探索心脏外科团队的术中认知偏差。

Roger D Dias, Steven J Yule, Ryan Harari, Marco A Zenati
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引用次数: 0

摘要

本研究的重点是了解认知偏差对心脏外科团队术中决策过程的影响,并认识到此类环境的复杂性和高风险性质。我们旨在调查认知偏差在心脏外科团队中的流行程度和影响,以及这些偏差会如何影响术中决策、患者安全和预后。我们采用了一种混合方法,对心脏手术术中阶段 32 种不同认知偏差的 "发生可能性 "和 "对患者造成伤害的可能性 "进行了量化评分(0 到 100 分的视觉模拟量表)。在这些评分的基础上,我们对在心脏手术室工作的外科医生、麻醉师和灌注师进行了半结构化访谈,收集了他们对评分最高的认知偏差的定性分析。包括心脏外科研究人员和临床医生在内,共有 16 人参与了这项研究。我们发现存在大量认知偏差,尤其是确认偏差和过度自信,它们影响了决策过程,并有可能对患者造成伤害。在 32 种认知偏差中,有 6 种在两个标准(对患者造成伤害的可能性和发生的可能性)中的评分都超过了第 75 百分位数。我们的初步研究结果为深入了解手术室临床推理和决策的复杂认知机制迈出了第一步。未来的研究应进一步探讨这一课题,尤其是术中认知偏差的发生与术后手术结果之间的关系。此外,还应该研究元认知策略(如去伪存真训练)对减少认知偏差影响和提高术中表现的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Exploring Intraoperative Cognitive Biases in Cardiac Surgery Teams.

This study focuses on understanding the influence of cognitive biases in the intra-operative decision-making process within cardiac surgery teams, recognizing the complexity and high-stakes nature of such environments. We aimed to investigate the perceived prevalence and impact of cognitive biases among cardiac surgery teams, and how these biases may affect intraoperative decisions and patient safety and outcomes. A mixed-methods approach was utilized, combining quantitative ratings across 32 different cognitive biases (0 to 100 visual analogue scale), regarding their "likelihood of occurring" and "potential for patient harm" during the intraoperative phase of cardiac surgery. Based on these ratings, we collected qualitative insights on the most-rated cognitive biases from semi-structured interviews with surgeons, anaesthesiologists, and perfusionists who work in a cardiac operating room. A total of 16 participants, including cardiac surgery researchers and clinicians, took part in the study. We found a significant presence of cognitive biases, particularly confirmation bias and overconfidence, which influenced decision-making processes and had the potential for patient harm. Of 32 cognitive biases, 6 were rated above the 75th percentile for both criteria (potential for patient harm, likelihood of occurring). Our preliminary findings provide a first step toward a deeper understanding of the complex cognitive mechanisms that underlie clinical reasoning and decision-making in the operating room. Future studies should further explore this topic, especially the relationship between the occurrence of intraoperative cognitive biases and postoperative surgical outcomes. Additionally, the impact of metacognition strategies (e.g. debiasing training) on reducing the impact of cognitive bias and improving intraoperative performance should also be investigated.

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