence of optimism
bias, affect heuristic, state dependence, anchoring and availability bias; and little
or no evidence of affective forecasting. Framing effects were apparent in overestimation
of benefits and downplaying or omitting potential harms.
Conclusions
We found evidence of cognitive bias in decision making for ICD implantation. The majority
of these biases appeared to encourage ICD treatment.
Key Words
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References
- ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons.Circulation. 2008; 117 (e350–408)
- Educational and psychological interventions to improve outcomes for recipients of implantable cardioverter defibrillators and their families a scientific statement from the American Heart Association.Circulation. 2012; 126: 2146-2172
- Causes and consequences of heart failure after prophylactic implantation of a defibrillator in the multicenter automatic defibrillator implantation trial II.Circulation. 2006; 113: 2810-2817
- A study to improve communication between clinicians and patients with advanced heart failure: methods and challenges behind the working to improve discussions about defibrillator management trial.J Pain Symptom Manage. 2014; 48: 1236-1246
- Patient perceptions, physician communication, and the implantable cardioverter-defibrillator.JAMA Intern Med. 2013; 173: 571-577
- Patient preference in the decision to place implantable cardioverter-defibrillators.Arch Intern Med. 2012; 172: 1104-1105
- Making decisions about implantable cardioverter-defibrillators from implantation to end of life: an integrative review of patients' perspectives.Patient. 2014; 7: 243-260
- Nudge.Yale University Press, New Haven2008
- Thinking Fast and Slow.Farrar, Straus and Giroux, New York2011
- Using the framework method for the analysis of qualitative data in multi-disciplinary health research.BMC Med Res Methodol. 2013; 13: 117
- Doing Qualitative Research.2nd ed. Sage Publications, Thousand Oaks, CA1999
- Patient and cardiologist perceptions on decision making for implantable cardioverter-defibrillators: a qualitative study.Pacing Clin Electrophysiol. 2011; 34: 1634-1644
- Technological and treatment imperatives, life-sustaining technologies, and associated ethical and social challenges.(Paper presented at; Mayo Clinic Proceedings)2013
- Clinical effectiveness of implantable cardioverter-defibrillators among medicare beneficiaries with heart failure.Circ Heart Fail. 2010; 3: 7-13
- Decision making in advanced heart failure: a scientific statement from the American Heart Association.Circulation. 2012; 125: 1928-1952
- Patients' knowledge about 9 common health conditions: the DECISIONS survey.Med Decis Making. 2010; 30: 35S-52S
- Medical care inconsistent with patients' treatment goals: association with 1-year Medicare resource use and survival.J Am Geriatr Soc. 2002; 50: 496-500
- Risk perception and affect.Curr Dir Psychol Sci. 2006; 15: 322-325
- Affective forecasting knowing what to want.Curr Dir Psychol Sci. 2005; 14: 131-134
- The anchoring-and-adjustment heuristic why the adjustments are insufficient.Psychol Sci. 2006; 17: 311-318
- Availability: a heuristic for judging frequency and probability.Cognit Psychol. 1973; 5: 207-232
- Defaults and donation decisions.Transplantation. 2004; 78: 1713-1716
- The framing of decisions and the psychology of choice.Science. 1981; 211: 453-458
- The halo effect: Evidence for unconscious alteration of judgments.J Pers Soc Psychol. 1977; 35: 250
- Neural mechanisms mediating optimism bias.Nature. 2007; 450: 102-105
Article info
Publication history
Published online: March 28, 2017
Accepted:
March 24,
2017
Received in revised form:
February 5,
2017
Received:
July 19,
2016
Footnotes
Funding: This work was supported by a career development award from the National Institute on Aging (K23AG040696).
Identification
Copyright
Published by Elsevier Inc.
