- •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.
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.
We found evidence of cognitive bias in decision making for ICD implantation. The majority of these biases appeared to encourage ICD treatment.
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Published online: March 28, 2017
Accepted: March 24, 2017
Received in revised form: February 5, 2017
Received: July 19, 2016
Funding: This work was supported by a career development award from the National Institute on Aging (K23AG040696).
Published by Elsevier Inc.