The Role of Representative Design in an Ecological Approach to Cognition

Effect of Size, Shape and Map Background in Cartographic Visualization: Experimental Study on Czech and Chinese Populations

This paper deals with the issue of the perceptual aspects of selected graphic variables (specifically shape and size) and map background in cartographic visualization. The continued experimental study is based on previous findings and the presupposed cross-cultural universality of shape and size as a graphic variable. The results bring a new perspective on the usage of shape, size and presence/absence of background as graphic variables, as well as a comparison to previous studies. The results suggest that all examined variables influence the speed of processing. Respondents (Czech and Chinese, N = 69) identified target stimuli faster without a map background, with larger stimuli, and with triangular and circular shapes. Czech respondents were universally faster than Chinese respondents. The implications of our research were discussed, and further directions were outlined.

Emergence of Skilled Behaviors in Professional, Amateur and Junior Cricket Batsmen During a Representative Training Scenario

The aim of this study was to explore the emergence of skilled behaviors, in the form of actions, cognitions and emotions, between professional state level cricket batters and their lesser skilled counterparts. Twenty-two male cricket batsmen (n = 6 state level; n = 8 amateur grade club level, n = 8 junior state representative level) participated in a game scenario training session against right arm pace bowlers (n = 6 amateur senior club). The batsmen were tasked with scoring as many runs as possible during a simulated limited-overs game. The actions, cognitions, and emotions of each batsmen were recorded in situ with findings showing differences between state level players and those lesser skilled. State level batsmen played more scoring shots and scored more runs, underpinned by superior bat-ball contact and technical efficiency. Furthermore, the state player's cognitive evaluations of their own performance differed from junior batters, with more reported strategies based on an external outcome focus, such as where to score runs, rather than a focus on internal processes, such as making technical changes. State level batsmen also reported lower levels of nervousness compared with junior level batsmen. These results highlight the importance of viewing the emergence of skilled behavior as multi-faceted, rather than simply the acquisition of superior execution and technical proficiency.

Effects of Overlap Between Consecutive Words on Speeded Typing Inform About Representation of Serial Order Within Words

Typing is an everyday activity that requires people to use the correct serial order of phonological and orthographic forms of words. The evidence until now shows that different forms of representation of serial order have mixed contributions to typing performance. It is not clear whether and how representational overlap between subsequent words impacts the speed of typing. In three experiments, we used speeded typing of six-letter words. Including conditions with secondary task load to counteract potential ceiling effects, we varied whether subsequent words had partial overlap with respect to a chaining representation (e.g., kirsch → schaum; same triplet in different position) or, in addition, overlapped with respect to a potential positional representation (e.g., berlin → dublin, same triplet in the same position). Differently from previous findings (e.g., Snyder & Logan, 2014), Experiments 1 and 2 suggest that (a) chaining as well as positional coding are involved as representations of serial order and (b) partial overlap of representation of serial order leads to costs in typing speed. Experiment 3 demonstrated that full overlap speeds up typing. Across all experiments, the overlap effects were most revealed in the latency of the first keystroke, indicating the planning of motor programs. Taken together, the results suggest that even in highly practiced tasks such as typing, the activation of representations of serial order has side effects beyond the production of the current sequence.

Nutrient-specific system versus full fact panel: Testing the benefits of nutrient-specific front-of-package labels in a student sample

Current food labels include comprehensive nutritional information, but evaluations of their effects on judgments of nutritional quality and food choice are scarce. Building on previous empirical research that demonstrated that amount and complexity of information is negatively related to judgment accuracy, this study used an experimental design to evaluate nutritional information labels of varying complexity. Lens model analysis (Brunswik, 1952; Cooksey, 1996; Hammond, 1955; Stewart, 1976) was used to study the judgment process. Nutrition judgment accuracy was assessed by comparing nutrition judgments to a nutrition expert criterion (NuVal^®) in three package labeling conditions. The conditions were: no nutritional information highlighted; nutrients highly related to nutritional quality highlighted using a front-of-package (FOP) label; and nutrients unrelated to nutritional quality highlighted using a FOP label. Findings indicate a limited role of FOP labeling in increasing judgment accuracy, consistency of nutritional information usage, and food choice. Implications for understanding labeling efforts to improve food choices are discussed.

Using Psychophysiological Sensors to Assess Mental Workload During Web Browsing

Knowledge of the mental workload induced by a Web page is essential for improving users’ browsing experience. However, continuously assessing the mental workload during a browsing task is challenging. To address this issue, this paper leverages the correlation between stimuli and physiological responses, which are measured with high-frequency, non-invasive psychophysiological sensors during very short span windows. An experiment was conducted to identify levels of mental workload through the analysis of pupil dilation measured by an eye-tracking sensor. In addition, a method was developed to classify mental workload by appropriately combining different signals (electrodermal activity (EDA), electrocardiogram, photoplethysmo-graphy (PPG), electroencephalogram (EEG), temperature and pupil dilation) obtained with non-invasive psychophysiological sensors. The results show that the Web browsing task involves four levels of mental workload. Also, by combining all the sensors, the efficiency of the classification reaches 93.7%.

The Socio-Moral Image Database (SMID): A novel stimulus set for the study of social, moral and affective processes

A major obstacle for the design of rigorous, reproducible studies in moral psychology is the lack of suitable stimulus sets. Here, we present the Socio-Moral Image Database (SMID), the largest standardized moral stimulus set assembled to date, containing 2,941 freely available photographic images, representing a wide range of morally (and affectively) positive, negative and neutral content. The SMID was validated with over 820,525 individual judgments from 2,716 participants, with normative ratings currently available for all images on affective valence and arousal, moral wrongness, and relevance to each of the five moral values posited by Moral Foundations Theory. We present a thorough analysis of the SMID regarding (1) inter-rater consensus, (2) rating precision, and (3) breadth and variability of moral content. Additionally, we provide recommendations for use aimed at efficient study design and reproducibility, and outline planned extensions to the database. We anticipate that the SMID will serve as a useful resource for psychological, neuroscientific and computational (e.g., natural language processing or computer vision) investigations of social, moral and affective processes. The SMID images, along with associated normative data and additional resources are available at https://osf.io/2rqad/.

Simultaneous utilization of multiple cues in judgments of learning

There is much evidence that metacognitive judgments, such as people's predictions of their future memory performance (judgments of learning, JOLs), are inferences based on cues and heuristics. However, relatively little is known about whether and when people integrate multiple cues in one metacognitive judgment or focus on a single cue without integrating further information. The current set of experiments systematically addressed whether and to what degree people integrate multiple extrinsic and intrinsic cues in JOLs. Experiment 1 varied two cues: number of study presentations (1 vs. 2) and font size (18 point vs. 48 point). Results revealed that people integrated both cues in their JOLs. Experiment 2 demonstrated that the two word characteristics concreteness (abstract vs. concrete) and emotionality (neutral vs. emotional) were integrated in JOLs. Experiment 3 showed that people integrated all four cues in their JOLs when manipulated simultaneously. Finally, Experiment 4 confirmed integration of three cues that varied on a continuum rather than in two easily distinguishable levels. These results demonstrate that people have a remarkable capacity to integrate multiple cues in metacognitive judgments. In addition, our findings render an explanation of cue effects on JOLs in terms of demand characteristics implausible.

Kenneth R. Hammond’s contributions to the study of judgment and decision making

Kenneth R. Hammond (1917–2015) made several major contributions to the science of human judgment and decision making. As a student of Egon Brunswik, he kept Brunswik’s legacy alive – advancing his theory of probabilistic functionalism and championing his method of representative design. Hammond pioneered the use of Brunswik’s lens model as a framework for studying how individuals use information from the task environment to make clinical judgments, which was the precursor to much ‘policy capturing’ and ‘judgment analysis’ research. Hammond introduced the lens model equation to the study of judgment processes, and used this to measure the utility of different forms of feedback in multiple-cue probability learning. He extended the scope of analysis to contexts in which individuals interact with one another – introducing the interpersonal learning and interpersonal conflict paradigms. Hammond developed social judgment theory which provided a comprehensive quantitative approach for describing and improving judgment processes. He proposed cognitive continuum theory which states that quasi-rationality is an important middle-ground between intuition and analysis and that cognitive performance is dictated by the match between task properties and mode of cognition. Throughout his career, Hammond moved easily from basic laboratory work to applied settings, where he resolved policy disputes, and in doing so, he pointed to the dichotomy between theories of correspondence and coherence. In this paper, we present Hammond’s legacy to a new generation of judgment and decision making scholars.

Within-person adaptivity in frugal judgments from memory

Humans can exploit recognition memory as a simple cue for judgment. The utility of recognition depends on the interplay with the environment, particularly on its predictive power (validity) in a domain. It is, therefore, an important question whether people are sensitive to differences in recognition validity between domains. Strategic, intra-individual changes in the reliance on recognition have not been investigated so far. The present study fills this gap by scrutinizing within-person changes in using a frugal strategy, the recognition heuristic (RH), across two task domains that differed in recognition validity. The results showed adaptive changes in the reliance on recognition between domains. However, these changes were neither associated with the individual recognition validities nor with corresponding changes in these validities. These findings support a domain-adaptivity explanation, suggesting that people have broader intuitions about the usefulness of recognition across different domains that are nonetheless sufficiently robust for adaptive decision making. The analysis of metacognitive confidence reports mirrored and extended these results. Like RH use, confidence ratings covaried with task domain, but not with individual recognition validities. The changes in confidence suggest that people may have metacognitive access to information about global differences between task domains, but not to individual cue validities.

Cognitive continuum theory in interprofessional healthcare: A critical analysis

Effective clinical decision making is among the most important skills required by healthcare practitioners. Making sound decisions while working collaboratively in interprofessional healthcare teams is essential for modern healthcare planning, successful interventions, and patient care. The cognitive continuum theory (CCT) is a model of human judgement and decision making aimed at orienting decision-making processes. CCT has the potential to improve both individual health practitioner, and interprofessional team understanding about, and communication of, clinical decision-making processes. Examination of the current application of CCT indicates that this theory could strengthen interprofessional team clinical decision making (CDM). However, further research is needed before extending the use of this theoretical framework to a wider range of interprofessional healthcare team processes. Implications for research, education, practice, and policy are addressed.

Situational and person-related factors influencing momentary and retrospective soundscape evaluations in day-to-day life

Soundscape research draws on both experiments conducted in laboratory settings and studies in the field to explore peoples' perception and understanding of their acoustic environments. One opportunity to combine the strength of both approaches is the so-called Experience Sampling Method (ESM). This method was used to investigate the influence of situational and person-related variables on soundscape evaluations. Further, the relationship between momentary and retrospective soundscape judgments was explored. In the course of the 7-day ESM study, 32 participants were prompted ten times per day by a smartphone application to evaluate their soundscape and report on situational factors. Additionally, they performed summary retrospective judgments evaluating the whole of each day and their whole week. Upon completion, an exit interview probed personality traits (e.g., Big Five, information processing styles). Results revealed that both situational and person-related factors significantly contributed to the judgments of three soundscape dimensions (pleasantness, eventfulness, familiarity). Retrospective judgments of soundscape pleasantness were not only the average of the momentary judgments, but were also affected by the peak moment, the linear trend of the experience, and a person's mood while performing the judgment. Hence, the study provides valuable insights into the complex structure of momentary and retrospective soundscape evaluations.

Use of the recognition heuristic depends on the domain's recognition validity, not on the recognition validity of selected sets of objects

According to the recognition-heuristic theory, decision makers solve paired comparisons in which one object is recognized and the other not by recognition alone, inferring that recognized objects have higher criterion values than unrecognized ones. However, success-and thus usefulness-of this heuristic depends on the validity of recognition as a cue, and adaptive decision making, in turn, requires that decision makers are sensitive to it. To this end, decision makers could base their evaluation of the recognition validity either on the selected set of objects (the set's recognition validity), or on the underlying domain from which the objects were drawn (the domain's recognition validity). In two experiments, we manipulated the recognition validity both in the selected set of objects and between domains from which the sets were drawn. The results clearly show that use of the recognition heuristic depends on the domain's recognition validity, not on the set's recognition validity. In other words, participants treat all sets as roughly representative of the underlying domain and adjust their decision strategy adaptively (only) with respect to the more general environment rather than the specific items they are faced with.

Adolescents display distinctive tolerance to ambiguity and to uncertainty during risky decision making

Although actuarial data indicate that risk-taking behavior peaks in adolescence, laboratory evidence for this developmental spike remains scarce. One possible explanation for this incongruity is that in the real world adolescents often have only vague information about the potential consequences of their behavior and the likelihoods of those consequences, whereas in the lab these are often clearly stated. How do adolescents behave under such more realistic conditions of ambiguity and uncertainty? We asked 105 participants aged from 8 to 22 years to make three types of choices: (1) choices between options whose possible outcomes and probabilities were fully described (choices under risk); (2) choices between options whose possible outcomes were described but whose probability information was incomplete (choices under ambiguity), and (3) choices between unknown options whose possible outcomes and probabilities could be explored (choices under uncertainty). Relative to children and adults, two adolescent-specific markers emerged. First, adolescents were more accepting of ambiguity; second, they were also more accepting of uncertainty (as indicated by shorter pre-decisional search). Furthermore, this tolerance of the unknown was associated with motivational, but not cognitive, factors. These findings offer novel insights into the psychology of adolescent risk taking.

What Constitutes Strong Psychological Science? The (Neglected) Role of Diagnosticity and A Priori Theorizing

A Bayesian perspective on Ioannidis’s (2005) memorable statement that “Most Published Research Findings Are False” suggests a seemingly inescapable trade-off: It appears as if research hypotheses are based either on safe ground (high prior odds), yielding valid but unsurprising results, or on unexpected and novel ideas (low prior odds), inspiring risky and surprising findings that are inevitably often wrong. Indeed, research of two prominent types, sexy hypothesis testing and model testing, is often characterized by low priors (due to astounding hypotheses and conjunctive models) as well as low-likelihood ratios (due to nondiagnostic predictions of the yin-or-yang type). However, the trade-off is not inescapable: An alternative research approach, theory-driven cumulative science, aims at maximizing both prior odds and diagnostic hypothesis testing. The final discussion emphasizes the value of pluralistic science, within which exploratory phenomenon-driven research can play a similarly strong part as strict theory-testing science.

Effects of the Advisor and Environment on Requesting and Complying With Automated Advice

Given the rapid technological advances in our society and the increase in artificial and automated advisors with whom we interact on a daily basis, it is becoming increasingly necessary to understand how users interact with and why they choose to request and follow advice from these types of advisors. More specifically, it is necessary to understand errors in advice utilization. In the present study, we propose a methodological framework for studying interactions between users and automated or other artificial advisors. Specifically, we propose the use of virtual environments and the tarp technique for stimulus sampling, ensuring sufficient sampling of important extreme values and the stimulus space between those extremes. We use this proposed framework to identify the impact of several factors on when and how advice is used. Additionally, because these interactions take place in different environments, we explore the impact of where the interaction takes place on the decision to interact. We varied the cost of advice, the reliability of the advisor, and the predictability of the environment to better understand the impact of these factors on the overutilization of suboptimal advisors and underutilization of optimal advisors. We found that less predictable environments, more reliable advisors, and lower costs for advice led to overutilization, whereas more predictable environments and less reliable advisors led to underutilization. Moreover, once advice was received, users took longer to make a final decision, suggesting less confidence and trust in the advisor when the reliability of the advisor was lower, the environment was less predictable, and the advice was not consistent with the environmental cues. These results contribute to a more complete understanding of advice utilization and trust in advisors.

Drug Benefit Decisions among Older Adults: A Policy-Capturing Analysis

Purpose . Under the Medicare Prescription Drug Improvement and Modernization Act, beneficiaries remaining in the traditional fee-for-service plan will face a variety of drug benefit options provided by private stand-alone prescription drug plans. Although these plans likely will differ with regard to a number of important attributes, little is known about older adults’ judgment processes in this context. The objectives of this study were to 1) better understand the manner in which drug insurance attributes are weighted in older adults’ judgments of drug benefit suitability, 2) explore variability in judgment strategies among seniors, and 3) assess seniors’ insight into their judgment policies. Methods . Three focus groups were conducted with 19 older adults to elicit important drug plan attributes. A policy-capturing study with 32 seniors, none of whom had participated in the focus groups, then was employed to quantify the impacts of these attributes on judgments of plan suitability. Results . Focus group participants reported that copayment, monthly premium, deductible, formulary use, and mail-order pharmacy use were important drug insurance attributes. The policy-capturing study showed that deductibles and premiums were weighted most heavily in judgment formation. However, significant variability in judgment policies was apparent, with 3 distinct groups emerging from cluster analysis. The first emphasized deductibles and copayments, the second premiums and deductibles, and the third use of a mail-order pharmacy and deductibles. Study volunteers exhibited insight into the role of some plan attributes in their judgments, but notm others. Conclusions. Cost-sharing provisions appear to be most important in older adults’ evaluations of drug benefit plans. However, significant heterogeneity in attribute preferences also was apparent in this study. Older adults may not be cognizant of the manner in which some plan attributes affect their evaluations, suggesting a role for decision aids in this process.

Political diversity versus stimuli diversity: Alternative ways to improve social psychological science

Instead of enhancing diversity in research groups, we suggest that in order to reduce biases in social psychological research a more basic formulation and systematic testing of theories is required. Following the important but often neglected ecological research approach would lead to systematic variation of stimuli and sometimes representative sampling of stimuli for specific environments.

Questionable Research Practices Revisited

The current discussion of questionable research practices (QRPs) is meant to improve the quality of science. It is, however, important to conduct QRP studies with the same scrutiny as all research. We note problems with overestimates of QRP prevalence and the survey methods used in the frequently cited study by John, Loewenstein, and Prelec. In a survey of German psychologists, we decomposed QRP prevalence into its two multiplicative components, proportion of scientists who ever committed a behavior and, if so, how frequently they repeated this behavior across all their research. The resulting prevalence estimates are lower by order of magnitudes. We conclude that inflated prevalence estimates, due to problematic interpretation of survey data, can create a descriptive norm (QRP is normal) that can counteract the injunctive norm to minimize QRPs and unwantedly damage the image of behavioral sciences, which are essential to dealing with many societal problems.

Bayesian probability estimates are not necessary to make choices satisfying Bayes' rule in elementary situations

This paper has two aims. First, we investigate how often people make choices conforming to Bayes’ rule when natural sampling is applied. Second, we show that using Bayes’ rule is not necessary to make choices satisfying Bayes’ rule. Simpler methods, even fallacious heuristics, might prescribe correct choices reasonably often under specific circumstances. We considered elementary situations with binary sets of hypotheses and data. We adopted an ecological approach and prepared two-stage computer tasks resembling natural sampling. Probabilistic relations were inferred from a set of pictures, followed by a choice which was made to maximize the chance of a preferred outcome. Use of Bayes’ rule was deduced indirectly from choices. Study 1 used a stratified sample of N = 60 participants equally distributed with regard to gender and type of education (humanities vs. pure sciences). Choices satisfying Bayes’ rule were dominant. To investigate ways of making choices more directly, we replicated Study 1, adding a task with a verbal report. In Study 2 (N = 76) choices conforming to Bayes’ rule dominated again. However, the verbal reports revealed use of a new, non-inverse rule, which always renders correct choices, but is easier than Bayes’ rule to apply. It does not require inversion of conditions [transforming P(H) and P(D|H) into P(H|D)] when computing chances. Study 3 examined the efficiency of three fallacious heuristics (pre-Bayesian, representativeness, and evidence-only) in producing choices concordant with Bayes’ rule. Computer-simulated scenarios revealed that the heuristics produced correct choices reasonably often under specific base rates and likelihood ratios. Summing up we conclude that natural sampling results in most choices conforming to Bayes’ rule. However, people tend to replace Bayes’ rule with simpler methods, and even use of fallacious heuristics may be satisfactorily efficient.

Toward an ecological analysis of Bayesian inferences: how task characteristics influence responses

In research on Bayesian inferences, the specific tasks, with their narratives and characteristics, are typically seen as exchangeable vehicles that merely transport the structure of the problem to research participants. In the present paper, we explore whether, and possibly how, task characteristics that are usually ignored influence participants’ responses in these tasks. We focus on both quantitative dimensions of the tasks, such as their base rates, hit rates, and false-alarm rates, as well as qualitative characteristics, such as whether the task involves a norm violation or not, whether the stakes are high or low, and whether the focus is on the individual case or on the numbers. Using a data set of 19 different tasks presented to 500 different participants who provided a total of 1,773 responses, we analyze these responses in two ways: first, on the level of the numerical estimates themselves, and second, on the level of various response strategies, Bayesian and non-Bayesian, that might have produced the estimates. We identified various contingencies, and most of the task characteristics had an influence on participants’ responses. Typically, this influence has been stronger when the numerical information in the tasks was presented in terms of probabilities or percentages, compared to natural frequencies – and this effect cannot be fully explained by a higher proportion of Bayesian responses when natural frequencies were used. One characteristic that did not seem to influence participants’ response strategy was the numerical value of the Bayesian solution itself. Our exploratory study is a first step toward an ecological analysis of Bayesian inferences, and highlights new avenues for future research.

I Eat Healthier Than You: Differences in Healthy and Unhealthy Food Choices for Oneself and for Others

The present study investigated self-other biases in actual eating behavior based on the observation of three different eating situations. To capture the complexity of real life food choices within a well-controlled setting, an ecologically valid fake food buffet with 72 different foods was employed. Sixty participants chose a healthy, a typical, and an unhealthy meal for themselves and for an average peer. We found that the typical meal for the self was more similar to the healthy than to the unhealthy meal in terms of energy content: The mean difference between the typical and healthy meals was MΔ = 1368 kJ (327 kcal) as compared to a mean difference between the typical and unhealthy meals of MΔ = 3075 kJ (735 kcal). Moreover, there was evidence that people apply asymmetrical standards for themselves and others: Participants chose more energy for a peer than for themselves (M = 4983 kJ or 1191 kcal on average for the peers' meals vs. M = 3929 kJ or 939 kcal on average for the own meals) and more high-caloric food items for a typical meal, indicating a self-other bias. This comparatively positive self-view is in stark contrast to epidemiological data indicating overall unhealthy eating habits and demands further examination of its consequences for behavior change.

Quantifying biopsychosocial aspects in everyday contexts: an integrative methodological approach from the behavioral sciences

Contextual factors are crucial for evaluative research in psychology, as they provide insights into what works, for whom, in what circumstances, in what respects, and why. Studying behavior in context, however, poses numerous methodological challenges. Although a comprehensive framework for classifying methods seeking to quantify biopsychosocial aspects in everyday contexts was recently proposed, this framework does not contemplate contributions from observational methodology. The aim of this paper is to justify and propose a more general framework that includes observational methodology approaches. Our analysis is rooted in two general concepts: ecological validity and methodological complementarity. We performed a narrative review of the literature on research methods and techniques for studying daily life and describe their shared properties and requirements (collection of data in real time, on repeated occasions, and in natural settings) and classification criteria (eg, variables of interest and level of participant involvement in the data collection process). We provide several examples that illustrate why, despite their higher costs, studies of behavior and experience in everyday contexts offer insights that complement findings provided by other methodological approaches. We urge that observational methodology be included in classifications of research methods and techniques for studying everyday behavior and advocate a renewed commitment to prioritizing ecological validity in behavioral research seeking to quantify biopsychosocial aspects.

Views That Are Shared With Others Are Expressed With Greater Confidence and Greater Fluency Independent of Any Social Influence

Research on group influence has yielded a prototypical majority effect (PME): Majority views are endorsed faster and with greater confidence than minority views, with the difference increasing with majority size. The PME was attributed to conformity pressure enhancing confidence in consensual views and causing inhibition in venturing deviant opinions. Our results, however, indicate that PME for binary choices can arise from the process underlying confidence and latency independent of social influence. PME was demonstrated for tasks and conditions that are stripped of social relevance; it was observed in within-individual analyses in contrasting the individual’s more frequent and less frequent responses to the same item, and was found for the predictions of others’ responses. A self-consistency model, which assumes that choice and confidence are based on the sampling of representations from a commonly shared pool of representations, yielded a PME for confidence and latency. Behavioral implications of the results are discussed.

Probability of Responding: A Return to the Original Brunswik

This paper traces the conceptual foundations of the Brunswik based Social Judgment Theory. The historical transition from measurement through probability of responding (i.e., a constancy ratio) to measurement via correlations is documented. It is shown that there are substantive limitations with the correlation approach for the idiographic analysis of human perception or decision-making. Instead, the constancy ratio developed originally by Brunswik as well as the measurement of the probability of accuracy in responding are better suited to the analysis of human responding under conditions of uncertainty and complexity. These measures are relevant for the development of psychological laws of individual responding. It was concluded that focusing on the probability of individual responses to situations through analysing the pattern of responding intensively is more consistent with the original approach of Brunswik.

Perceived difficulty and appropriateness of decision making by General Practitioners: a systematic review of scenario studies

BACKGROUND

Health-care quality in primary care depends largely on the appropriateness of General Practitioners' (GPs; Primary Care or Family Physicians) decisions, which may be influenced by how difficult they perceive decisions to be. Patient scenarios (clinical or case vignettes) are widely used to investigate GPs' decision making. This review aimed to identify the extent to which perceived decision difficulty, decision appropriateness, and their relationship have been assessed in scenario studies of GPs' decision making; identify possible determinants of difficulty and appropriateness; and investigate the relationship between difficulty and appropriateness.

METHODS

MEDLINE, EMBASE, PsycINFO, the Cochrane Library and Web of Science were searched for scenario studies of GPs' decision making. One author completed article screening. Ten percent of titles and abstracts were checked by an independent volunteer, resulting in 91% agreement. Data on decision difficulty and appropriateness were extracted by one author and descriptively synthesised. Chi-squared tests were used to explore associations between decision appropriateness, decision type and decision appropriateness assessment method.

RESULTS

Of 152 included studies, 66 assessed decision appropriateness and five assessed perceived difficulty. While no studies assessed the relationship between perceived difficulty and appropriateness, one study objectively varied the difficulty of the scenarios and assessed the relationship between a measure of objective difficulty and appropriateness. Across 38 studies where calculations were possible, 62% of the decisions were appropriate as defined by the appropriateness standard used. Chi-squared tests identified statistically significant associations between decision appropriateness, decision type and decision appropriateness assessment method. Findings suggested a negative relationship between decision difficulty and appropriateness, while interventions may have the potential to reduce perceived difficulty.

CONCLUSIONS

Scenario-based research into GPs' decisions rarely considers the relationship between perceived decision difficulty and decision appropriateness. The links between these decisional components require further investigation.