Medical Decision Making

How health professionals and patients make treatment decisions, and the barriers to, and facilitators of, effective decision making.

Association of Cognitive Biases with Human Papillomavirus Vaccine Hesitancy: A Cross-Sectional Study

Dec. 20, 2019

Tiffany D. Poares, Alison M. Buttenheim, Avnika B. Amin, Caroline M. Joyce, Rachael M. Porter, Robert A. Bednarczyk, Saad B. Omer

Abstract [from journal]

Given the link between vaccine hesitancy and vaccine-preventable disease outbreaks, it is critical to examine the cognitive processes that contribute to the development of vaccine hesitancy, especially among parents of adolescents. We conducted a secondary analysis of baseline data from a two-phase randomized trial on human papillomavirus to investigate how vaccine hesitancy and intent to vaccinate are associated with six decision-making factors: base rate neglect, conjunction fallacy, sunk cost bias, present bias


Advance Care Planning Claims and Health Care Utilization Among Seriously Ill Patients Near the End of Life

Nov. 1, 2019

Deepshikha Ashana, Xiaoxue Chen, Abiy Agiro, Gayathri Sridhar, Ann Nguyen, John Barron, Kevin Haynes, Michael Fisch, David Debono, Scott D. Halpern, Michael O. Harhay

Abstract [from journal]

Importance: Although advance care planning is known to increase patient and caregiver satisfaction, its association with health care utilization is not well understood.

Objective: To examine the association between billed advance care planning encounters and subsequent health care utilization among seriously ill patients.

Design, Setting, and Participants: This retrospective cohort study conducted from October 1, 2015, to May 31, 2018, used a national commercial insurance claims database


Can Machine Learning Improve Cancer Care?

Oct. 25, 2019

“How long do I have?”

It is the first question many patients ask after a cancer diagnosis. It is also among the hardest to answer. For decades, predicting cancer survival was more art than science. But now, unprecedented computing power and access to digital health information offer a tantalizing opportunity: can machine learning (ML) algorithms succeed where others fail?

Performance of a Clinical Decision Support Tool to Identify PICU Patients at High Risk for Clinical Deterioration

Heather Wolfe, MD
Oct. 2, 2019

Maya Dewan, Naveen Muthu, Eric Shelov, Christopher Bonafide, Patrick Brady, Daniela Davis, Eric Kirkendall, Dana Niles, Robert Sutton, Danielle Traynor, Ken Tegtmeyer, Vinay Nadkarni, Heather Wolfe

Abstract [from journal]

Objectives: To evaluate the translation of a paper high-risk checklist for PICU patients at risk of clinical deterioration to an automated clinical decision support tool.

Design: Retrospective, observational cohort study of an automated clinical decision support tool, the PICU Warning Tool, adapted from a paper checklist to predict clinical deterioration events in PICU patients within 24 hours.

Setting: Two quaternary care medical-surgical PICUs—The Children’s Hospital of Philadelphia and...

Opioid Prescribing After Surgery in the United States, Canada, and Sweden

Mark D. Neuman, MD
Sep. 4, 2019

Karim S. Ladha, Mark D. Neuman, Gabriella Broms, Jennifer Bethell, Brian T. Bateman, Duminda N. Wijeysundera, Max Bell, Linn Hallqvist, Tobias Svensson, Craig W. Newcomb, Colleen M. Brensinger, Lakisha J. Gaskins, Hannah Wunsch

Abstract [from journal]

Importance: Small studies and anecdotal evidence suggest marked differences in the use of opioids after surgery internationally; however, this has not been evaluated systematically across populations receiving similar procedures in different countries.

Objective: To determine whether there are differences in the frequency, amount, and type of opioids dispensed after surgery among the United States, Canada, and Sweden.

Design, Setting, and Participants: This cohort study included patients...

Evolution of Excisional Surgery Practices for Melanoma in the United States

Jeremy Etzkorn
Aug. 28, 2019

Michael P. Lee, Joseph F. Sobanko, Thuzar M. Shin, Nicole M. Howe, John S. Barbieri, Christopher J. Miller, Jeremy R. Etzkorn

Abstract [from journal]

Importance: National Comprehensive Cancer Network guidelines for melanoma have consistently recommended wide local excision as the standard of care since their inception. Although surgery with more comprehensive margin assessment (eg, Mohs surgery) has been advocated for certain subsets of melanoma, how often these techniques are used in clinical practice is uncertain.

Objective: To examine trends in the use of comprehensive margin assessment surgery for melanoma by tracking claims data for


Cognitive Biases Influence Decision-Making Regarding Postacute Care in a Skilled Nursing Facility

Aug. 21, 2019

Robert E Burke, Chelsea Leonard, Marcie Lee, Roman Ayele, Ethan Cumbler, Rebecca Allyn, S Ryan Greysen

Abstract [from journal]

Background: Decisions about postacute care are increasingly important as the United States population ages, its use becomes increasingly common, and payment reforms target postacute care. However, little is known about how to improve these decisions.

Objective: To understand whether cognitive biases play an important role in patient and clinician decision-making regarding postacute care in skilled nursing facilities (SNFs) and identify the most impactful biases.

Design: Secondary analysis of...

What Are the Costs of Cervical Radiculopathy Prior to Surgical Treatment?

Jul. 1, 2019

Cameron Barton, Piyush Kalakoti, Nicholas Bedard, Nathan Hendrickson, Comron Saifi, Andrew Pugely

Abstract [from journal]

Study Design: Retrospective, observational study.

Objective: To examine the costs associated with nonoperative management (diagnosis and treatment) of cervical radiculopathy in the year prior to anterior cervical discectomy and fusion (ACDF).

Summary of Background Data: While the costs of operative treatment have been previously described, less is known about nonoperative management costs of cervical radiculopathy leading up to surgery.

Methods: The Humana claims


Impact of Public Reporting of Cardiovascular Outcomes on a Non-Reported Procedure

Apr. 26, 2019

Public reporting of cardiovascular outcomes remains controversial, 20 years after New York became the first state to mandate reporting of mortality data for percutaneous coronary intervention (PCI). It has been associated with a lower likelihood of performing potentially lifesaving procedures, perhaps reflecting an avoidance of intervening in high-risk cases.

Factors Affecting Fertility Decision-Making Among Transgender Adolescents and Young Adults

Apr. 15, 2019

Diane Chen, Moira A. Kyweluk, Afiya Sajwani, Elisa J. Gordon, Emilie K. Johnson, Courtney A. Finlayson, and Teresa K. Woodruff

Abstract [from journal]

Purpose: This study aimed to identify factors affecting transgender adolescents' and young adults' (AYA) decisions to pursue fertility preservation (FP).



Shared decision-making in the BREATHE asthma intervention trial: A research protocol

Marilyn Sommers, PhD, RN, FAAN
Apr. 1, 2019

Maureen George, Michael V. Pantalon, Marilyn (Lynn) S. Sommers, Karen Glanz, Haomiao Jia, Annie Chung, Allison A. Norful, Lusine Poghosyan, Danielle Coleman, Jean‐Marie Bruzzese

Abstract [from journal]

Aim: To evaluate the preliminary effectiveness of the BRief Evaluation of Asthma THerapy intervention, a 7-min primary care provider-delivered shared decision-making protocol that uses motivational interviewing to address erroneous asthma disease and medication beliefs.

Design: A multi-centre masked two-arm group-randomized clinical trial.

Methods: This 2-year pilot study is funded (September 2016) by the National Institute of Nursing Research. Eight providers will be randomized to one of two arms: the...

Do framing effects debunk moral beliefs?

Mar. 1, 2019

Matthew L. Stanley, Siyuan Yin, Walter Sinnott-Armstrong

Abstract [from journal]

The moral dumbfounding phenomenon for harmless taboo violations is often cited as a critical piece of empirical evidence motivating anti-rationalist models of moral judgment and decision-making. Moral dumbfounding purportedly occurs when an individual remains obstinately and steadfastly committed to a moral judgment or decision even after admitting inability to provide reasons and arguments to support it (Haidt, 2001). Early empirical support for the moral dumbfounding phenomenon led some philosophers and psychologists to suggest that affective