Is clinical decision making in stepped-care psychological services influenced by heuristics and biases?

IF 2 4区 心理学 Q3 PSYCHOLOGY, CLINICAL
Benjamin Michael, Stephen Kellett, Jaime Delgadillo
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Abstract

Background: The manner in which heuristics and biases influence clinical decision-making has not been fully investigated and the methods previously used have been rudimentary.

Aims: Two studies were conducted to design and test a trial-based methodology to assess the influence of heuristics and biases; specifically, with a focus on how practitioners make decisions about suitability for therapy, treatment fidelity and treatment continuation in psychological services.

Method: Study 1 (N=12) used a qualitative design to develop two clinical vignette-based tasks that had the aim of triggering heuristics and biases during clinical decision making. Study 2 (N=133) then used a randomized crossover experimental design and involved psychological wellbeing practitioners (PWPs) working in the Improving Access to Psychological Therapies (IAPT) programme in England. Vignettes evoked heuristics (anchoring and halo effects) and biased responses away from normative decisions. Participants completed validated measures of decision-making style. The two decision-making tasks from the vignettes yielded a clinical decision score (CDS; higher scores being more consistent with normative/unbiased decisions).

Results: Experimental manipulations used to evoke heuristics did not significantly bias CDS. Decision-making style was not consistently associated with CDS. Clinical decisions were generally normative, although with some variability.

Conclusions: Clinical decision-making can be 'noisy' (i.e. variable across practitioners and occasions), but there was little evidence that this variability was systematically influenced by anchoring and halo effects in a stepped-care context.

阶梯式心理服务的临床决策是否受到启发式和偏见的影响?
背景:启发式和偏见影响临床决策的方式尚未得到充分调查,以前使用的方法还很初级。目的:进行了两项研究,以设计和测试基于试验的方法来评估启发式和偏差的影响;具体地说,重点是从业者如何在心理服务中做出治疗的适宜性、治疗的保真性和治疗的连续性的决定。方法:研究1 (N=12)采用定性设计来开发两个基于临床小场景的任务,目的是在临床决策过程中触发启发式和偏差。研究2 (N=133)采用了随机交叉实验设计,并纳入了在英国改善心理治疗(IAPT)项目中工作的心理健康从业者(PWPs)。小插曲引发了启发式(锚定和光环效应)和偏离规范决策的偏见反应。参与者完成了经过验证的决策风格测试。来自小插曲的两个决策任务产生临床决策评分(CDS;得分越高,越符合规范/公正的决定)。结果:用于唤起启发式的实验操作对CDS没有显著的偏倚。决策风格并不总是与CDS相关。临床决定通常是规范的,尽管有一些差异。结论:临床决策可能是“嘈杂的”(即不同的医生和场合的变量),但很少有证据表明,这种变异性系统地受到锚定效应和光环效应的影响。
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来源期刊
CiteScore
3.50
自引率
5.60%
发文量
82
期刊介绍: An international multidisciplinary journal aimed primarily at members of the helping and teaching professions. Behavioural and Cognitive Psychotherapy features original research papers, covering both experimental and clinical work, that contribute to the theory, practice and evolution of cognitive and behaviour therapy. The journal aims to reflect and influence the continuing changes in the concepts, methodology, and techniques of behavioural and cognitive psychotherapy. A particular feature of the journal is its broad ranging scope - both in terms of topics and types of study covered. Behavioural and Cognitive Psychotherapy encompasses most areas of human behaviour and experience, and represents many different research methods, from randomized controlled trials to detailed case studies.
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