‘Cognitive Biases Plus’ and healthcare evidence
| Description | |
|---|---|
| Conflicts of interest (CoIs) | |
| Financial, non-financial and intellectual CoIs (often co-occur) | Circumstances in which a self-serving factor (gain) has the potential to prejudice views and decisions. Non-financial CoIs include desire for promotion, prestige, etc. Intellectual CoI is driven by a strong personal belief and likely confounds all discourses. Potential for succumbing to CoI is intrinsic to all humans. CoIs are necessary catalysts for the cascade (see figure 1) |
| Individual or group cognitive biases | |
| Self-serving bias (incentive bias) | The most important of all biases. Judgment influenced by personal or organisational (self-serving) motives |
| Confirmation bias (interpretive bias) | Favouring evidence supporting one's preconception and ignoring evidence that does not support it. Often associated with anchoring and consistency |
| In-group conformity (social proof) | Increasing confidence in a decision when it is in agreement with others |
| Authority bias and halo effect | Uncritical acceptance, even without coercion, of the views of authority, including expert groups and high-impact publications |
| Reductionism | Reducing complex or uncertain scenarios into simpler ideas or concepts. The resulting evidence risks being flawed for the often complex clinical situations seen in clinical practice |
| Automation | Uncritical use of automated technology, including statistical software, apps with preappraised sources of evidence, decision support systems and the like. An increasingly important bias |
| Group or organisational cognitive biases | |
| Scientific inbreeding | The practice of those trained in the same school of thought/or by the same experts, working together in the same field. High risk for groupthink and replication publication biases. Similar to academic or intellectual inbreeding |
| Groupthink (inside view) | The views of close-knit/inbred decision-making groups risk becoming homogeneous; opposing views are discouraged or disregarded |
| Herd effect (lemming effect, emperor's new clothes effect) | Alignment of thoughts or behaviours in a group/organisation, often catalysed by authority. Decisions or opinions of authority are accepted/obeyed unquestioningly. Social media are becoming important catalysts (‘the viral effect’) |
| Fallacies (logical errors in reasoning) | |
| Two examples (individual, group or organisational level) | Planning fallacy: Incorrectly estimating the benefits of policies or actions, and/or unrealistically discounting costs and consequences Sunk cost fallacy: Reluctance or inability to change course when too much has been invested |
| Ethical violations | |
| A spectrum | Range of behaviours including subtle statistical manipulations, selective publication and outright fabrication. Associated with rationalisation and self-deception. In healthcare, no ethical violation is minor: all can harm |
Elements of ‘cognitive biases plus’. Only some of the many (frequently co-occurring) cognitive biases and fallacies are listed. The table and figure supplement each other. The contents are substantially condensed and revised from (1) table 1 in Seshia et al.4 and (2) table 1 in Seshia et al.5 Publisher: John Wiley & Sons Ltd. Please refer to the references for details and primary references.