Abstract
Cognitive and other biases can influence the quality of healthcare decision making. While substantial research has explored how biases can lead to diagnostic or other errors in medicine, fewer studies have examined how they impact the decision making of other healthcare professionals. This scoping review aimed to identify and synthesise a broad range of research investigating whether decisions made by allied health professionals are influenced by cognitive, affective or other biases. A systematic literature search was conducted in five electronic databases. Title, abstract and full text screening was undertaken in duplicate, using prespecified eligibility criteria designed to identify studies attempting to demonstrate the presence of bias when allied healthcare professionals make decisions. A narrative synthesis was undertaken, focussing on the type of allied health profession, type of decision, and type of bias reported within the included studies. The search strategy identified 149 studies. Of these, 119 studies came from the field of psychology, with substantially fewer from social work, physical and occupational therapy, speech pathology, audiology and genetic counselling. Diagnostic and assessment decisions were the most common decision types, with fewer studies assessing treatment, prognostic or other clinical decisions. Studies investigated the presence of over 30 cognitive, affective and other decision making biases, including stereotyping biases, anchoring, and confirmation bias. Overall, 77% of the studies reported at least one outcome that represented the presence of a bias. This scoping review provides an overview of studies investigating whether decisions made by allied health professionals are influenced by cognitive, affective or other biases. Biases have the potential to seriously impact the quality, consistency and accuracy of decision making in allied health practice. The findings highlight a need for further research particularly in professional disciplines outside of psychology, using methods that reflect real life healthcare decision making.
Highlights
Quality health service delivery is dependent on good decision making
This does not alter our adherence to PLOS ONE policies on sharing data and materials. This scoping review provides an overview of studies investigating whether decisions made by allied health professionals are influenced by cognitive, affective or other biases
The findings highlight a need for further research in professional disciplines outside of psychology, using methods that reflect real life healthcare decision making
Summary
Quality health service delivery is dependent on good decision making. An important component of this is the process of clinical reasoning that leads to a decision being made by a health professional. Human cognitive resources are limited, affecting how information is processed, stored and retrieved [1] Both intrinsic cognitive and extrinsic environmental or systemic factors can influence the way information is used to make decisions. Either inherent (‘hard wired’) or learned, can lead to systematic deviations from the rules of logic and probability, concepts that are largely considered to be the basis of rational thinking [2,3]. These deviations are often referred to as decision making biases. There is evidence suggesting that these reasoning errors can influence decisions in numerous professional scenarios, including in the delivery of health and social services [7,8,9,10]
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