High-stakes Situation Research Articles

Trust and deception with high stakes: Evidence from the friend or foe dataset

Many social interactions rely on the premise of mutual trust, but deception violates trust and poses risk. Empirically examining trust and deception, particularly in high-stakes situations, is challenging but essential for improving the research realism and generalizability. To address this difficulty, we study trusting and deceptive behaviors in a high-stakes situation by using a novel dataset created from an American game show, Friend or Foe (FoF). In the show, a contestant's reward was determined through a trust game modified from the prisoner's dilemma. We explore how numerous human behaviors including facial expressions, gaze, head pose, body motion, language, and socio-demographic attributes, were related to a contestant's trusting or deceptive decision. Using a data-driven approach, we find that the deceivers' (contestants who chose Foe) behavior featured a neutralized face, negative facial emotions, enhanced upper body motion, and language with a lower sense of immediacy and agreeableness. The contestants who chose to trust (chose Friend) exhibited opposite behavioral patterns. Socio-demographic factors such as age, height, and facial attractiveness were also associated with a contestant's choice. Combining multimodal information, machine learning classifiers could predict the contestant's choice with an accuracy about 25% greater than earlier reported human accuracy. We contribute to both trust and deception literature by examining the generalizability of trusting and deceptive behaviors to a new high-stakes scenario. We also add to the decision support literature by showing the superior predictive performances of combining behavioral and socio-demographic features. Furthermore, we contribute to the academic community by introducing the FoF dataset.

Impact of Personality Traits and Socio-Demographic Factors on Depression among Doctors and Nurses

The workplace is not immune to conflict and stress, specifically when fulfilling people's responsibilities at great personal costs. Doctors and nurses are always on the frontline in hospitals, vaulting from one stressful high-stakes situation to the next. The HEXACO model of personality traits: Honesty-humility, Emotionality, Extraversion, Agreeableness, Conscientiousness, and Openness, has long been hypothesized to be a major predicting factor when determining individuals' responses to stress and susceptibility to experiencing depression. Most research suggests that personality traits resonate with a person's cognitive abilities and how they can deal with stress and depression. However, there is a lack of research on their correlation to depression severity in the Middle East. The current study aimed to investigate the impact of HEXACO personality traits and socio-demographic factors on depression amongst doctors and nurses. A sample of 170 doctors and nurses (62.1% doctors) completed HEXACO-60 and PHQ-9 depression severity questionnaires. The data were analyzed through descriptive statistics, independent samples t-test, ANOVA, correlation, and regression analysis. The findings showed that Honesty-humility was the strongest predictor, while extraversion was the second strongest. Emotionality had the least impact on depression. The relationship between Agreeableness and Openness to Experience with depression was insignificant. However, gender, age, working hours, and work experience were significant predictors of depression. Marital status and level of specialization were insignificant predictors. Thus, it was concluded that not all HEXACO traits and socio-demographics predict depression. Study findings could be utilized in the implementation of employee recruitment, job crafting, positive psychology, and coaching.

Comprehensive Risk Pathway of the Qualitative Likelihood of Human Exposure to Severe Acute Respiratory Syndrome Coronavirus 2 from the Food Chain

A group of experts from all Canadian federal food safety partners was formed to monitor the potential issues relating to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) food contamination, to gather and consider all of the relevant evidence and to determine the impact for Canadian food safety. A comprehensive risk pathway was generated to consider the likelihood of a SARS-CoV-2 contamination event at any of the relevant steps of the food processing and handling chain and the potential for exposure and transmission of the virus to the consumer. The scientific evidence was reviewed and assessed for each event in the pathway, taking into consideration relevant elements that could increase or mitigate the risk of contamination. The advantage of having an event-wise contextualization of the SARS-CoV-2 transmission pathway through the food chain is that it provides a systematic and consistent approach to evaluate any new data and communicate its importance and impact. The pathway also increases the objectivity and consistency of the assessment in a rapidly evolving and high-stakes situation. Based on our review and analysis, there is currently no comprehensive epidemiological evidence of confirmed cases of SARS-CoV-2, or its known variants, causing coronavirus disease 2019 from transmission through food or food packaging. Considering the remote possibility of exposure through food, the likelihood of exposure by ingestion or contact with mucosa is considered negligible to very low, and good hygiene practices during food preparation should continue to be followed.

Faking Detection Improved: Adopting a Likert Item Response Process Tree Model

With the increasing popularity of noncognitive inventories in personnel selection, organizations typically wish to be able to tell when a job applicant purposefully manufactures a favorable impression. Past faking research has primarily focused on how to reduce faking via instrument design, warnings, and statistical corrections for faking. This article took a new approach by examining the effects of faking (experimentally manipulated and contextually driven) on response processes. We modified a recently introduced item response theory tree modeling procedure, the three-process model, to identify faking in two studies. Study 1 examined self-reported vocational interest assessment responses using an induced faking experimental design. Study 2 examined self-reported personality assessment responses when some people were in a high-stakes situation (i.e., selection). Across the two studies, individuals instructed or expected to fake were found to engage in more extreme responding. By identifying the underlying differences between fakers and honest respondents, the new approach improves our understanding of faking. Percentage cutoffs based on extreme responding produced a faker classification precision of 85% on average.

Moral injury: the effect on mental health and implications for treatment

Moral injury: the effect on mental health and implications for treatment

Invisible Moral Wounds of the COVID-19 Pandemic: Are We Experiencing Moral Injury?

Invisible Moral Wounds of the COVID-19 Pandemic: Are We Experiencing Moral Injury?

A Critical Review: Moral Injury in Nurses in the Aftermath of a Patient Safety Incident.

To date, there has been no published work towards understanding or classifying patient safety incidents (PSIs) or their aftermath as potential morally injurious experiences (pMIEs). A morally injurious experience is one that violates deeply held moral values and beliefs, and can put an individual at risk for burnout, post-traumatic stress disorder, and other trauma-related problems. This can also set the stage for moral injury, which can occur when there has been a betrayal of what is right by someone in a position of legitimate authority, or by one's self, in a high-stakes situation. The objective of this review of nurse second victim literature is to describe symptoms of moral injury empirically observed in nurses in the aftermath of a PSI. A critical review using a SALSA (search, appraisal, synthesis, analysis) method commenced with a search of electronic data base-indexed original evidence between 1980 and December 2018, focusing on registered nurses involved with a PSI. The nurse empirical literature reviewed included qualitative (n = 10), quantitative (n = 7), and mixed-methods (n = 4) studies (total n = 21). Core moral injury symptoms included guilt (67%), shame (71%), spiritual-existential crisis (9%), and loss of trust (52%). Secondary symptoms of moral injury included depression (33%), anxiety (57%), anger (71%), self-harm, (19%), and social problems (48%). Moral injury better describes what historically has been called the nurse second victim phenomenon. Through identification of pMIEs and symptoms of moral injury, nurses and organizations can be empowered to advance training and intervention programs addressing pMIEs that affect nurses' safety and retention in the aftermath of a PSI. By describing the experiences associated with a PSI as potentially morally injurious, we set the stage to describe the potential consequences associated with the aftermath of the PSI. Furthermore, this language avoids victimizing those involved by more accurately reflecting the pMIEs of the aftermath.

Simulation and Skills Training for Pediatric Fellows: Improving Confidence in High-Stakes Care at End of Life

Background: End-of-life (EOL) care for a child is a high-stakes situation that requires careful planning and practice; there is only one chance to get it right. Additionally, distress is often high in those caring for dying children. Despite the fact that treating patients with life-threatening illnesses necessitates providing EOL care at some point, formal training and skills practice is not a routine part of pediatric subspecialty training. In contrast, resuscitation - another high-stakes situation - is a skill that is nearly always required for staff. …

Differential Performance in High Versus Low Stakes Tests: Evidence from the Gre Test*

Abstract We study how different demographic groups respond to incentives by comparing their performance in ‘high’ and ‘low’ stakes situations. The high stakes situation is the Graduate Record Examination (GRE), and the low stakes situation is a voluntary experimental section of the GRE. We find that males exhibit a larger drop in performance between the high and low stakes examinations than females, and that whites exhibit a larger drop in performance than minorities. Differences between high and low stakes tests are partly explained by the fact that males and whites exert lower effort in low stakes tests compared with females and minorities.

Differential Performance in High vs. Low Stakes Tests: Evidence from the GRE Test

We study how different demographic groups respond to incentives by comparing their performance in and stakes situations. The high stakes situation is the GRE examination and the low stakes situation is a voluntary experimental section of the GRE. We find that Males exhibit a larger drop in performance between the high and low stakes examinations than females, and Whites exhibit a larger drop in performance compared to minorities. Differences between high and low stakes tests are partly explained by the fact that males and whites exert lower effort in low stakes tests compared to females and minorities.

Engaging Patients in Clinical Trial Planning: Exploring the Concept of a Minimal Clinically Important Difference Among Patients with Obstetrical Antiphospholipid Syndrome

INTRODUCTIONWomen with antiphospholipid syndrome are at increased risk of pregnancy loss. A large randomized controlled trial is still needed to confirm or refute the efficacy of low-molecular-weight heparin (LMWH) and aspirin (ASA) prophylaxis during pregnancy in women with antiphospholipid syndrome (APS) and past pregnancy loss. The minimal clinically important difference (MCID) is a statistical concept that quantifies the smallest amount of benefit from a treatment that a patient would identify as important, and is used to adequately power clinical trials. When planning a clinical trial, the MCID is most often determined by specialists in the field. How patients make sense of MCID as a concept, and how patients' perceptions of MCID compare to physician responses is unknown. In a challenging and high stakes situation, understanding different patients' perspectives must be considered when planning a large clinical trial. METHODSConsecutive patients were approached from a specialty Thrombosis clinic and from the TIPPS (Thrombophilia in Pregnancy Prophylaxis Study) screening logs between January 2017 and March 2018 in Ottawa, Canada to complete a survey and interview. Patients were eligible if they met the revised Sapporo/Sydney laboratory criteria for antiphospholipid syndrome and had at least 1 late pregnancy loss or 2 early losses (<10 weeks gestation). A similar survey was distributed to 350 specialists identified through 5 professional organizations between May-Sept 2016. Both patient and physician groups had access to an introductory video. The mean MCID between the patient group and physician group was compared using an independent t-test, with p<0.05 being significant. Patient interview data were collected and analysed iteratively, in keeping with constructivist grounded theory methodology. RESULTSThere were 22 (33%) patients who completed surveys and 10 patients who completed semi-structured interviews. Among the physician group, 72 (20.6%) responded to the survey, including obstetricians (34.7%), hematologists (26.4%), general internists (18%), maternal fetal medicine specialists (6.9%) and other specialties (12.6%). Assuming a live birth rate of 60% in the ASA alone arm, the mean MCID answered by physicians was 11.6% (range 5-25%, SD 5.2), compared to the mean MCID answered by patients was 10.0% (range 5-20%, SD 6.4) (p=0.28). The mean number needed to treat (NNT) answered by both physicians and patients was 16. In the majority of cases from both groups, the related concepts of MCID and NNT did not match statistically (i.e. an MCID of 15% is a NNT of 7).An overarching theme from the patient survey comments and interviews was that statistics were somewhat irrelevant. The majority of women thought that “any increase in a chance of live birth” was worth it. However, there was variation in patient responses where some women would only accept a certain success rate of LMWH to justify its use because of drug cost or side effects. Some women acknowledged that they would not use LMWH themselves, but still advocated for other patients to have the option of LMWH use for a chance of a live birth. CONCLUSIONThe mean MCID and NNT were similar between patient and physician groups. The low mean MCID and NNT values likely reflect the importance of the outcome studied (avoiding pregnancy loss) and the perceived safety of the proposed interventions of LMWH and/or ASA, which is supported by qualitative data from patient interviews. While the MCID and NNT responses were similar among physicians and patients, the understanding of statistics was somewhat limited in both groups. By better understanding patients' rationale and beliefs about LMWH use, we can better engage them in clinical trial planning and patient care and ensure that we are performing research that is relevant to patients. DisclosuresSkeith:Leo Pharma: Honoraria; CSL Behring: Research Funding. Rodger:Biomerieux: Research Funding.

SUBJECT-SENSITIVE INVARIANTISM, HIGH-STAKES/LOW-STAKES CASES, AND PRESUPPOSITION SUSPENSION

ABSTRACTIt is a familiar criticism of Subject-Sensitive Invariantism that the view makes incorrect predictions about cases in which the attributor of knowledge is in a high-stakes situation and the subject of the attribution in a low-stakes situation. In a recent paper in this journal, Brian Kim has argued that the mentioned type of case should be ignored, since the relevant knowledge ascriptions are inappropriate in virtue of violating an epistemic norm of presupposing. I show, pace Kim, that the mentioned utterances do not carry factivity presuppositions. To this end I discuss a phenomenon known as presupposition suspension, which is widely associated with the presuppositions of epistemic factives such as know that p or discover that p. I argue further that the problem of unknown presuppositions discussed by Kim can be circumvented by slightly amending the cases at hand. In particular, I demonstrate that factivity presuppositions are unobjectionable in problem cases in which the high-stakes ascriber knows the presuppositions at issue to be true.

Deciphering moral intuition: How agents, deeds, and consequences influence moral judgment.

Moral evaluations occur quickly following heuristic-like intuitive processes without effortful deliberation. There are several competing explanations for this. The ADC-model predicts that moral judgment consists in concurrent evaluations of three different intuitive components: the character of a person (Agent-component, A); their actions (Deed-component, D); and the consequences brought about in the situation (Consequences-component, C). Thereby, it explains the intuitive appeal of precepts from three dominant moral theories (virtue ethics, deontology, and consequentialism), and flexible yet stable nature of moral judgment. Insistence on single-component explanations has led to many centuries of debate as to which moral precepts and theories best describe (or should guide) moral evaluation. This study consists of two large-scale experiments and provides a first empirical investigation of predictions yielded by the ADC model. We use vignettes describing different moral situations in which all components of the model are varied simultaneously. Experiment 1 (within-subject design) shows that positive descriptions of the A-, D-, and C-components of moral intuition lead to more positive moral judgments in a situation with low-stakes. Also, interaction effects between the components were discovered. Experiment 2 further investigates these results in a between-subject design. We found that the effects of the A-, D-, and C-components vary in strength in a high-stakes situation. Moreover, sex, age, education, and social status had no effects. However, preferences for precepts in certain moral theories (PPIMT) partially moderated the effects of the A- and C-component. Future research on moral intuitions should consider the simultaneous three-component constitution of moral judgment.

“Basically, I look at it like combat”: Reflections on moral injury by parents involved with child protection services

This study considers any “moral injury” occurring among parents involved with the Child Protection System (CPS). Moral injury refers to the lasting psychological, spiritual and social harm caused by one's own or another's actions in a high stakes situation that transgress deeply held moral beliefs and expectations. The existing literature focuses on military contexts, but moral injury also may play a role in increasing the vulnerability of CPS clients who are threatened with loss of their parental rights and dissolution of their families. We administered a modified version of the Moral Injury Events Scale (MIES) (Nash et al., 2013) to 10 CPS involved parents. We then conducted in-depth, semi-structured, audio recorded individual interviews with parents to elaborate their responses to the MIES. Parents' MIES scores and interview elaborations suggest that some CPS-involved parents do experience moral injury. Moral injury was reported as a result of their own parenting behaviors, but also as a result of parents' involvement with professionals and within social systems that are charged with providing assistance to struggling families. For instance, some parents perceived professionals to be shaming, social services to be harmful and legal proceedings stigmatizing. Parents' reported reactions to morally injurious events included lasting feelings of guilt, shame and anger; and loss of trust in professionals. These responses impeded their perceived abilities to fully engage in services. If involvement in CPS places parents at increased risk of moral injury, then moral injury is a critically important construct for child welfare policy makers and workers to understand and address in the conduct of effective, ethical child welfare practice.

The successful test taker: exploring test-taking behavior profiles through cluster analysis

To be successful in a high-stakes testing situation is desirable for any test taker. It has been found that, beside content knowledge, test-taking behavior, such as risk-taking strategies, motivation, and test anxiety, is important for test performance. The purposes of the present study were to identify and group test takers with similar patterns of test-taking behavior and to explore how these groups differ in terms of background characteristics and test performance in a high-stakes achievement test context. A sample of the Swedish Scholastic Assessment Test test takers (N = 1891) completed a questionnaire measuring their motivation, test anxiety, and risk-taking behavior during the test, as well as background characteristics. A two-step cluster analysis revealed three clusters of test takers with significantly different test-taking behavior profiles: a moderate (n = 741), a calm risk taker (n = 637), and a test anxious risk averse (n = 513) profile. Group difference analyses showed that the calm risk taker profile (i.e., a high degree of risk-taking together with relatively low levels of test anxiety and motivation during the test) was the most successful profile from a test performance perspective, while the test anxious risk averse profile (i.e., a low degree of risk-taking together with high levels of test anxiety and motivation) was the least successful. Informing prospective test takers about these insights can potentially lead to more valid interpretations and inferences based on the test scores.

Moral Injury: Invisible Wounds of Combat (SA517)

•Define and understand Moral Injury as defined in recent scholarship and how it differs from PTSD.•Discuss examples of moral injury using actual veteran stories.•Understand the impact of moral injury upon veterans at the end of life. Various definitions of moral injury exist. Jonathan Shay describes it as “a betrayal of what’s right, by someone who holds legitimate authority, in a high stakes situation.” Brett Litz defines moral injury as “perpetrating, failing to prevent, bearing witness to, or learning about acts that transgress deeply held moral beliefs and expectations.” Moral injury as an entity has only recently been recognized and efforts to address it begun. At the present time, it is not accepted as a diagnosis by the Department of Defense or the Veterans Administration. Moral Injury related to combat is a concept as old as war itself. It is referred to in ancient Greek literature and throughout history. When the noble cause for which one volunteered is compromised a moral injury occurs. Several centers across the country are now conducting research about moral injury and its treatment. Spiritual and faith communities have taken a significant role in addressing and healing moral injury. Outcomes of moral injury include: shame, guilt, anger, isolation, desperation, despair, demoralization, self-handicapping behaviors and self-harming behaviors including suicidality. Unresolved moral injury can complicate the care of Veterans with serious, life limiting, or life-threatening illnesses and have serious effects on their quality of life. Therefore, it is very important that palliative care providers caring for Veterans have a good understanding of the complexities of moral injury. This concurrent session will review the definition of moral injury and how it differs from PTSD. Using stories of combat Veterans, role play and short video presentations, causes of moral injury will be discussed. The effects of moral injury on the care of Veterans in general and Veterans dealing with serious, life limiting, or life-threatening illnesses in particular will be illustrated. This multidisciplinary panel will discuss current treatment options both in the mental health and chaplaincy fields.

A scoping study of moral injury: Identifying directions for social work research

This paper presents a scoping study of moral injury that identified directions for social work research. “Moral injury” refers to lasting psychological, spiritual and social harm caused by one's own or others' actions in a high stakes situation that transgress deeply held moral beliefs and expectations. A “scoping study” is a type of systematic review and knowledge synthesis useful when considering complex, emerging areas of research. Results revealed an increasing interest in moral injury over the past five years primarily in psychology/psychiatry. The majority of published articles are conceptual. Empirical studies aim to better understand the experience of moral injury, qualitatively; and develop and evaluate instruments to assess moral injury, quantitatively. Most empirical studies of moral injury involve US war veterans with little attention to moral injury in other groups, sociocultural contexts, or at different times in development. Failure to address issues of moral injury in social work may leave vulnerable clients struggling with issues of guilt, shame, moral confusion, and an absence of meaning that may persist for years and create obstacles to positive change. In addition, social workers may experience moral injury as they witness morally injurious behavior of others and of systems. If unaddressed, such injuries may diminish effectiveness, or lead to burn out. Social workers need relevant research to understand the extent to which moral injury affects them and their clients, and how to identify and address it.

The Psychiatric Ramifications of Moral Injury Among Veterans

The Psychiatric Ramifications of Moral Injury Among Veterans

Using Classical Test Theory, Item Response Theory, and Rasch Measurement Theory to Evaluate Patient-Reported Outcome Measures: A Comparison of Worked Examples

ObjectiveTo provide comparisons and a worked example of item- and scale-level evaluations based on three psychometric methods used in patient-reported outcome development—classical test theory (CTT), item response theory (IRT), and Rasch measurement theory (RMT)—in an analysis of the National Eye Institute Visual Functioning Questionnaire (VFQ-25). MethodsBaseline VFQ-25 data from 240 participants with diabetic macular edema from a randomized, double-masked, multicenter clinical trial were used to evaluate the VFQ at the total score level. CTT, RMT, and IRT evaluations were conducted, and results were assessed in a head-to-head comparison. ResultsResults were similar across the three methods, with IRT and RMT providing more detailed diagnostic information on how to improve the scale. CTT led to the identification of two problematic items that threaten the validity of the overall scale score, sets of redundant items, and skewed response categories. IRT and RMT additionally identified poor fit for one item, many locally dependent items, poor targeting, and disordering of over half the response categories. ConclusionsSelection of a psychometric approach depends on many factors. Researchers should justify their evaluation method and consider the intended audience. If the instrument is being developed for descriptive purposes and on a restricted budget, a cursory examination of the CTT-based psychometric properties may be all that is possible. In a high-stakes situation, such as the development of a patient-reported outcome instrument for consideration in pharmaceutical labeling, however, a thorough psychometric evaluation including IRT or RMT should be considered, with final item-level decisions made on the basis of both quantitative and qualitative results.

How to Help Patients and Families Make Better End-of-Life Decisions

How can clinical ethics consultants best assist patients and their family members when patients may be dying? In this introduction, I consider this concern in light of four articles that appear in this issue of The Journal of Clinical Ethics, by Jeffrey T. Berger; Mary T. White; Linying Hu, Xiuyun Yin, Xiaolei Bao, and Jin-Bao Nie; and Thaddeus Mason Pope and Melinda Hexum. Patients and family members experience extreme stress at the end of life, a high-stakes situation in which few of us have extensive experience. This stress can make us less able to process new information, cripple decision making, and even lead to long-term harm. I provide a number of practical approaches that clinical ethics consultants can use to help patients and family members in these situations, so that their decisions may reflect more what they really want and so that, after this stress has diminished, they may then do better.