Common Cognitive Biases Research Articles

Cognitive bias: how understanding its impact on antibiotic prescribing decisions can help advance antimicrobial stewardship

The way clinicians think about decision-making is evolving. Human decision-making shifts between two modes of thinking, either fast/intuitive (Type 1) or slow/deliberate (Type 2). In the healthcare setting where thousands of decisions are made daily, Type 1 thinking can reduce cognitive load and help ensure decision making is efficient and timely, but it can come at the expense of accuracy, leading to systematic errors, also called cognitive biases. This review provides an introduction to cognitive bias and provides explanation through patient vignettes of how cognitive biases contribute to suboptimal antibiotic prescribing. We describe common cognitive biases in antibiotic prescribing both from the clinician and the patient perspective, including hyperbolic discounting (the tendency to favour small immediate benefits over larger more distant benefits) and commission bias (the tendency towards action over inaction). Management of cognitive bias includes encouraging more mindful decision making (e.g., time-outs, checklists), improving awareness of one's own biases (i.e., meta-cognition), and designing an environment that facilitates safe and accurate decision making (e.g., decision support tools, nudges). A basic understanding of cognitive biases can help explain why certain stewardship interventions are more effective than others and may inspire more creative strategies to ensure antibiotics are used more safely and more effectively in our patients.

Factors associated with missed and misinterpreted cases of pancreatic ductal adenocarcinoma.

To retrospectively examine US, CT, and MR imaging examinations of missed or misinterpreted pancreatic ductal adenocarcinoma (PDAC), and identify factors which may have confounded detection or interpretation. We reviewed 107 examinations in 66/257 patients (26%, mean age 73.7years) diagnosed with PDAC in 2014 and 2015, with missed or misinterpreted imaging findings as determined by a prior study. For each patient, images and reports were independently reviewed by two radiologists, and in consensus, the following factors which may have confounded assessment were recorded: inherent tumor factors, concurrent pancreatic pathology, technical limitations, and cognitive biases. Secondary signs of PDAC associated with each examination were recorded and compared with the original report to determine which findings were missed. There were 66/107 (62%) and 49/107 (46%) cases with missed and misinterpreted imaging findings, respectively. A significant number of missed tumors were < 2cm (45/107, 42%), isoattenuating on CT (32/72, 44%) or non-contour deforming (44/107, 41%). Most (29/49, 59%) misinterpreted examinations were reported as uncomplicated pancreatitis. Almost all examinations (94/107, 88%) demonstrated secondary signs; pancreatic duct dilation was the most common (65/107, 61%) and vascular invasion was the most commonly missed 35/39 (90%). Of the CT and MRIs, 28 of 88 (32%) had suboptimal contrast dosing. Inattentional blindness was the most common cognitive bias, identified in 55/107 (51%) of the exams. Recognizing pitfalls of PDAC detection and interpretation, including intrinsic tumor features, secondary signs, technical factors, and cognitive biases, can assist radiologists in making an early and accurate diagnosis. • There were 66/107 (62%) and 49/107 (46%) cases with missed and misinterpreted imaging findings, respectively, with tumoral, technical, and cognitive factors leading to the misdiagnosis of pancreatic ductal adenocarcinoma. • The majority (29/49, 59%) of misinterpreted cases of pancreatic ductal adenocarcinoma were mistaken for pancreatitis, where an underlying mass or secondary signs were not appreciated due to inflammatory changes. • The most common missed secondary sign of pancreatic ductal adenocarcinoma was vascular encasement, missed in 35/39 (90%) of cases, indicating the importance of evaluating the peri-pancreatic vasculature.

Dark Nudges and Sludge in Big Alcohol: Behavioral Economics, Cognitive Biases, and Alcohol Industry Corporate Social Responsibility.

Policy Points Nudges steer people toward certain options but also allow them to go their own way. “Dark nudges” aim to change consumer behavior against their best interests. “Sludge” uses cognitive biases to make behavior change more difficult.We have identified dark nudges and sludge in alcohol industry corporate social responsibility (CSR) materials. These undermine the information on alcohol harms that they disseminate, and may normalize or encourage alcohol consumption.Policymakers and practitioners should be aware of how dark nudges and sludge are used by the alcohol industry to promote misinformation about alcohol harms to the public. Context“Nudges” and other behavioral economic approaches exploit common cognitive biases (systematic errors in thought processes) in order to influence behavior and decision‐making. Nudges that encourage the consumption of harmful products (for example, by exploiting gamblers’ cognitive biases) have been termed “dark nudges.” The term “sludge” has also been used to describe strategies that utilize cognitive biases to make behavior change harder. This study aimed to identify whether dark nudges and sludge are used by alcohol industry (AI)–funded corporate social responsibility (CSR) organizations, and, if so, to determine how they align with existing nudge conceptual frameworks. This information would aid their identification and mitigation by policymakers, researchers, and civil society.MethodsWe systematically searched websites and materials of AI CSR organizations (e.g., IARD, Drinkaware, Drinkwise, Éduc'alcool); examples were coded by independent raters and categorized for further analysis.FindingsDark nudges appear to be used in AI communications about “responsible drinking.” The approaches include social norming (telling consumers that “most people” are drinking) and priming drinkers by offering verbal and pictorial cues to drink, while simultaneously appearing to warn about alcohol harms. Sludge, such as the use of particular fonts, colors, and design layouts, appears to use cognitive biases to make health‐related information about the harms of alcohol difficult to access, and enhances exposure to misinformation. Nudge‐type mechanisms also underlie AI mixed messages, in particular alternative causation arguments, which propose nonalcohol causes of alcohol harms.ConclusionsAlcohol industry CSR bodies use dark nudges and sludge, which utilize consumers’ cognitive biases to promote mixed messages about alcohol harms and to undermine scientific evidence. Policymakers, practitioners, and the public need to be aware of how such techniques are used to nudge consumers toward industry misinformation. The revised typology presented in this article may help with the identification and further analysis of dark nudges and sludge.

Cognitive Bias and Public Health Policy During the COVID-19 Pandemic

This Viewpoint reviews common cognitive biases that led health centers and the public to favor patient- over population health–oriented policy responses to the initial COVID-19 pandemic, and proposes messaging to better articulate the rationale for more effective population health responses.

Don’t fight the tape! Technical Analysis Momentum and Contrarian Signals as Common Cognitive Biases

Purpose: Stock market participants use technical analysis to seek trends in stock price charts despite its doubtful efficiency. We tested whether technical analysis signals represent typical and common cognitive biases associated with the continuation or reversal of the trend. Methodology: We compared investors’ opinions about the predictive power of technical analysis signals grouped into five conditions: real technical analysis signals associated with trend continuation (real momentum signals) or trend reversal (real contrarian signals), fake momentum or fake contrarian signals, and fluctuation signals. Findings: Investors assigned larger predictive power to real and fake signals associated with trend continuation than to signals associated with trend reversal. Fake signals, which represented cognitive biases, elicited similar predictions about trend continuation or reversal to real technical analysis signals. Originality: Market players assess momentum signals to have greater predictive power than contrarian signals and neutral signals to have the least predictive power. These results are independent of whether technical analysis signals were well-known to investors or made up by experimenters. The hardwired propensity of our brains to detect patterns combined with the non-natural environment of the stock market creates the illusion of expertise that is not easy to dispel.

Cognitive Biases in Link Sharing Behavior and How to Get Rid of Them: Evidence from the 2019 Spanish General Election Twitter Conversation

After a few years focusing on issues such as electoral prediction through social media data, many analysts turned their attention toward fake news spreading and misinformation. A coherent next step in elections research through social media data would be identifying what makes communities and individuals less open to manipulation. Misinformation is not simply bad or false information but selective information circulated among isolated and unconnected groups. Here, I will discuss common cognitive biases in link sharing behavior and its effects on politically shaped communities in the Twitter public debate on the 2019 Spanish general election campaign. Finally, I will present and discuss some data-driven mechanisms that may contribute to the mitigation of mass manipulation.

Common Cognitive Biases in Nephrology Critical Care: A Plea for Metacognition.

The intensive care unit (ICU) is an incredibly complex environment, and ICU rounds are mentally taxing. The cognitive biases that tend to arise in mentally taxing environments such as the ICU pose a risk to patients. This review discusses 10 common cognitive biases and logical fallacies using examples in Nephrology Critical Care. Our objective is to promote metacognition (i.e., an awareness of one’s cognition) among physicians. A state of metacognition is not a panacea, but aspiring for metacognition allows the critical care physician to improve chances for optimal patient outcomes.

Data visualization and cognitive biases in audits

Purpose This paper aims to examine major cognitive biases in auditors’ analyses involving visualization, as well as proposes practical approaches to address such biases in data visualization. Design/methodology/approach Using the professional judgment framework of KPMG (2011), this study performs an analysis of whether and how five major types of cognitive biases (framing, availability, overconfidence, anchoring and confirmation) may occur in an auditor’s data visualization and how such biases potentially compromise audit quality. Findings The analysis suggests that data visualization can trigger and/or aggravate the common cognitive biases in audit. If not properly addressed, such biases may adversely affect auditors' judgment and decision-making. Practical implications To ensure that data visualization improves audit efficiency and effectiveness, it is essential that auditors are aware of and successfully address cognitive biases in data visualization. Six practical approaches to debias cognitive biases in auditors’ visualization are proposed: using data visualization to complement rather than supplement traditional audit evidence; positioning data visualization to support rather than replace sophisticated analytics tools; using a dashboard with multiple dimensions; using both visualized and tabular data in analyses; assigning experienced audit staff; and providing pre-audit tutorials on cognitive bias and visualization. Originality/value The study raises awareness of psychological issues in an audit setting.

Cognitive Bias: The Downside of Shared Decision Making.

This narrative review presents theoretical and empirical evidence of common cognitive biases that are likely to influence treatment choices of patients with cancer and other illnesses. We present an overview of common cognitive biases that result from how and when information is presented to patients. We supplement these descriptions with cancer-specific examples or those from other health fields if no cancer-specific examples are available. The results provide compelling evidence that patient treatment choices are subconsciously influenced by both known and unknown biases. Shared decision making is ideal in theory, but in reality, it is fraught with risks resulting from cognitive biases and undue influence of even the best-intentioned physicians and family members. Efforts should be made to minimize these concerns and to help patients to make decisions that their future selves are least likely to regret.

The Temptation of Zero Price: Event-Related Potentials Evidence of How Price Framing Influences the Purchase of Bundles.

Studies have revealed that consumers are susceptible to price framing effect, a common cognitive bias, due to their limited capacity in processing information. The effect of price framing in a bundling context and its neural correlates, however, remain not clearly characterized. The present study applied the event-related potentials (ERPs) approach to investigate the role of price framing in information processing and purchase decision making in a bundling context. Three price frames were created with practically identical total prices (with a maximum difference of ¥0.1, which was about equal to 0.016 US dollars) for a bundle with two components, a focal product and a tie-in product. In normal price condition (NP), both the focal and tie-in products were offered at a normal discounted price; in zero price condition (ZP), the tie-in product was offered free while the total price of the bundle remained the same as NP; whereas in low price condition (LP), the tie-in product was offered at a low token price (¥0.1), and the focal product shared the same price as the focal product of ZP. The behavioral results showed a higher purchase rate and a shorter reaction time for ZP in contrast to NP. Neurophysiologically, enlarged LPP amplitude was elicited by ZP relative to NP, suggesting that ZP triggered a stronger positive affect that could motivate decision to buy. Thus, this study provides both behavioral and neural evidence for how different price framing information is processed and ultimately gives rise to price framing effect in purchase decision making.

To err is human: A case-based review of cognitive bias and its role in clinical decision making

To err is human: A case-based review of cognitive bias and its role in clinical decision making

Utilização de Redes Neurais Artificiais como Estratégia de Previsão de Preços no Contexto de Agronegócio

This paper presents an analysis of the use of artificial neural networks as a strategy for forecasting prices in the context of agribusiness. For this purpose, data were adopted from EMATER/RS (1992-2006) on four specific commodities: soybean, live cattle, corn, and wheat. The methodology adopted during the research followed the steps shown in Hair et al. (2005), using neural network perception. The data discussed demonstrate the possibility of using neural networks as a strategy for predicting the price of agricultural commodities in future markets. However, one should pay attention to the common cognitive bias in the process of decision making, as it is believed that a significant contribution to academia lies there, as well as a starting point for improving management decisions in rural business.

Cognitive biases associated with medical decisions: a systematic review.

BackgroundCognitive biases and personality traits (aversion to risk or ambiguity) may lead to diagnostic inaccuracies and medical errors resulting in mismanagement or inadequate utilization of resources. We conducted a systematic review with four objectives: 1) to identify the most common cognitive biases, 2) to evaluate the influence of cognitive biases on diagnostic accuracy or management errors, 3) to determine their impact on patient outcomes, and 4) to identify literature gaps.MethodsWe searched MEDLINE and the Cochrane Library databases for relevant articles on cognitive biases from 1980 to May 2015. We included studies conducted in physicians that evaluated at least one cognitive factor using case-vignettes or real scenarios and reported an associated outcome written in English. Data quality was assessed by the Newcastle-Ottawa scale. Among 114 publications, 20 studies comprising 6810 physicians met the inclusion criteria. Nineteen cognitive biases were identified.ResultsAll studies found at least one cognitive bias or personality trait to affect physicians. Overconfidence, lower tolerance to risk, the anchoring effect, and information and availability biases were associated with diagnostic inaccuracies in 36.5 to 77 % of case-scenarios. Five out of seven (71.4 %) studies showed an association between cognitive biases and therapeutic or management errors. Of two (10 %) studies evaluating the impact of cognitive biases or personality traits on patient outcomes, only one showed that higher tolerance to ambiguity was associated with increased medical complications (9.7 % vs 6.5 %; p = .004). Most studies (60 %) targeted cognitive biases in diagnostic tasks, fewer focused on treatment or management (35 %) and on prognosis (10 %). Literature gaps include potentially relevant biases (e.g. aggregate bias, feedback sanction, hindsight bias) not investigated in the included studies. Moreover, only five (25 %) studies used clinical guidelines as the framework to determine diagnostic or treatment errors. Most studies (n = 12, 60 %) were classified as low quality.ConclusionsOverconfidence, the anchoring effect, information and availability bias, and tolerance to risk may be associated with diagnostic inaccuracies or suboptimal management. More comprehensive studies are needed to determine the prevalence of cognitive biases and personality traits and their potential impact on physicians’ decisions, medical errors, and patient outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12911-016-0377-1) contains supplementary material, which is available to authorized users.

Voter Response to Peak and End Transfers: Evidence from a Conditional Cash Transfer Experiment

In a Honduran field experiment, sequences of cash transfers to poor households varied in amount of the largest (peak) and last (end) transfers. Larger peak-end transfers increased voter turnout and the incumbent party’s vote share in the 2013 presidential election, independently of cumulative transfers. A plausible explanation is that voters succumbed to a common cognitive bias by applying peak-end heuristics. Another is that voters deliberately used peak-end transfers to update beliefs about the incumbent party. In either case, the results provide experimental evidence on the classic non-experimental finding that voters are especially sensitive to recent economic activity. (JEL C93, D72, I32, O15, O17)

Rereading as a Mechanism of Defamiliarization in Proust

One of the enigmas of Marcel Proust's great novel is the unusual type of engagement it necessitates. It is impossible to read without frequently referring back to earlier portions of the text. Hypotactic sentences and unanticipated developments not only trigger reflection; they sometimes also prompt us to physically revisit pages we have already turned. While many Proust scholars have commented on this perplexing quality of the work and theorists of rereading have offered partial accounts of it, no one has explained for what purpose A la recherche du temps perdu (translated as In Search of Lost Time or Remembrance of Things Past) cannot be read without also being reread. The answer to this question illuminates a new facet of Proust's aesthetic philosophy, namely, his vision of what literature offers that nonliterary texts cannot. As my title suggests, it is a notable variant of the effect that Victor Shklovsky called defamiliarization. Perhaps what is most interesting about this reward in Proust is that readers must restructure their everyday interpretive habits to experience it. The sensation of renewed vision is available only to those who, through both careful reading and rereading, manage to overcome common cognitive biases or patterns of error that most people make when processing information. In this respect, the value of rereading the Recherche extends beyond Proust and even beyond literature, for ultimately the question at hand is whether literature can change our interpretive habits. My conclusion is that it can, perhaps even in ways that expository and instructive texts cannot.

Rethinking the training of intelligence analysts

Despite intense scrutiny and promised fixes resulting from intelligence ‘transformation’ efforts, erroneous analytic assessments persist and continue to dominate news coverage of the US intelligence community. Existing analytic training teaches analysts about common cognitive biases and then aims to correct them with structured analytic techniques. On its face, this approach is eminently reasonable; on close inspection, incomplete and imbalanced. Current training is anchored in a mid-twentieth century understanding of psychology that focuses on checking over-confidence and rigidity but ignores the problems of under-confidence and excessive volatility. Moreover it has never been validated against objective benchmarks of good judgment. We propose a new approach: (a) adopting scientifically validated content and regularly testing training to avoid institutionalizing new dogmas; (b) incentivizing analysts to view training guidelines as means to the end of improved accuracy, not an end in itself.

Is bias in the eye of the beholder? A vignette study to assess recognition of cognitive biases in clinical case workups

BackgroundMany authors have implicated cognitive biases as a primary cause of diagnostic error. If this is so, then physicians already familiar with common cognitive biases should consistently identify biases present...

Common sense or cognitive bias and groupthink: does it belong in our clinical reasoning?

You go to a medical equipment shop and buy a stethoscope and reflex hammer for £105. The stethoscope cost £100 more than the reflex hammer. How much did the reflex hammer cost? If your answer to the above question was £5, you may have been using common sense (type-1 reasoning). If on the other hand your answer was based on analytical thinking (type-2 reasoning) your answer would have been more like £2.50. Like most successful biological organisms, we have evolved for economy of effort, to save energy. Type-2 reasoning requires more effort and more time than type-1, so we tend to apply common sense …

Metacognitive group training for schizophrenia spectrum patients with delusions: a randomized controlled trial.

Metacognitive training (MCT) for patients with psychosis is a psychological group intervention that aims to educate patients about common cognitive biases underlying delusion formation and maintenance, and to highlight their negative consequences in daily functioning. In this randomized controlled trial, 154 schizophrenia spectrum patients with delusions were randomly assigned to either MCT+treatment as usual (TAU) or TAU alone. Both groups were assessed at baseline, and again after 8 and 24 weeks. The trial was completed fully by 111 patients. Efficacy was measured with the Psychotic Symptom Rating Scales (PSYRATS) Delusions Rating Scale (DRS), and with specific secondary measures referring to persecutory ideas and ideas of social reference (the Green Paranoid Thoughts Scale, GPTS), cognitive insight (the Beck Cognitive Insight Scale, BCIS), subjective experiences of cognitive biases (the Davos Assessment of Cognitive Biases Scale, DACOBS) and metacognitive beliefs (the 30-item Metacognitions Questionnaire, MCQ-30). Economic analysis focused on the balance between societal costs and health outcomes (quality-adjusted life years, QALYs). Both conditions showed a decrease of delusions. MCT was not more efficacious in terms of reducing delusions, nor did it change subjective paranoid thinking and ideas of social reference, cognitive insight or subjective experience of cognitive biases and metacognitive beliefs. The results of the economic analysis were not in favour of MCT+TAU. In the present study, MCT did not affect delusion scores and self-reported cognitive insight, or subjective experience of cognitive biases and metacognitive beliefs. MCT was not cost-effective.

The Development of the Heuristics and Biases Scale (HBS)

Problem StatementThere is no comprehensive tool capturing general vulnerability to biases caused by the use of heuristics. Existing tools focus only on one specific bias or on personality traits. Research QuestionsCan general vulnerability to heuristic thinking be assessed and what are the sub-dimensions of this construct? Can undergraduate students be successfully involved in the research process? Purpose of the StudyTo demonstrate the results of an educational experiment in which undergraduate students are involved in the first stage of development of the Heuristics and Biases Scale (HBS). Research MethodsAfter getting acquainted with the underlying theory, students chose one specific bias or heuristic, investigated related results of the experiments and paradigms. At the later stage, under supervision, students developed items intended to capture the chosen bias. Finally, positively evaluated items were combined together and piloted. The psychometrical properties of the items and course outcomes were assessed. FindingsDeveloped items formed scales with satisfactory reliability. Course received positive student evaluations, and the assessment indicated that the majority of students achieved intended learning outcomes. ConclusionsThe study indicates that it is possible to develop a psychometrically sound assessment to measure vulnerability to a range of common cognitive biases. Moreover, it is also possible to successfully involve undergraduate students in the development of a psychometrical tool. AcknowledgmentsAuthors would like to thank the Students of University College Roosevelt contributing to this work as their Independent Research Projects or as a part of Social Psychology or Statistics Course.