Light and adapted to the context
Incorporating deliberation in busy clinical settings
Every man hears only what he understands. ~Goethe
Research in cognitive psychology has proposed that humans make decisions using two distinct pathways: intuitive and deliberative. Intuitive decisions are fast, take place at a subconscious level and require little effort but are hard to explain to others and can be easily affected by cognitive biases and emotional states. Deliberative decisions require thought and effort. Consequently they are slower, but also more logical, explicit, and less susceptible to the adverse effects of cognitive biases and emotions. Because they are explicit, they are necessary for effective shared decision making when multiple people are involved in making a decision. [1,2]
As discussed in the October 4, 2022 Musing, one of the characteristics of decision support systems that have proven to be effective in busy applied settings is support for both intuitive and deliberative decision making processes.
The research regarding decisions made by soccer players reviewed in last week’s Musing, suggests that people can learn to use deliberative thinking methods to guide decisions in situations as dynamic and fluid as an ongoing soccer game.
Taken together, these findings raise the question of how to help providers and patients use an appropriate combination of intuitive and deliberative processes when making decisions in busy clinical settings.
As noted last week, the soccer research suggests that the answer is making the deliberative methods “…light and adapted to the constraints of the context…” [3] The simplest and fastest way to do this is probably through the creation of a decision model.
A decision model is a diagram that maps out the decision objective, the options, and the factors being used to judge which option to choose. By making the decision explicit, it is by definition a deliberative decision making procedure that fosters communication among decision makers and the integration and puts data and other decision-related information. I discussed how this process could work in the December 23, 2022 Musing.
Models can be created simply on a piece of paper, or after considerable study by a guidelines panel or similar group. A good general model to use for most clinical decisions is the decision quality chain, discussed in the December 2, 2022 Musing.
Musings
Decision models are basic elements of decision analysis - a proven set of tools to help people engage in deliberative decision making processes and, by so doing, make better choices. Why they are not a fundamental part of clinical, and especially shared decision making, is a mystery to me.
References
1. Stanovich KE, West RF. Individual differences in reasoning: Implications for the rationality debate? Behavioral and Brain Sciences. 2000 Oct;23(5):645–65.
2. Daniel Kahneman. Thinking, Fast and Slow [Internet]. Farrar, Straus and Giroux; 2011.
3. Petiot GH, Bagatin R, Aquino R, Raab M. Key characteristics of decision making in soccer and their implications. New Ideas in Psychology. 2021 Apr;61:100846.